Nasal Reverse Block or not ?

[Remy B.]

I like to share my experience to see if this event need some attention or not.

The Dive: 6*C water no deeper than 13m. for 45min

Last weekend I went diving, I was coming out from a flu, but days before that weekend, I was able to breath normally through my nose and clear my ears without problem at surface.

As I started to descent soon I got a intense pain in the middle of my forehead right between my eyes, I was able to clear my ears descending without problem, for a moment I was going to aboard the dive and ascent but then I felt that an air like bubble stream dislodged from my forehead in between my eyes through my respiratory passage, then the pain stopped, since the pain stopped I decided to not ascent and continue my dive.

after 20min I felt like a little runny nose, I thought that due to the cold my nose started to get a little runny which is not unusual even without a flu.

the dive continue normally uneventful, I did my safety stop and still slowly dive under the water round 2.5m deep for about 5 min more until I reach shore, there I went to clear my nose, and had a lot of blood mixed with thick snot I believe ( or maybe pieces of brain who knows hahaha )

my buddy noticed as well my bloody nose but after cleaning it with water is was over.

The rest of the week everytime my nose was getting a little runny and I blowed clean traces of old dark blood come out and when I clear my breathing passage I spit out dark blood, every day it reduced and for the last two days I have not seen much just little traces.

All the time I have been feeling good.

Now my concern is, how bad and dangerous was this event ?

Will it affect my diving future ?

Can it bring problems underwater and maybe above ?

I do sporadic Tec dives, will or can this affect my future deep dives ?

Thanks in advance for your reply's Dr's

 

[Duke Dive Medicine]

Hi Remy, it sounds like you had a classic sinus squeeze. The sinuses are rigid gas-filled spaces. If the pressure around them increases, as with descending during a dive, air needs to enter them through the meatus (opening) in order to keep them equalized with the ambient pressure. Normally this happens without any effort on the diver's part. If the area around the meatus is swollen, air can't enter the sinus on descent. The walls of the sinuses are very vascular, and so when there's a large negative pressure differential between the sinus and the ambient water, blood will be pulled out of the blood vessels in the sinus lining. On ascent, the pressure differential in the sinus changes and the blood and mucus are forced out. This explains the nasty discharge. The bits of brain were probably blood clots, unless you've noticed weird things like forgetting your violin lessons ;-) This usually looks a lot worse than it is, and it should not affect your diving in the future as long as you give it a few weeks to heal.

Best regards,
DDM

 

[doctormike]

Exactly what DDM said, with one caveat... sometimes there is a physical reason for the sinus squeeze, like a polyp, which is inflamed tissue lining the sinuses which can get big enough to stop good gas exchange. This is exactly what my 28 year old son has (frontal sinus polyp, documented on a CT scan), and it was the main reason that he stopped diving!

In any case, if you are an experienced diver, it's unlikely that you have a fixed obstruction, but it might be a good idea to do a shallow pool or open water dive before your next tech dive. If you have similar symptoms, you might want to see an ENT doc and possibly get a scan. This is one of the few equalization things that is "fixable", but hopefully this was just a transient bit of congestion.

One point of clarification - a reverse block happens on ascent, and is potentially more serious since you can't just abort the dive like you can with a block on descent. From your description, this sounds like a standard block (sinus squeeze) and not a reverse block.

 

[chillyinCanada]

Drmike, why doesn't your son get his polyp removed and resume diving?

 

[doctormike]

Drmike, why doesn't your son get his polyp removed and resume diving?

Good question! I think that he doesn't really care that much about diving, and it doesn't bother him unless he dives.

[insert millennial joke here]

 

[Duke Dive Medicine]

Thanks Mike!

 

[Remy B.]

Thanks DDM and Dr. Mike

I have skipped two sundays of diving to give it time to heal, there is no more blood as well, I will see the next dive how I feel or if I notice something out of the ordinary, then I will step it up and see if something has change.

 

[doctormike]

Sounds like a plan!

 

[Remy B.]

Yesterday I went for shallow dive, 48min @10m in 6*C, dive was uneventful, will step it up to 35m in two weeks and report back.

 

[doctormike]

Terrific...!