Nose bleed after two deep dives

[yupito]

I am a 61-year old male in decent shape that exercises regularly. After doing two dips the Vandenberg, max 94 on the first and max 83 on the second, my nose started bleeding, and I saw a number of fairly thick clots. Should I be concerned?

 

[Macan]

It's best to seek medical attention. You may have suffered from Sinus Barotrauma. Signs and symptoms include swelling and bleeding from the nose also pain above and behind the eye. These can manifest during and after the dive upon surfacing.

This happens when you dive with acute sinusitis or chronic sinusitis. Acute sinusitis is when mucus is not normally removed from the sinuses and the sinuses become blocked and infected. When one of the sinuses (there are 4) is blocked, it will not equalize properly as pressure increases. You'll feel pain almost immediately as pressure changes since the sinus cavities are incompressible. Bleeding and pain can happen almost immediately as blood is forced to the area in an attempt to equalize the cavity.

I tell my students never to dive if they have an acute sinusitis.

 

[dberry]

I posted a similar question a few months ago:
Bloody Mucous After Dives

The responses generally fell into two categories: (a) "blood = trauma somewhere = bad, see an ENT" and (b) "Happens to me all the time. It's been years and it's nothing to worry about."

In my case, there was never pain associated with equalizing, and there was no active bleeding by the time I was back on the boat; the thick clots were really gross (especially to others on the boat!), but no dripping blood after wiping the clots away. FWIW, sometimes there would be clots after a 50' dive, but not after a 100' dive. (Not too surprising: the most sudden pressure changes happen in the shallow parts of a dive.)

I did see an ENT specialist and had my sinuses fully scoped. He found no damage or obstructions and suggested the bleeding was from the front of the septum - i.e. from squeezing my nose too hard while clearing. I've worked on clearing more carefully and not squeezing my mask so hard. It's been less of an issue for the past several months (including 5 days of relatively deep diving in a deco procedures / wreck class.)

I'm glad I put my mind to rest by seeing an ENT, YMMV. Your situation may be different, especially if you feel a lot of pain while descending and clearing.
Happy Diving!
-Don

 

[chillyinCanada]

If there's no pain, my guess is your equalizing too hard, either by squeezing your nose too hard causing delicate blood vessels to spring a leak or justice plain honking too hard. Equalize early, equalize often, equalize when you get up in the morning, a few more times before boarding, a few times while gearing up and again just before descending and then keep it up. The equalizing you do onshore is more the wsy you would get your ears to clear on a plane. Hope this helps.

 

[Stoo]

I'm with Chilly... odds are, you either equallized too hard, or not enough. In either case, a little blood has pooled in your sinuses and as you come back up, it's "blown" out of your honker. This tends to happen on deeper dives when people are "rushing" to get down to maximize time on the wreck.

You might consider a light decongestant or nasal spray prior to diving... or just take your time getting down and insuring that you equalize properly and completely.

That's one of the things that so cool about diving... spewing bodily fluids is all part of the fun.

 

[Duke Dive Medicine]

I am a 61-year old male in decent shape that exercises regularly. After doing two dips the Vandenberg, max 94 on the first and max 83 on the second, my nose started bleeding, and I saw a number of fairly thick clots. Should I be concerned?

Concur with the other posters that you most likely suffered from sinus barotrauma. It may or may not be painful - if it happens on descent, the diver often won't feel it. The sinuses are normally continuous with the airway, but if they are inflamed the mucosal lining may swell and close them off. This produces an enclosed, gas-filled space that is subject to Boyle's Law, which says that pressure and volume are inversely related. That is, as the pressure around you increases, the volume of your sinuses will try to decrease. In practice this may result in damage to the delicate blood vessels in the lining of the sinuses and subsequent extravasation (leakage) of blood into the affected sinus. On ascent, the trapped air expands and the blood is expelled. This usually looks scarier than it is (emphasis on the "usually"). If it happens once, there's probably nothing to worry about. However, the inflammation from a sinus squeeze can take quite some time to subside, so if you dive repeatedly you may experience repeated barotraumas, which could result in a vicious cycle.

Sinus barotrauma of ascent is another thing entirely. This can happen if the sinuses become inflamed at depth and close off. Then, Mr. Boyle will try to make your sinuses bigger, which hurts like heck. This is why divers are advised to exercise caution when using decongestants, because if they wear off at depth, barotrauma could result.

Best regards,
DDM

 

[yupito]

Thank you all for your very insightful replies. I recognize the symptoms from the description related to the Sinus Barotrauma. Although I did not think that I had any sinus issues before the dives, I did have a bit of a problem equalizing the day before when I did a couple of shallow dives. Interestingly I now breathe a lot better than I have in a while, it feels like my breathing has cleared up .

I usually use Afrin the night before I dive to help me with the equalization, and I did this the night before the shallow dives, but not the night before the Vandenberg dives. I had been sneezing and with a runny nose and thought that the Afrin was creating an allergic reaction.

I had no pain whatsoever before, during or after, and had no further bleeding since. I have no plans to dive in the next couple of weeks, although planning to do some snorkeling next weekend, and will see what happens.

Again, thank you for the information and advise. I feel a lot better just knowing that it is not a major issue

 

[fmerkel]

If you have chronic sinus issues you might consider trying one of the over the counter nasal steroids. They don't work quickly like Afrin so need to be used on a more constant basis or for at least a few days before diving. Very useful if you have hayfever kind of allergies.

 

[Bratface]

I use Afrin occasionally, and it can dry me out. If your nasal passages were dry, that could account for the bleeding but with the clots, I tend to agree with the forceful equalization.

Have you tried saline rinse? I use the neti bottle almost every day but especially in the morning before diving.

 

[Duke Dive Medicine]

Thank you all for your very insightful replies. I recognize the symptoms from the description related to the Sinus Barotrauma. Although I did not think that I had any sinus issues before the dives, I did have a bit of a problem equalizing the day before when I did a couple of shallow dives. Interestingly I now breathe a lot better than I have in a while, it feels like my breathing has cleared up .

I usually use Afrin the night before I dive to help me with the equalization, and I did this the night before the shallow dives, but not the night before the Vandenberg dives. I had been sneezing and with a runny nose and thought that the Afrin was creating an allergic reaction.

I had no pain whatsoever before, during or after, and had no further bleeding since. I have no plans to dive in the next couple of weeks, although planning to do some snorkeling next weekend, and will see what happens.

Again, thank you for the information and advise. I feel a lot better just knowing that it is not a major issue

The duration of oxymetazoline (Afrin, others) is about 12 hours. If you're using it the night before, you're at risk of having it wear off at pressure. If you're going to use it, you're better off using it the morning of the dive.

Best regards,
DDM