Nose bleeds while diving

[leabre]

Greetings,

I was diving this weekend and had to equalize more than normal on decent. Within about 15 seconds after my last equalization at depth, my nose began to bleed. It took a while before I realized the cloudy visibility was from my nose and buddies didn't realize it until I thumbed the dive, but the instructor knew something was wrong just not what, he was behind me. We were supposed to do an S-Drill technical style. I thumbed the dive and we ascended. On the surface, it took about 30 minutes to get it to stop. It wasn't a gusher, but it wasn't a trickle either.

I am prone to nose bleeds during the summer months, but not in many years. In my younger years (pre-teen, I'm now post-30), I'd often have to visit a hospital to get it under control. It has never happened to me before, during, or after a dive in the past.

I had what felt like a reverse squeeze during my decent, I had to ascent to assist a buddy having a drysuit inflater problem. But had stronger equalization issues on my way down after that (but none before that). I had just finished a roughly 40-50 minute dive just minutes before this particular ascent, and had no issues whatsoever. My sinus was not inflamed before ascending, but on ascent, it was stuffed something fierce (and still is 2 days later).

I currently have no symptoms of anything but my left side is clogged (as it was after the nose bleed). No headache, nothing. I arrived home feeling as if I never entered the water and hadn't done three 50+ minute dives at all at 28 ft). I scheduled an apmt with my doc for tomorrow. I'm included to finally get it caterized but was wondering if that might pose any issues with an avid diver that dives roughly 4x per month or often more.

Thanks,
Shawn

 

[DocVikingo]

Hi Shawn,

There are several primary causes for bleeds such as this. Probably most common, especially in the newer diver, is mechanical trauma from pinching the nose/equalizing too vigorously.

"Mask squeeze" is another common cause and occurs when the pressure within the mask is not equalized upon descent. This creates a vacuum leading delicate blood vessels lining the nasal passages to rupture. It is avoided by making slow descents and frequently exhaling air from the nose into the mask.

The situation described in this post sounds like the result of inability to fully equalize the sinuses. That the diver "had to equalize more than normal on descent" suggests the possibility that sinuses may have been congested/constricted. Under such conditions, capillary beds within the sinus cavities can be dilated by the air contracting inside and rupture. The scheduled ENT appt should prove informative regarding return to SCUBA. Please let the board know of the outcome. It's part of how we learn.

Helpful?

Best of luck,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such.

 

[TSandM]

What Doc Vikingo said . . . with the addition that, if you did get bleeding into one of your sinuses, that could account for the feeling of fullness. Clot takes a while to liquify and disperse.

 

[leabre]

I saw the doctor today. My ears are fine: no bleeding, irritation, inflamation, congestion, etc. My sinus she says looks fine too, but my left nostril area has a weird shape as if broken when I was younger that appears to possibly prevent proper drainage. I will be getting a CT scan soon and tested for allergies (I might have a smoke ash allergy).

She was unable to answer whether getting cauterized would have ill effects later on with deeper and longer (deco) dives. She's not a diver. I might have to change physicians.

 

[Ben_ca]

Just wondering... Would taking the mask off for a few minutes in cold (50 ish) water have helped stop the blood flow?
(until the sharks come to check out you out... but then again you don't have your mask on anyways )

 

[leabre]

Just wondering... Would taking the mask off for a few minutes in cold (50 ish) water have helped stop the blood flow?
(until the sharks come to check out you out... but then again you don't have your mask on anyways )

The water was low 60's, but I didn't think about whether to remove the mask until after I was reflecting on the ordeal. Had I thought of it, that would have been a better approach than what I did, place my hand on my buddies are to use as a reference. In any case, I don't know what would be better. Watching a mask fill with blood though, has got to be scary for anyone watching. Perhaps it would be better to remove the mask.

 

[DocVikingo]

I saw the doctor today. She was unable to answer whether getting cauterized would have ill effects later on with deeper and longer (deco) dives. She's not a diver.

Hi leabre,

I'm a little confused about this cauterization discussion and believe you may be getting ahead yourself.

Given the reported history of, "I am prone to nose bleeds during the summer months, but not in many years. In my younger years (pre-teen, I'm now post-30), I'd often have to visit a hospital to get it under control," perhaps this technique was applied in your past to manage nasal bleeding.

However, cautery most certainly is not the treatment of choice to correct anatomical abnormalities of the shape of the nose that possibly may be preventing proper drainage and flow of air. Ditto for controlling allergies.

Has your doctor actually suggested, or even mentioned, this procedure as an appropriate treatment for the conditions so far suspected?

For the moment, it's probably best to wait for all examinations and tests to be done. Once these are completed, treatment options can be discussed and appropriate experts located.

Since you asked, used sparingly, cautiously and skillfully, cauterization itself should have no implications for diving, including "deeper and longer (deco) dives" once all healing is complete. However, the ultimate cause of the episodic nose bleeds may not be addressed by cautery and the bleeds recur. Also, when cauterization is overused or done clumsily, it can create problems that last a lifetime.

Move forward prudently and enlist specialists as needed.

Helpful?

Best of luck,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such.

 

[leabre]

So many people suggest I might finally get cauterized. I never did. I was happier knowing maybe just a few times a year it would happen and be over with. It always happens at the most inconvenient of times when it does, but I live with it. My left nostril sinus is weird shaped according to her, my right nostril is always the one the bleeds.

In conjunction with diving, if cauterizing is the solution, I'm more open to it than before. I do not like to go on meds or have procedures except as last resorts to correct a problem. Just how I am. My reason for asking is merely to guage whether it is an acceptible risk given my diving appetites. On the other hand, having a nose bleed at a deeper depth where I must complete 30-45 minutes deco before surfaces, all the while bleeding could be bad too. On the surface, it wasn't draining, it just wasn't stopping if I unplugged my nose or tilted head forward. In water, I don't know how easily I could manage the same affect.

Doc wants to go through the sinus tests before even thinking about cauterizing. I'm not trying for a second opinion, only trying to evaluate risk and likely hood of solutoin for cauterizing.

Thanks,
Shawn

 

[TSandM]

Cauterizing a small bleeder is a minor procedure and should have no implications for your diving at all, once appropriate time for healing has been allowed. I'm not sure why your doctor is worried about it, unless he/she is contemplating something far more aggressive than the cauterization I routinely do.

Cautery does require, however, that one be able to identify an abnormality which is the source of the bleeding. This is easiest done in the setting of an active bleed, or very recent one.