Nose bleeds...

[The Chairman]

Hey All,

Whenever I go deeper than 80', I get a nose bleed on the first dive of the day. When I am ascending, I hear a lot of equalization noises in my eustacion tubes. When I get to within 15 ft I have to blow my nose. In fresh water I just take off my mask and let her rip, and I can see a bloody discharge into the water. If I am in salt, I just blow into the mask, and when I surface and check it is like a blood clot with fine bubbles in it. I can not remember it recurring on subsequent deep dives on the same day.

I have had ppp& deviated septum surgery. I have always had a blood discharge in the am when I wake (I do use cpap)
After I do a deep dive the discharge is gone for at least a few weeks. My doc has put me on a cortizone nasal spray, and I am anxious to see what this does.

Any ideas on this? I have heard that a deep dive nose bleed is not TOO uncommon, but I would like to hear it again from you guys.

Pete from Orlando...

 

[John Reinertson]

Nosebleeds occurring from pressure changes, especially when accompanied by equalization sounds, sounds like a sinus squeeze. This is the same physically as failing to equalize the ears.
Many people with "sinus problems" have difficulty equalizing and traumatize their sinuses occasionally.

I have had good luck using nasal steroid sprays to control this in several patients, so I suspect your doc is on the right track.

I would not recommend ignoring this or being cavalier about it. Each time you get bleeding you've created a connection between the nasal mucosa (covered with bacteria) and your bloodstream. A sinus full of blood can nourish a really nasty sinus infection.
A doc that deals with diving or the ENT that did your sinus surgery may be a necessary addition if the nasal steroid doesn't work.

As I said above, I've had good luck with using nasal steroids, and I would hope they solve your problem, but if they don't, I'd keep searching.

Dive safe and Bloodless..
John

 

[scubadoc]

Dr. Reinertson is quite correct - bleeding from any source usually means to the doctor that something is wrong and needs correcting. In diving, severe headache and nosebleeds are almost always due to sinus barotrauma. Bleeding can also be caused by trauma from squeezing the nose too tightly during attempts to clear the Eustachian tubes. The sinuses are air-filled and are subject to the same pressure changes of descent and ascent as the ears. If the sinus cannot equalize due to blockage of the ostium (opening into the back of the nose), there will be damage done to the vascular mucous lining of the sinus. For more on headaches while diving, go to http://www.scuba-doc.com/headache.html.

Rarely do nosebleeds cause enough bleeding to become dangerous to a diver, and then only if associated with severe hypertension, anticoagulants or blood vessel tumor. The decision to continue diving is debatable in light of the reoeated history and the surgery that you have had performed.

Dr. Reinertson's advice to get another examination to check out your nasopharynx is valid.

 

[The Chairman]

Hey Dr Reinertson, & ScubaDoc...

Thanks for both of your input. I have had a slight bloody nasal discharge every morning for the past seven or eight years, ever since the PPP & Deviated septum was repaired. The ENT (several years ago) thought that this was atypical, yet not remarkable (as you med types put it), in that there was no "staining" of the the nasal membranes. Actually, I think he thought I was making this up. After I dive below 80 ft, the morning discharge is gone for at least 2 weeks. It will eventually resume. There is no pain associated with the discharge, and it can accompany "easy" as well as "forced" val salva (sp?) manuevers.

I have always had a continual allergic reation since childhood... red eyes, congestion. The CPAP eliminates that somewhat. I have been put on "pills" (I simply can't remember the name, but its a popular prescription) four times, but I end up with a kidney infection every time.

However, since he has put me on this cortizone based nasal spray, I have not had the nose bleeds in the morning, and I DO breathe clear all day (not just on the dry filtered CPAP air). I am hoping that this general physician has found the (simple?) cure for this condition. I guess time will tell. He has cleared me for diving and I will be doing PADI's Deep Diver Course next month. Please don't feel that I am taking this lightly at all. The doctors that I have been to have all pretty muched dismissed this as trivial, although it concerns me greatly. This new Doctor I am seeing (GP) seems to really care about his patients, and I feel better with him than with the ENT. Go figure!

Pete from Orlando...

 

[John Reinertson]

I'm glad the nasal steroids are working for you.
One more happy diver!

See you underwater someday
John