Right side of head and Jaw burning and pain

[FrankPro1]

Hi, I'm new around here and unfortunately my first post is going to be about a diving health issue On my fourth open water dive at a depth of 40ft my right side of my head began to ache and burn. It then quickly ran down the side of my head and through my jaw. That was less then a week ago and after an attempted free-dive this morning, I can sadly say that I still have a problem. This ache is there at very low depths and the burn and tingly goes on and off, even now hours after the dive. Obviously I am going to go to a doctor and see whats going on, but until then I wanted to see if anyone out there can give me a heads up. I have never had any problems equalizing in all the years I've been free-diving and now to have this happen so early on in my scuba career is quite concerning. Any help or insight on what the possibilities of what occurred would be much appreciated.
The Facts:
About 40 ft
Occured at depth, not during ascent or descent
descending did not clear problem
ascending did not clear problem
ear equalizes fine " or appears too"
was the 2nd dive of the day "shallower then first dive"

 

[DandyDon]

Wow, Frank?! :11: Keep checking in over the next few days to see if any of the physicians have any ideas. Good luck...

And Welcome to SB.

 

[doctormike]

The Facts:
About 40 ft
Occured at depth, not during ascent or descent
descending did not clear problem
ascending did not clear problem
ear equalizes fine " or appears too"
was the 2nd dive of the day "shallower then first dive"

Wow, that's not the typical barotrauma story..! Basically, a symptom that reproducibly happens at depth is almost always related to pressure change (with a rare exception being a temperature related problem that happens when you hit a thermocline).

From your post, I understand that the symptom happened again when you tried to free dive after a week. Do you mean that the symptom happened at 40 feet, then eventually went away after the dive, then came back a week later when you dove again? Or do you mean that it happened at 40 feet and then just never went completely away? I am assuming for this discussion that we are not talking about a contact with a jellyfish or something that caused a skin reaction, but rather a reproducible symptom related to depth...

In order for there to be symptoms related to pressure, there has to be gas involved, since everything else in the body (muscle, bone, blood, etc...) acts like a fluid at depth - that is to say, not compressible to any significant degree. So there is little effect of ambient pressure, or ambient pressure changes, on anything that isn't filled with a gas.

The ears are the space that most commonly has issues with ventilation, but of course we all know the dangers of not equalizing pressure in the airway (breath holding during ascent). Less common sources of symptoms related to pressure changes would be air trapped in the sinuses or around teeth. Tooth squeeze is a particularly difficult problem, since you can usually equalize the spaces in your ears and sinuses with the gas in your airway (which matches ambient pressure, due to the regulator). An exam (possibly including a CT scan) would identify any trapped air pockets in the area that is causing your symptoms, such as the teeth, jaw, skull, etc. Occasionally there can even by small air-filled cysts in unanticipated places.

The one thing that is not typical of these types of problems would be the fact that your symptoms do not seem to be affected by ascent or descent. However, if the gas filled space is truly not in good communication with the airway, then you would not expect the pain to change quickly with ascent or descent, so it might just be a question of a delay in the time it takes for the pressure gradient to naturally resolve.

The localization of the symptoms is less mysterious, as pain in the head and neck region is often "referred", presenting is places different from the source. This is because the sensory nerves of this area are dense and interconnected.

Keep us posted, let us know when you get more information...! What kind of doctor are you seeing for this? You might want to see someone with dive medicine experience, and an ENT doctor would be a good choice for this type of issue...

Best,

Mike

 

[TSandM]

My first thought, since this occurred at depth and wasn't affected by changing depth, is that it is something related to your equipment -- pressure from your mask, or TMJ type problems from holding a regulator in your mouth. Do you have a snorkel in your mouth when you freedive? (I don't freedive, so I don't know anything about it.)

 

[FrankPro1]

1. Do you mean that the symptom happened at 40 feet, then eventually went away after the dive, then came back a week later when you dove again? Or do you mean that it happened at 40 feet and then just never went completely away?

2. An exam (possibly including a CT scan) would identify any trapped air pockets in the area that is causing your symptoms, such as the teeth, jaw, skull, etc. Occasionally there can even by small air-filled cysts in unanticipated places.

3. What kind of doctor are you seeing for this? You might want to see someone with dive medicine experience, and an ENT doctor would be a good choice for this type of issue...

Best,

Mike

Thanks Mike for the detailed and informative response... You got me thinking on quite a few different things.

1. The problem happened at 40ft and then mostly subsided throughout the end of the day. I could still feel it almost a week later, "slight ache and mild on and off burning" but wanted to get back in the water "the free dive when it re occurred at very shallow depth". Even a slight head dip in the water now feels uncomfortable and at depth is even worse.

2. I've had a problem with cysts before... My nodes / glands on the right side of my neck are swollen right now and have been causing slight pain. But they didn't give me problem on the dive. "Another medical issue I need to get resolved"

3. I would love to see someone with dive experience but unfortunately I was denied health care and haven't been to a normal physician in years. I'm going to go to a free clinic on Monday morning and will take it from there. Hopefully they can point me in the direction of a good ear and throat doctor.

 

[FrankPro1]

My first thought, since this occurred at depth and wasn't affected by changing depth, is that it is something related to your equipment -- pressure from your mask, or TMJ type problems from holding a regulator in your mouth. Do you have a snorkel in your mouth when you freedive? (I don't freedive, so I don't know anything about it.)

I usually take the snorkel out on a deep dive 40ft +. I did experience some awkwardness in my jaw after holding the reg in my mouth during my confined dives, but got used to it by the time I hit the open ocean.

All in all I'm somewhat glad it occurred when it did. I was still able to get certified and at the same time I got some valuable experience on learning how to act when something does go wrong. I kept my cool, didn't panic and finished the dive without having to cut it short. Ya I was in a hell of alot of pain but I completed my skills and made a safe ascent.

Thanks everyone for your help and I'll keep you updated on my recovery.

 

[Dive-aholic]

When you say your head, do you mean your scalp area or the side of your face? Where exactly did the pain start and what was the path it took?

 

[FrankPro1]

1.When you say your head, do you mean your scalp area or the side of your face? 2.Where exactly did the pain start and what was the path it took?

1. Head pain located up and forward from the ear, going towards the brow "Side of Face"
2. Started in the region described above, then radiated down through my jaw

It can still be felt as a dull ache accompanied by sporadic tingling and burning

 

[SPKelpDiver]

Somebody help this guy out he is supposed to be my dive buddy!

 

[doctormike]

Thanks Mike for the detailed and informative response... You got me thinking on quite a few different things.

1. The problem happened at 40ft and then mostly subsided throughout the end of the day. I could still feel it almost a week later, "slight ache and mild on and off burning" but wanted to get back in the water "the free dive when it re occurred at very shallow depth". Even a slight head dip in the water now feels uncomfortable and at depth is even worse.

Sure, no problem..!

If just dipping your head in the water causes the symptom to recur, that would actually be MORE encouraging (from the point of view of your diving future)... Something like that suggests to me that this is more related to your skin, sensory nerves, etc... rather than some deep underlying problem with equalization.

Now all we need to do is figure out what is going on...

First of all, someone with experience in the head and neck area needs to get a good look at you, to made sure that there isn't anything obviously abnormal on the physical examination of your head and neck. Are there any rashes, cysts, skin infections, dental problems, etc...? The fact that your lymph nodes are swollen (on the side of your symptoms?) suggests some sort of inflammatory/infectious process. I know that this is frustrating, hopefully you will be seen soon.

One other thought - there are syndromes in which severe pain is induced from seemingly minor stimuli in certain trigger areas (such as trigeminal neuralgia, or tic doulouroux). Now I'm not suggesting over the Internet that this is what you have, but if nothing else turns up on the physical exam, and the symptoms are always in the same place and reproducibly triggered by simple exposure to water on the surface, you might at some point want to see a neurologist. But I would start with a basic ENT exam...

I'm sure that this is very frustrating! But hang in there, don't give up on diving yet...



Mike