Severe sinus issues when seawater gets into nose?

[DevonDiver]

Not sure of the cause of this - it's not something I've noticed before approx 12 months ago.

Whenever I get seawater into my nose, I seem to get a quite severe reaction in my facial sinuses. The initial 'salt water' sting persists long after the dive, becoming a sore throat and causing phlegm. Then a slight feverish reaction, followed (before the next day) by extreme congestion in the facial sinuses - puffy face, inability to equalize.

Getting a little water in my nose is something that can't be avoided sometimes, especially when teaching technical level diving courses; for instance inverted/head-down/upside-down mask remove, replace and clearance.

I'm assuming this is some sort of allergic rhinitus? Can't be a cold, as it happens almost like clockwork if I get seawater in my nose. Has only happened in the last year or so. Has also only happened where I dive locally.

I use Muconase (saline wash) and Drixine... to keep decongested and diving, but I'd love to know the root causes of the issue (allergy to something?) Is there anything I can do to help prevent (other than take more care not to get seawater in my nose)?

 

[Bratface]

I had a similar problem when the water turned colder. I felt like I had been hit in the face with a board after diving. The doctor felt I had vasomotor rhinitis and prescribed 2 nasal inhalers. One was a steroid and the other was an antihistamine. I continued to use my saline nasal rinse followed by the inhalers. Cured me. Go see an ENT doc. Hope you will be feeling better soon.

 

[DocVikingo]

Hey Andy,

Seems paradoxical given that saline based sprays are a mainstay in the treatment of allergic rhinitis & kindred maladies, doesn't it?

As you report that the reaction only happens where you dive locally, the suspicion is an allergen in the local seawater.

Might want to explore with your ENT the med regimen suggested by Bratface.

Regards,

DocV

 

[doctormike]

Not sure of the cause of this - it's not something I've noticed before approx 12 months ago.

Whenever I get seawater into my nose, I seem to get a quite severe reaction in my facial sinuses. The initial 'salt water' sting persists long after the dive, becoming a sore throat and causing phlegm. Then a slight feverish reaction, followed (before the next day) by extreme congestion in the facial sinuses - puffy face, inability to equalize.

Getting a little water in my nose is something that can't be avoided sometimes, especially when teaching technical level diving courses; for instance inverted/head-down/upside-down mask remove, replace and clearance.

I'm assuming this is some sort of allergic rhinitus? Can't be a cold, as it happens almost like clockwork if I get seawater in my nose. Has only happened in the last year or so. Has also only happened where I dive locally.

I use Muconase (saline wash) and Drixine... to keep decongested and diving, but I'd love to know the root causes of the issue (allergy to something?) Is there anything I can do to help prevent (other than take more care not to get seawater in my nose)?

Hey, DD...

Doesn't sound like allergic rhinitis, that's really a reaction to airborne particulate matter. I suppose it is possible if you were doing diving in contaminated water that some irritant could be causing the problem (non-allergic contact rhinitis), and if this regularly happens in one place but not another, that would be a possibility.

This sounds like the result of not just the contact of salt water with your nasal mucosa (as was pointed out, saline is pretty benign and is in fact what makes up most of the lubricating sprays that people use), but rather the entry of salt water under pressure into your nose. That would allow water (along with any bacteria in the water or in your nasal airway) to be forced into the sinus cavities, setting the stage for what sounds like a sinus infection (or at least barotrauma) the next day.

Maybe it's something that happens when you are teaching those maneuvers at home, but doesn't happen when you are just diving for pleasure elsewhere? Also, maybe something is causing partial obstruction of the sinuses that has developed over the past year, and it's just a coincidence that you didn't have this earlier in other locations?

In any case, it might not be a bad idea to see an ENT doc for nasal endoscopy and most likely a CT scan - that would show if there was any abnormality (deviated septum, cyst, polyp, obstructing air cell or chronic sinusitis) that is interfering with the normal ventilation of the paranasal sinus outflow tracts. My son had something very much like this, and it wasn't until he got a scan that we could see a polyp in one of his sinuses... That doesn't necessarily mean that surgery is necessary, sometimes medical treatment can open things up. Especially since this is a new problem, it is more likely to be reversible.

PM me with your location and I might be able to give you a local referral.

 

[Quero]

I get inflamed nasal and sinus tissues whenever I get seawater up my nose also. I can never understand people who do sinus irrigation with seawater off the back of the boat. That would keep me on the boat for sure! If I'm ever upside down needing to keep the sea water out of my nostrils, I try really hard to close off my nose with the tiny little muscles in the sides to minimize the amount of water that gets in.

 

[Randy43068]

Oh my gosh, I would think using sea water to irrigate the sinuses would be a horrible idea. I would think that would be putting all sorts of bacterial and bad things into the sinuses.

I get inflamed nasal and sinus tissues whenever I get seawater up my nose also. I can never understand people who do sinus irrigation with seawater off the back of the boat. That would keep me on the boat for sure! If I'm ever upside down needing to keep the sea water out of my nostrils, I try really hard to close off my nose with the tiny little muscles in the sides to minimize the amount of water that gets in.

 

[Quero]

I actually get that same reaction from my pool water, which is saline (no chlorine in my pool), so I don't think in my case it's a bacterial thing. I have always thought I just have very sensitive nasal passages. In fact, I'm an allergy sufferer, so just about anything irritates my nose and sinuses--I can't sit in the line of a fan, for example, and cigarette smoke, diesel fumes, mustiness, etc., will block me right up.

 

[DevonDiver]

The issue is more than irritation. Since the initial post, 6 days ago, I'm still suffering with extreme congestion, thick green mucus, flu-like symptoms and fatigue. I use saline spray after every dive, as a matter of course... with limited use of Drixine for those dives I really cannot miss (teaching).

It's not something I've experienced before in 20 years of diving (until last year). I used to think that it 'was' a cold... possibly caught due to over-working and/or travelling on air-con bus service here in the Philippines. It became more regular, until I had some form of effect following every trip I made to Subic to teach/dive. Now, it is more direct - coming immediately after any seawater that gets into my nose.

The after-effects seem to get worse on each occasion. It's definitely linked to seawater entering the nose - on this occurrence I was teaching inverted mask clearing as part of a sidemount course, which often results in a good snort of water flooding the sinuses.

The initial 'irritation' doesn't fade - it gets progressively worse. By the next morning, my nose is streaming. The mucus then thickens and goes greener over several days - coupled with 'flu like' symptoms; aching, shivering, fatigue. It persists for a week or so... and also (overnight) allows the congestion to run into my lungs. I use Ibuprofen to help me sleep, when symptoms are worst. Saline throughout the day.

Strongly suspect that it's an issue with local water - either a reaction that has worsened over several years, or a new contaminant in the water that wasn't there previously. No similar issues noted with other divers in the area. That leaves me to believe it's either an allergy or a repeated infection.

Subic is a very confined bay... with several rivers feeding into it. Those rivers feed via local city (bad sewage) and also source from tropical jungle. There can be a lot of floating 'snot-like' algae in the water. Also, much of the diving is conducted on wrecks... possible very low-level petrochemical contamination and/or issues with oxidized metal in the water??

I spend much of my non-diving time (gaps between courses) at home in Manila.... one of the most polluted places in the world...with a very high occurrence of allergic rhinitis... so coming to Subic should ease any allergic rhinitis, not worsen it? Subic has much cleaner air - low traffic, surrounded by primary jungle and benefiting from fresh onshore breezes.

Will investigate the anti-histamine/steroid options.... my partner is an ENT, so I've got that covered.... I've just got to get home (won't for another week or so) to do that.

@Bratface: Did the treatment resolve your symptoms permanently, or just on a limited/direct basis, on each occurrence?

 

[JamesK]

Your issues sound a lot like mine. However, the water has to get in my sinus cavities where I can taste it in the back of my throat. The next day comes the itchy throat and then full blown nasty green phlegm and brown mucus. The doctors here give me mucinex and clairitin to clear it up, but it takes a week or so.

 

[DevonDiver]

Yes, that does sound the same...and, yes, flooding into the sinuses is what causes the immediate/severe reaction (although I do notice a less severe/slower onset reaction even when I don't get my sinuses flooded (such as mask removals on OW courses).

My issue is that I can't afford to wait a week for it to clear up, every time - because I have courses to run. Just coming to the end of a sidemount-tech program now... been suffering since day 2 of 10... is very exhausting. Another course starting on Sunday (3 days), followed by another probable on Wednesday (another 3 days).

Getting water in the sinuses can be unavoidable with some of the drills I teach at tech level, especially on the sidemount and/or technical wreck courses.

I'm pretty adept at keeping myself diving, even when suffering (top tip: never blow your nose, just hawk and spit)... but the general illness and fatigue makes my work to be a test of endurance, rather than a bunch of fun. LOL