Subcutaneous emphysema - HELP!

[Shericuba]

Hello Docs and Scuba folks, can you help?

I suffer from Subcutaneous emphysema on every second dive and have to stop diving for a few days, this happens on one side only (left) around my ear and lower neck - classic symptoms. I have a strong sense that it is due to air escaping from left sinus, I can simulate the effect on land by equalizing hard, (does this rule out the lungs?) I don't know what to do to avoid it! I don't want to quit diving forever because of this. Is there something I can do to pinpoint the problem and then solve it, maybe even surgically? Someone told me to equalize by swallowing instead …Please help, any good advice is welcome – Thank you very much!

 

[Laurence Stein DDS]

Hi Shericuba,

Out of curiosity, do you have an empacted or partially empacted wisdom tooth...especially in the lower jaw? Other possiblities are periodontal pockets, especially of lower teeth, recent extraction sites, other types of oral surgical sites done recently.

This is a possible site of air entry and is directly adjacent to potential spaces that can allow air to dissect into the neck.

Sinuses are not really situated to allow air into the neck. More likely, there would be swelling and crepitis in the cheek, under the eye on the affected side.

Regards,

Laurence Stein DDS
:doctor:

 

[cudachaser]

When my left maxmillary sinus clears on the way up I sometimes get air coming into my eye orb and escaping under my lower eyelid...weird sensation

I have had several simus surguries and I think the Doc may have dug too deep on the last one

 

[Laurence Stein DDS]

That can be air excaping through the tear duct and it is a strange sensation. But this is not the subcutaneous air emphysema that Shericuba described in her post.

Larry Stein

 

[cudachaser]

Ican get the same effect topside by holding my nose and blowing..(Valsalva technique)

 

[rmediver2002]

Would you mind describing the symptoms you are experiencing in more detail?

It may aid someone in giving a more accurate guess at what is going on...

Regardless of the exact symptom I would suggest you speak with an ear, nose, and throat specialist and ensure there is no physiological abnormality (normall easily repaired) that would explain the situation.

I would not stop diving forever but it would certainly be worth delaying some dives until you have some more information on what is occuring.


Please keep us posted, Hopefully this is a simple problem and you will be back in the water in no time!!

Stay Safe,

Jeff Lane

 

[Laurence Stein DDS]

I agree with you, Jeff. No diving until this is tracked down. The solution may, in fact, be simple but a diagnosis must be made first.

Larry Stein

 

[Shericuba]

Thanks everyone for the replies, I will see if I can book a slot with a specialist. I don't know if I have impacted teeth in the lower left side of my jaw, but I will check with my dentist. What can I do to prevent this from happening, I may be too agressive with equalizing as I am a Novice Diver. Come to think of it most of the bubles are under my scalp and just under my ear, at the juncture of the jaw. I don't get anything under the eye. OK, I will write back with more soon.

Thanks again, this is a great forum!

 

[dives2deep]

I had the dis-pleasure of experiencing this condition first hand.

Apparently my case was a bit more severe, my entire face and neck expanding out to the edge of the ears, throat closed down making it tought to breathe. A short helicopter ride (the EMT's were freaked out) to the local chamber equipped hospital revealed the nature of this condition.

Subcutaneous emphysema (spelling?). The Hyperbarics DR. informed me that the problem occurs when clearing your ears too vigorously, you create tears in the eustachian tubes which allows air between the skin and the underlying tissues.

Under pressure (at depth) this builds up, so when you surface the air, not being able to escape, expands. And your head or neck swells commensurate to the amoutn of air trapped.

The good news? The Dr. said it was avoidable, give the current 'event' time to heal 1-2 weeks. Then about 15-20 minutes prior to your next dive take two heavy hits of Afrin or similar nasal spray. This will open you up so to speak, and avoid clearing problems and 'forcing' the ear to clear.

This came from the Hyperbarics/Internal Medicine Dr. at the Hospital. His only advice, don't take the Afrin/nasal spray everyday or you'll get hooked.

I've been diving for 14 years, and this is the first I have ever experienced of anything like this. It was UNPLEASANT, and took three full days to not hurt like a mule kicked me. Afrin looks mighty cheap preventitive medicine.

Oh, and a mighty big thanks to DAN for pulling through.

 

[Otter]

Air under my skin because I blew my nose too hard....this sounds like Science Fiction.....maybe a hot needle could let the air out?

Just in case it isn't clear, I am NOT suggesting the above action be taken.