Yet another sinus question

[Griffo]

Hi Scubaboard.

My name is John, and it is 54 days since I last went for a dive. This is the longest time I have been dry since my first tentative taste of the sweet sport of diving. I need your help.

In the beginning of July I got the seasonal flu. It's been a particularly bad year this year, with everyone complaining that the flu took a very long time to get over. I think it took me a good 4 weeks to feel normal.

Since that time however, I have been unable to return to normal sinus function. I've had a slight nasal drip on and off, but a pretty constant "bad smell" which I am assuming is a sign of some kind of infection.
I've had two rounds of anti-biotics, but still whenever I fly, it still feels like someone is stabbing me above and behind my left eye. I am able to stop the pain with constant clearing on ascent, and valsalva on descent, but the fact it occurs has been keeping me out of the water.

Apart from time and another go on the drugs, is there anything else I should be trying? Neti pots or Saline squirts? Do those things work? My GP seemed dismissive, but she's also not a diving doctor.

Desperate and willing to try anything..

 

[whaylonsmithers]

:depressed:

 

[doctormike]

Hi...!

If you have specific localized pain around your eye on ascent or descent in an airplane, that does strongly suggest the possibility of poor ventilation in one of the air spaces in the midface known as the paranasal sinuses. However, the treatment for this really depends on a diagnosis, and in this case the only way to know for sure is a CT scan of the area. Remember, in addition to regular sinus infections (treated with antibiotics and decongestants) there are inflammatory conditions like polyps that do not necessarily respond to antibiotics, but may require other medical treatment or even surgery. Also, there are some anatomic problems (such as a deviated septum or abnormal bony walls of the sinuses) that will only be addressed by an operation.

Before going that route, it would make sense to see an ENT doctor for an internal examination of your nose. Hopefully, what you have is transient, and you will eventually be able to equalize again during air travel and even under water (which as you know represents a much greater pressure swing than that seen in flying).

Neti Pots are great, just make sure to use sterile water when you irrigate. Saline sprays don't do much apart from lubricating the nose (helpful for nosebleeds!). More than that, you really need a diagnosis first.

Sorry, don't know any ENT docs in Oz...

 

[Griffo]

Thanks Doctor Mike!

I got an ENT recommendation from the local hyperbaric chamber, so fingers crossed.

Cheers

 

[doctormike]

Great! Keep us posted...

Safe diving...!

 

[doctormike]

Great! Keep us posted...

Safe diving...!

 

[DevonDiver]

I swear by saline flushes. After 20+ years of diving, I began to suffer 're-current' colds after virtually every diving trip to a particular location. Those colds saw heavy congestion and flu like symptoms. After 6 months of severe problems, I came to the conclusion that the 'colds' occurred only when I got seawater into my nose (which happens regularly when teaching certain courses).

My partner, an ENT doctor, suggested it was an allergy to something in the water (tropical waters, fed by rivers through jungle areas). On the final occurence, I took a course of anti-biotics, along with nasal steroids. It resolved the issue much quicker than normal. I was also advised to use a saline flush regularly...and definitely after surfacing from each dive.

Surprise, surprise, no re-occurence in the last 4 months.

So... I swear by saline flushes now (they also help with general 'cleaning out the gunk' - thus equalizing).

 

[kbashara]

I'm a fan of sinus rinsing, too. Just make sure you are using distilled water or boiled tap water in your Neti Pot. I personally prefer the squeeze bottle because I can get a more powerful "squirt". I've had sinus surgery on my maxillary sinuses due to chronic sinusitis and infections and am able to dive with little problem. I also have a pretty significant Sudafed habit. I take a dose of pseudoephedrine on the morning of my dives (and many mornings where I feel congested. I realize this does not jive with the "no meds" recommendations for divers, but I'm unwilling to give up diving and am trying to put off a second surgery to improve drainage of my upper and ethmoid sinuses. Make sure you tell your ENT that you appear to have infections that are resistant to some antibiotics. That way, they won't mess around with the 3 or 5 day "Z-packs", causing you to need repetitive courses of antibiotics. They may also want to take a culture of your sinus to rule out a fungal infection (gross, I know).

Best of luck and get well! -Kirstin

​

 

[Griffo]

So I tried the neti pot / saline for a few weeks without any luck while I waited for an appointment with the ENT. I got a reccomendation from the head of the local hyperbaric chamber, so I decided to wait the extra long period to get in to see a doctor that was diving "aware".

4 weeks of Prednisolone, doxycycline, and Nasonex appears to have had some limited success (the wife says i've stopped snoring again). Hope I never have to go on prednisolone ever again - I think i had every side effect on the label plus some. Although it did also help fix my shoulder that I banged up skiing. Oh, and it made a Lipoma dissapear, how weird.

But still can't dive. Got new DUI drysuits due this week and no end in sight :-(

 

[doctormike]

But still can't dive. Got new DUI drysuits due this week and no end in sight :-(

You mean you can't dive because you can't equalize? Did you get a CT scan? That might have some answers about the specific anatomical issues involved...