Never underestimate sinus barotrauma. Do not dive until swelling and inflammation have resolved, and you can adequately equalize, preferably under otoscopic evaluation. Assess why the problem occurred lack of training, allergy, etc. The inability to equalize properly is disqualifying.
If you are unable to clear your sinuses or you have frequent nosebleeds when diving, you should see your primary care physician or an ear, nose and throat ENT specialist otolaryngologist for evaluation.
Anatomy and Functions of the Paranasal Sinuses The paranasal sinuses are gas-filled cavities in your facial bones and skull. The frontal sinuses area one are located within the forehead above your nose and eyes and are surrounded by thick, bony walls. The ethmoid cells area two are located within the ethmoid bone between your eyes and nose and are formed by a variable number of connected individual cells.
The sphenoidal sinuses area three are centrally located behind the nasal cavity and vary in size and shape.
The maxillary sinuses area four are located within the maxillary bone below your eyes and lateral to your nose and are the largest pair of paranasal sinuses. Paranasal sinuses. During Descent Squeeze Failure to equalize pressures on paranasal sinuses while descending keeps these cavities at atmospheric pressure, which results in a relative negative pressure vacuum as you descend to depth. During Ascent Reverse Block Sinus barotrauma can also happen during ascent, known as a reverse block.
For the Diver You can consider a return to diving if a physician determines that the injury has healed, and the risk of further injury is no greater than normal. Do not neglect these injuries. Some of the complications could negatively affect you for the rest of your life. For the Dive Operator Provide first aid treatment, as described above.
Be skeptical of any folkloric first aid treatments. Remember that you might be liable. Have them evaluated by a medical professional in a timely fashion. An ENT specialist is ideal, but any doctor should be able to help. Do not allow any further diving once the injury has occurred until they are cleared by a physician. For the Physician Provide symptomatic treatment anti-inflammatory drugs, decongestants, mucolytic agents. Prophylactic antibiotic therapy is controversial.
Although a middle-ear infection is a plausible secondary complication, this is not always the case in the acute phase. Assess concomitant middle-ear barotrauma. If present, consider referring the patient to an ENT specialist. Assess the cranial nerve function. Juggling Physical Exercise and Diving. Coral Scrapes and Cuts. The first thing to realize is that all sinus infections are not the same. A sinus infection, a. Sindwani says. Symptoms of the different strains are so similar that doctors typically recommend patients wait seven to 10 days before seeking treatment.
Viral infections — the common cold — usually work themselves out in that period of time with nothing more than liquids, rest and supportive care including things like acetaminophen or ibuprofen , Dr. The main reason to prescribe antibiotics is for patient comfort, Dr. The medical field used to be more convinced than it is today than untreated sinusitis would inevitably become a chronic issue, he says. Antibiotics also can help ward off rare but potentially dangerous complications that arise when a sinus infection spreads to the eyes or brain, Dr.
Complications around the eyes are the more common of the two. These complications can cause redness, swelling around the eyes and reduced vision, and even lead to blindness — in a severe form known as cavernous sinus thrombosis.
Diving can affect the external, middle, and inner ear. Typically, divers experience ear fullness and pain during descent; if pressure is not quickly equilibrated, middle ear hemorrhage or tympanic membrane rupture may occur. Inflow of cold water to the middle ear may result in vertigo, nausea, and disorientation while submerged. On examination of the ear canal, the tympanic membrane may show congestion, hemotympanum, perforation, or lack of mobility during air insufflation with a pneumatic otoscope; conductive hearing loss is usually present.
When pressure within the middle ear remains elevated during or after ascent from a dive, the facial nerve can be compressed facial baroparesis , resulting in ipsilateral upper and lower facial paresis.
Weakness of both upper and lower face distinguishes facial baroparesis from stroke or arterial gas embolism. Inner ear barotrauma IEBT occurs due to rupture of the labyrinthine window round or oval window or tears of the Reissner, basilar, or tectorial membranes.
Symptoms, which include tinnitus, hearing loss, dizziness, disequilibrium, vertigo, nystagmus, ataxia, nausea, and vomiting, often worsen with activity and loud noise, and improve with rest. Symptoms usually start during descent when there is difficulty equalizing middle ear pressure, but can occur during ascent, possibly due to air expansion within the cochlea or vestibular apparatus.
Symptoms can also occur days after a dive, often provoked by lifting or straining 1 Reference Barotrauma is tissue injury caused by a pressure-related change in body compartment gas volume. Sinus barotrauma most often affects the frontal sinuses, followed by the ethmoid and maxillary sinuses. Divers experience mild pressure to severe pain, with a feeling of congestion in the involved sinus compartments during ascent or descent and sometimes epistaxis.
Pain can be severe, sometimes accompanied by facial tenderness on palpation. Rarely, the sinus may rupture and cause pneumocephalus with facial or oral pain, nausea, vertigo, or headache. Rupture of a maxillary sinus can cause retro-orbital air with diplopia due to oculomotor dysfunction. Compression of the trigeminal nerve in the maxillary sinus can cause facial paresthesias. Sphenoid sinus barotrauma can cause optic nerve compression and blindness 2 Reference Barotrauma is tissue injury caused by a pressure-related change in body compartment gas volume.
Physical examination may detect tenderness in the sinuses or nasal hemorrhage. Elliott EJ, Smart DR : The assessment and management of inner ear barotrauma in divers and recommendations for returning to diving. Diving Hyperb Med, 44 4 , PMID: Res Sports Med, 26 1 Epub Aug
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