Diving-Related Headaches: Causes and Solutions - Diving Medicine

Dr. Lin Zhengyan reply Diving Medicine

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Hello LIPO: Your issue is barotrauma.
This occurs in a closed gas space where the volume of gas changes due to pressure alterations, leading to tissue deformation or damage caused by the change in gas volume, known as barotrauma.
You are currently experiencing mild discomfort, which should resolve on its own after rest; however, if symptoms persist, you should consult an otolaryngologist.
You have a history of sinusitis, which may cause similar issues during diving, making diving unsuitable for you.
Barotrauma is the most common injury among divers.
This is because divers engage in activities that involve air-filled cavities in the body, such as the ears, sinuses, respiratory tract, lungs, and gastrointestinal tract.
As a diver descends or ascends, changes in water pressure can cause these air-filled cavities to change in volume.
When these cavities shrink or expand to their limits, surrounding soft tissues can be compressed, resulting in tissue strain, edema, and congestion, which are manifestations of barotrauma.
Barotrauma in diving is influenced by Boyle's Law, which states that at constant temperature, the volume of a given mass of gas is inversely proportional to its pressure (higher pressure means smaller volume, and lower pressure means larger volume), expressed as pressure multiplied by volume equals a constant (P × V = K).
Therefore, when a diver descends, the increased water pressure compresses the air-filled organs, reducing their volume; conversely, when ascending, the reduced water pressure allows these organs to expand.
If there are factors obstructing gas flow in the ears, sinuses, respiratory tract, or gastrointestinal tract, it can lead to barotrauma due to impaired volume changes.
The human skull contains four pairs of paranasal sinuses: the frontal, sphenoid, ethmoid, and maxillary sinuses, each normally connected to the nasal cavity via small passages.
Under normal conditions, as pressure increases during descent, the volume of each sinus decreases, but because they remain open to the nasal cavity, pressure is balanced, preventing barotrauma.
Sinuses can become obstructed due to conditions such as allergies, inflammation, or polyps.
If the nasal cavity is congested due to sinusitis or rhinitis, causing swelling or blockage of the passages, the sinuses can form a closed space.
During descent, this blockage can lead to compression of the sinus mucosa, resulting in rupture and bleeding, causing barotrauma.
During ascent, if mucus plugs or polyps obstruct the sinus ostia, rapid ascent can cause the gas volume within the sinuses to expand quickly due to reduced pressure, but if the ostia are blocked, the gas cannot escape through the nasal cavity, leading to edema and bleeding of the sinus mucosa.
The most common symptom of sinus barotrauma is forehead pain, particularly from frontal sinus barotrauma.
It is generally believed that the frontal sinus has longer and more convoluted drainage pathways, increasing the likelihood of obstruction.
Therefore, pain is more likely to occur during descent.
The management for forehead pain during descent is to stop descending; if barotrauma symptoms occur, consult an otolaryngologist.
Preventive measures for sinus barotrauma include prohibiting diving for individuals with upper respiratory infections, sinusitis, or those who have undergone nasal surgery, descending at a controlled pace, and avoiding smoking to reduce irritation and damage to the nasal mucosa.
Most cases of sinus barotrauma do not require treatment; management includes suspending all diving activities, administering antibiotics or decongestants for upper respiratory infections, and surgical removal for polyps.

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Reply Date: 2010/08/03