Out of the blue sinus problem

[EMBpilot]

May be some of you had something similar happen. Please share how to deal with it.

Recently, on a descent, I had tremendous pain in my left frontal sinus - just above left eyebrow. It felt like nails penetrating my skull and my left eye released good amount of tears.

It persisted for about 7-10 minutes and then it became much less of a pain, but continued through the overnight - for good 13 -15 hours.

I didn't feel any congestion (before nor after) - no runny nose, I don't have any allergies, previously I did 2 other flights on that day and did not have any problems. Also the pain came only on descent, not during climbs.
I imagine the "descent pain" was a pressure equalizing issue and the "continued pain" from induced trauma??

I went to a grocery store and bought Afrin spray and Sudafed PE.
I started taking Sudafed (4 daily) to dry out the congestion (although I did'n feel having any) and decided to have Afrin ready to spray on the morning flight home where I planned to call in sick.

On the descent home I felt OK, did not use Afrin and decided to continue the trip.

As I was flying the following 3 days I was taking Sudafed and had only lingering pain in the same area - again I think because of the previous "trauma". It intensified during subsequent descents, but was very much manageable.

I am off now for a couple of days and wonder if I should find an ENT doctor and try to see him? Feels like the "damage" is healing and since I didn't have the pressure equalizing pain any more should I just close this chapter in my life or are there any chronic possibilities?

Thank you.

 

[dalegribble]

I'd see the ENT. Sounds like sinus block, I would have it checked by an ENT.

 

[LR25]

EMB, I had something like this about 7 years ago. I was at FL450 and around 16K on the descent I felt a feeling of pressure on a sinus, at 10K it turned to pain and right at the time I thought something serious was about happen, it released and could hear it in my ear like a baloon sqealing. At the time, I also had no symptoms or anything.

Nothing else ever has happened like it since. And since then I carry afrin.

It sounds like you had the same thing I did. I just stayed out of the airplane for a few days. No other problems since.

 

[ackattacker]

You had a sinus block. I'm definately not a doctor, but I give you this from the faa web:

c. Sinus Block.
1. During ascent and descent, air pressure in the sinuses equalizes with the aircraft cabin pressure through small openings that connect the sinuses to the nasal passages. Either an upper respiratory infection, such as a cold or sinusitis, or a nasal allergic condition can produce enough congestion around an opening to slow equalization, and as the difference in pressure between the sinus and cabin mounts, eventually plug the opening. This "sinus block" occurs most frequently during descent.
2. A sinus block can occur in the frontal sinuses, located above each eyebrow, or in the maxillary sinuses, located in each upper cheek. It will usually produce excruciating pain over the sinus area. A maxillary sinus block can also make the upper teeth ache. Bloody mucus may discharge from the nasal passages.
3. A sinus block is prevented by not flying with an upper respiratory infection or nasal allergic condition. Adequate protection is usually not provided by decongestant sprays or drops to reduce congestion around the sinus openings. Oral decongestants have side effects that can impair pilot performance.
4. If a sinus block does not clear shortly after landing, a physician should be consulted.​

 

[Gorilla]

Sudafed PE is not as good as the old Sudaphed with pseudoephedreine, which you now need to buy from the pharmacist, as its purchase is logged. That said, if you felt some pressure and had to work it going up, which is easier than going down, take some sudafed 40 minutes from top of descent to prep you. Stay VERY hydrated, too.

Since yours came out of the blue, this doesn't apply, but it sounds like you did some physical damage. Once damaged, your sinuses and ear tubes may be prone to additional episodes. Use caution, be very careful for a couple of weeks, so the damage can heal. Once it's chronic, it's a royal PITA.

I remember reading somewhere that to help with ears, at lest, in unpressurized fighters, the WW2 Luftwaffe used to surgically hole the eardrums. Ouch!

 

[CrewResearch]

EMBpilot -

I agree with the above posters: It does sound like a sinus block, and if it happens again -- or if you have a residual effect (not just pain, but sensations such as a "fullness" in the ear) you should see an ENT to be evaluated.

Re the drug fixes, Afrin is good as an "emergency" drug -- it's better to use a few squirts prior to descent if you're blocked rather than to risk damaging your eardrum and middle ear. But, it's not good to use Afrin on a regular basis.

Gorilla is correct that the "new" Sudafed PE does not work as well as the "old" Sudafed - pseudoephedrine. This is not opinion. It has been documented with clinical tests.

By the way, none of these products should be used if you have high blood pressure.

Another thing to keep in mind: pseudoephedrine -- or more accurately, its metabolites -- sometimes register a false positive for amphetamine in routine drug screens, especially if they are done using a method called immunoassay. Most routine drug screens use that method because it is relatively inexpensive and quick. Another method called gas chromatography/mass spectrometry rarely shows false positives like that, but the test is not often used for routine drug screens because it takes longer to process and is much more expensive.

In some cases, sinus block can be helped by taking ibuprofen (Advil, Motrin). In addition to its pain-killing effects, this drug is a very good anti-inflammatory, and it is that effect that helps the sinus block.

Here are some links to some useful info from "reliable sources:"

Airplane Ear - Mayo Clinic

Sinus Pain - Can over-the-counter medications help? - American Academy of Otolaryngology

Decongestants: OTC relief for congestion - American Academy of Family Physicians

Acute Sinusitis - Mayo Clinic

 

[SPilot]

I got this today, while on the sixth high-speed descent of the day (I fly skydivers). I had a mild cold from before, but using Afrin and pills I cleared up my nasals and flew without any problems the first part of the day.
Suddenly, like out of nowhere, extreme pain occurred over my left eyeball, while descending from 12,500 through 8000. The pain persisted until I stopped descending so fast at 5000, and went away within five minutes on the ground.
I blew my nose, and felt no pain going back up again, and on the seventh and eight high-speed descent (3000ft/min in C182) I felt much less pain - but definitively something wrong.

Will it be potentially damaging to internal tissue etc. if I go fly again tomorrow, doing only regular 500ft/min descents?

Using Afrin or other drugs, is there any way I can clear out this stuff from all the way up in my sinuses, and get on with flying painlessly? I don't have much experience with drugs/sprays, as I've practically never been sick before in my life.

 

[EMBpilot]

I got this today, while on the sixth high-speed descent of the day (I fly skydivers). I had a mild cold from before, but using Afrin and pills I cleared up my nasals and flew without any problems the first part of the day.
Suddenly, like out of nowhere, extreme pain occurred over my left eyeball, while descending from 12,500 through 8000. The pain persisted until I stopped descending so fast at 5000, and went away within five minutes on the ground.
I blew my nose, and felt no pain going back up again, and on the seventh and eight high-speed descent (3000ft/min in C182) I felt much less pain - but definitively something wrong.

Will it be potentially damaging to internal tissue etc. if I go fly again tomorrow, doing only regular 500ft/min descents?

Using Afrin or other drugs, is there any way I can clear out this stuff from all the way up in my sinuses, and get on with flying painlessly? I don't have much experience with drugs/sprays, as I've practically never been sick before in my life.

If you talk to Doctors they all say: "if it doesn't drain - it doesn't drain".
No one will try to determine how much is OK and how much will cause damage. They'll just ground you. "Sudafed and Afrin - to dry and drain and some antibiotics to kill, come back next week".

But if you feel OK and not stuffy just take (and keep taking for a day or two) sudafed per box instructions and see if you feel even better and if drainage occurs. No side effects there.
Then I am thinking 500 fmp should be OK.
All individual with person and condition though.

Welcome to the club

 

[SPilot]

Welcome to the club

Thanks.

The Club of a Thousand Rusty Needles pinched through the edge of the eye.

I flew again this morning and had no problems whatsoever. Didn't use any pills or spray etc either. Took it real easy on the descent, expecting mayhem to strike at any time, but it didn't. Now I'm a little scared of descending... Never felt such intense pain before.