Over the past few years, I have had the pleasure of introducing quite a few friends and family to the AirBuddy diving system, but I must confess, my success rate has varied.  Many of my friends expressed interest in   hookah diving in general and the AirBuddy system in particular, and I have always been eager to allow them a demonstration dive or two. They note how passionate I am about the product, see me using it frequently, asking if they can give it a supervised try.  Amongst the people I have introduced  to AirBuddy range from skilled SCUBA divers and experienced snorkelers to others who have not spent much time in the water. I suspect even a couple of them could not actually swim but lied about their water skills in order to give it a go.

For the less experienced, the introduction lesson is simply giving some basic instructions, fitting the harness to their backs, instructing them breath as they submerge, holding on to my ankles, while I stand in one meter of water. Most of the beginners find this satisfactory, if they can adjust to the strangeness of breathing underwater through their mouths. For those who professed to be more advanced, I try them with a buddy dive, hooking two hoses to the AirBuddy. Surprisingly to me, not all of these first-time hookah dives were successful. Quite a few of the beginner hookah divers, even those who claimed to be experienced, failed to enjoy the experience often citing sinus squeeze as the problem. I can certainly relate as any kind of underwater activity with partially or totally blocked sinus cavities can be painful. According to the National Institute of Health, this is called “barosinusitis or aerosinusitis”, and is “an irritation of the mucosal lining in the sinuses as a result of the failure to equalize intrasinus pressures with ambient environment pressure.” (Sinus Squeeze – StatPearls – NCBI Bookshelf (nih.gov). In my experience it seems to occur  after diving for a few minutes, most often while ascending, even in water as shallow as several meters.

While the pain is a caused by tissue irritation, in my experience it really hurts, especially in the frontal sinus, where it feels like a metal band had been installed  around your forehead and successively tightened as you surface.  Of course, internal equalizing the expanding pressure is designed to take place via small openings in your sinuses, called ostia. When these small openings are blocked, an equilibrium cannot be easily achieved, thus compressing the sinus mucus lining and creating discomfort. My students did not enjoy the experience when this occured.

It’s very hard to determine if someone diving for the first time in a long time or inexperienced in using a hookah system, has blocked ostia. The discomfort they experience is genuine.  When this occurs, I have to quickly look on the beach for a whiteboard so I can explain the effects of Boyle’s Law on gases. A few people told me they already knew the law but had forgotten while others thought I was making it all up. They were not happy.

Since those experiences I now ask anyone who wants to try the AirBuddy, if they have any sinus issues on the day, but it is still a shame when I see someone clearly experiencing an equalizing problem, not enjoying  either the AirBuddy experience or the beauty of the underwater world.

Recently I saw a post on Facebook about this issue, from a group of divers in Canada. Their recommendations for minimizing sinus squeeze was to dive in colder water, they suggested 6 degrees C as a starting point, and ensuring the dive is at least to 3 m deep. In their experience, the depth squeezes out mucus and debris from the sinus cavity, opening up the ostia for better drainage. Secondly, they report that the cooler temperatures results in vasoconstriction (narrowing of the blood vessels) reducing membrane swelling. Finally, the cooler water increases oxygen flow to the nasal passages, helping to reduce inflammation of the tissue.

Upon reflection, I think waiting for the water to reach 6 degrees C might be good to clear sinuses, but probably will not increase the novice’s enjoyment of the AirBuddy system. This is true especially if they could not feel their hands or feet. Personally, I would not dive in water that cold, ever! I do understand, however, the benefits of cooler water diving and that it could assist those trying to adjust to using hookah, and who might be unaware they have a sinus issue. I will encourage them to keep trying and over time, their bodies will adjust to operating in an alien world of varying pressures, depths and sensations. I look forward to their next attempt, maybe in Winter.