Swimmer's Sinus Problems: Sinusitis Risk After Choking on Water and Prevention

The Relationship Between the Sinuses and Swimming

The sinuses are 4 pairs of air-filled cavities inside the skull (frontal, maxillary, ethmoid, and sphenoid sinuses) that connect to the nasal cavity through small openings. Under normal conditions the sinuses are sterile and dry, but swimming disrupts this balance.

The Mechanism and Effects of Choking on Water

When water enters the nasal cavity, depending on pressure and movement it can:

1. Flow back out quickly (most common): causes momentary stinging
2. Flow backward into the throat: swallowed or coughed out
3. Flow backward into the sinuses: the source of the problem

The third scenario is rare, but repeated occurrences can lead to chronic issues:

• Chlorine irritates and inflames the sinus lining
• Bacteria enter the sterile cavity
• The sinus openings swell and become blocked
• Retained secretions allow bacteria to grow

Symptoms of Acute Sinusitis

Appearing 1-3 days after swimming:

Symptom	Description
Facial pain	Pressure in the forehead, cheeks, or bridge of the nose
Nasal congestion	One-sided or bilateral
Yellow-green discharge	Draining from the nose or down the throat
Reduced sense of smell	Partial or complete
Headache	Worsens when bending the head down
Low-grade fever	Below 38°C
Tooth pain	Upper teeth pain (maxillary sinusitis)

Warning Signs of Chronic Sinusitis

Symptoms lasting more than 12 weeks or recurring 4 or more times:

• Persistent nasal congestion
• Postnasal drip (mucus in the throat)
• A feeling of heaviness in the head
• Reduced sense of smell
• Chronic cough

High-Risk Groups

The following situations carry higher risk:

• History of allergic rhinitis
• Deviated nasal septum
• Enlarged turbinates
• Nasal polyps
• Recurrent upper respiratory infections
• Children (sinus structures not yet fully developed)

Prevention Strategies

1. Using a Nose Clip

Butterfly and breaststroke swimmers commonly use nose clips, with notable effectiveness:

Advantages:

• Completely blocks water from entering the nasal cavity
• Suitable for those with recurring sinus problems
• Inexpensive and easy to obtain

Disadvantages:

• Changes breathing habits (forces mouth breathing)
• Prolonged pressure on the bridge of the nose
• Cosmetic concerns

Selection tips:

• Silicone material
• Wide contact surface on the nose bridge that doesn’t pinch
• Fine for training; use during competition is a matter of personal preference

2. Improving Breathing Technique

Freestyle Breathing

• Continuously exhale through the nose while breathing
• Mouth inhalation only occupies the last 0.5 seconds of the breath
• Nasal exhalation creates positive pressure that keeps water out of the nose

Butterfly and Breaststroke Breathing

• Exhale forcefully through the nose 0.5 seconds before surfacing
• Continue exhaling through the nose 0.5 seconds before submerging
• Train “80% exhalation underwater, 20% inhalation above water”

3. Handling a Water-Choking Incident

At the moment of choking on water:

• Do not tilt the head backward (this lets water flow into the sinuses)
• Lower the head and tilt it to the side
• Gently blow the nose (one side at a time, to avoid excessive pressure)
• Avoid choking again before finishing the set

Within 1 hour after choking on water:

• Rinse the nasal cavity with saline solution
• Watch for any head discomfort
• Drink plenty of water to thin the mucus

4. Nasal Irrigation

Saline nasal irrigation is the most effective method for preventing and treating sinus problems:

Frequency:

• Daily swimmers: rinse after training
• During a sinusitis flare-up: 2-3 times per day
• For prevention: 2-3 times per week

Method:

1. Use a nasal irrigation bottle or neti pot
2. Use isotonic or mildly hypertonic saline solution
3. Tilt the head 45 degrees to the side and pour the solution into the upper nostril
4. The water will flow out of the lower nostril
5. Alternate sides, 2-3 times each

Notes:

• Use boiled and cooled water, or distilled water
• Never use tap water (it may contain amoebae)
• Pause during an acute sinusitis flare-up

5. Special Care for Those With Allergies

For swimmers with allergic rhinitis:

• Take an antihistamine 1 hour before training
• Use a steroid nasal spray after training (as prescribed by a physician)
• Reduce swimming frequency during seasonal flare-up periods
• Avoid outdoor pools during pollen season

Managing Acute Sinusitis

Self-Care Phase (Days 1-7)

• Rinse the nasal cavity with saline solution 2-3 times per day
• Drink plenty of water (3000ml per day)
• Steam inhalation (warm compress on the face, hot showers)
• Get adequate rest
• Pause swimming

Medication Phase

• Decongestants (oral or nasal spray)
• Antihistamines (for allergic individuals)
• Pain relievers (acetaminophen or ibuprofen)
• Antibiotics require a physician’s prescription

When to See a Doctor

Seek immediate medical attention if:

• Symptoms have not improved after 10 days
• High fever above 39°C
• Severe headache
• Changes in vision
• Redness and swelling around the eyes (possible orbital cellulitis)
• Neck stiffness (suggesting spreading infection)

Adjusting Swim Training

Acute Phase

Stop swimming completely for 5-7 days until:

• Nasal congestion improves
• Fever is gone
• Discharge becomes clear
• Headache resolves

Recovery Phase (1-2 weeks after symptoms resolve)

• Focus mainly on backstroke (nose stays above water)
• Avoid butterfly and breaststroke (unfavorable breathing direction)
• Wear a nose clip mandatorily
• Shorten training sessions to 45 minutes

Long-Term Management

For those with recurrent chronic sinusitis:

• Wear a nose clip year-round
• Perform daily nasal irrigation
• Manage allergies
• Annual ENT follow-up
• Surgical evaluation if necessary (sinus surgery)

Special Considerations for Children

Children’s sinuses are not yet fully developed, which makes them more susceptible:

• Children under 4 should enter water cautiously to avoid choking
• Those with recurrent otitis media combined with sinus problems need careful evaluation
• Coaches should teach correct breathing technique
• Do not force a frightened child to dive underwater

Additional Risks in Open Water

Open water has complex water quality, creating nasal risks such as:

• Bacteria and parasites entering the nose
• Naegleria fowleri (rare but fatal)
• Increased likelihood of chronic sinusitis

Recommendations:

• Wear a nose clip in open water
• Rinse the nasal cavity after exiting the water
• Avoid training in polluted water

Sinus problems may seem minor, but they can significantly affect athletic performance. Prevention is better than treatment, and correct breathing technique is fundamental.

Related Reading

• ENT Care for Swimmers: Strategies Against Swimmer’s Ear, Sinusitis, and Throat Irritation
• ENT Problems in Swimming: Prevention and Management of Otitis Externa and Sinusitis
• Swimming and Asthma: How Chlorinated Environments Affect the Airways and How to Cope
• Effects of Chlorine on Skin and Eyes: A Complete Post-Swim Care Routine and Product Guide