Tuesday, March 6, 2012

Barosinusitis

Barosinusitis

The paranasal sinuses contain a fixed amount of water vapor, mucus and air. The sinus pressure is generally in equilibrium with the ambient pressure. The sinus pressure changes with the changes in the ambient air pressure to achieve the equilibrium. If the equilibrium is not attained, pain in the sinus may start. This imbalance generally happens while descending from altitude. However, if the free air passage of the sinuses is obstructed, airflow from and to the sinuses is interrupted, disturbing the equilibrium. An injury to the sinus tissues, therefore, may occur. These injuries are referred to as barotraumas. The medical condition is commonly experienced by flyers and scuba divers. Barotrauma could be of ascent and descent.



Barotrauma of ascent may develop in flyers when the airplane ascends. The airflow obstruction may cause pressure or pain behind the eyes.  
Barotrauma of descent is also popularly called ‘squeeze’ by divers. As they descend into the water, the ambient pressure rises and the air in enclosed spaces, like sinuses, compresses. While descending, sinus pressuremay not equalize with the ambient pressure, causing barosinusitis or a sinus squeeze. Barosinusitis means inflammation or pain of the nasal sinuses because of change in the pressure.  The squeeze has a direct effect on the maxillary and frontal sinuses.  Barosinusitis may also develop in the patients already having nasal inflammation or pathology. If the sinus blockage occurs while descending during flying or diving, the intra sinus pressure decreases substantially, causing even mucosa hemorrhage.
Symptoms and signs
  • Pain in the sinus affected
  • The pain will be above the eyes in case of the frontal sinus squeeze and below the eyes if the maxillary sinus is affected.
  • Nose bleeding
  • Blood may come out from the mouth. 
  • Tenderness over the sinus affected when it is tapped lightly.
  • Vertigo
  • Tinnitus
  • Vomiting and / or nausea

Treatment
  • Stop diving until problem is fully resolved.
  • Use analgesics and decongestants.
  • Administer antibiotics for treating the frontal sinus squeeze.
  • Try Valsalva technique as it offers temporary relief.
  • Use systemic and topical vasoconstrictor agents to heal the swollen nasal mucosa and open the sinus ostia.
  • Avoid changes in atmospheric pressure until the condition improves.

Recovery from barosinusitis requires at least one to two weeks. A word of caution, do consult the physician before starting any treatment.

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