eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Nasal & Sinus Diseases

Barosinusitis: Follow-up

Author: J Kim Thiringer, DO, Otolaryngologist, Ear, Nose, and Throat Associates
Contributor Information and Disclosures

Updated: Nov 11, 2008

Follow-up

Further Outpatient Care

  • Depending on the clinical situation, the vast majority of patients undergoing endoscopic sinus surgery may return to full activities within 1-3 weeks following surgery.
  • Warn patients to avoid activities that may be hazardous (eg, piloting aircraft, diving) until the attending surgeon is sure the patient is fully recovered.
  • Remember that other governing agencies (eg, Federal Aviation Administration, Department of Defense) may have ultimate authority over granting the patient's request to return to work or activity (eg, commercial or military flying or diving).

Deterrence/Prevention

  • Prevention is best accomplished by avoiding ambient pressure changes. This is particularly true when the individual attempts to fly or dive while they have a URTI, cold, or poorly controlled nasal allergy.
  • Repeated attacks of acute barosinusitis can cause permanent damage of the paranasal sinus mucosa, which leads to recurrent barosinusitis. This condition results from hematoma formation and fibrosis and chronic mucosal thickening, which can further impede adequate sinus ventilation.

Complications

  • Complications of barosinusitis are unusual, but they may include the following:
    • Orbital cellulitis, abscess, or hematoma
    • Pneumocephalus or subcutaneous emphysema
    • Complications associated with paranasal sinusitis

Prognosis

  • Isolated barosinusitis in a previously healthy individual is most commonly due to flying or diving with acute URTI or sinusitis. These patients generally do quite well with conservative treatment. Recurrent acute barosinusitis suggests fixed pathology of the paranasal sinuses and is more likely to require surgical therapy to establish ventilation. Prognosis is still excellent in previously healthy patients. Those with poorly controlled allergy, nasal polyposis, or extensive mucosal disease may not do as well in terms of returning to full activity.

Patient Education

  • Strongly caution individuals involved in work or recreation activities that include acute pressure changes not to participate if they are not 100% physically qualified.
  • If symptoms of barosinusitis occur while diving, return to the surface. If flying, return (usually climb) to the altitude at which symptoms first started, use topical decongestants if available, and start a slow descent as symptoms allow. The Valsalva maneuver may be helpful and is more effective after topical decongestion.

Miscellaneous

Medicolegal Pitfalls

  • Although the patient may be fully recovered and ready to return to work or full activity, authorization for such activity frequently comes from another supervisory agency, not the surgeon. The surgeon's input is important, although other regulations about which he or she may be unaware could be in effect. The patient has the responsibility to know the identity of any supervising authority. Ask the patient about this possibility without fail, and document his or her response.

Special Concerns

  • The views or opinions contained within this article are those of the author alone and do not reflect the official position of the US Navy, Department of Defense, Federal Aviation Administration, or any other US governmental agency.
 


More on Barosinusitis

Overview: Barosinusitis
Differential Diagnoses & Workup: Barosinusitis
Treatment & Medication: Barosinusitis
Follow-up: Barosinusitis
References
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References

  1. Parsons DS, Chambers DW, Boyd EM. Long-term follow-up of aviators after functional endoscopic sinus surgery for sinus barotrauma. Aviat Space Environ Med. Nov 1997;68(11):1029-34. [Medline].

  2. Vaughan WC. Review of balloon sinuplasty. Curr Opin Otolaryngol Head Neck Surg. Feb 2008;16(1):2-9. [Medline].

  3. Hanna HH, Tarington CT. Otolaryngology in aerospace medicine. In: DeHart RL, ed. Fundamentals of Aerospace Medicine. Philadelphia: Lippincott Williams & Wilkins; 1985:520-530.

  4. Jones JS, Sheffield W, White LJ, et al. A double-blind comparison between oral pseudoephedrine and topical oxymetazoline in the prevention of barotrauma during air travel. Am J Emerg Med. May 1998;16(3):262-4. [Medline].

  5. Setliff RC 3rd. Minimally invasive sinus surgery: the rationale and the technique. Otolaryngol Clin North Am. Feb 1996;29(1):115-24. [Medline].

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Further Reading

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Keywords

barosinusitis, sinusitis, sinus, sinus barotrauma, sinus squeeze, sinus inflammation, paranasal sinus barotrauma, barotrauma

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Contributor Information and Disclosures

Author

J Kim Thiringer, DO, Otolaryngologist, Ear, Nose, and Throat Associates
J Kim Thiringer, DO is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery
Disclosure: Nothing to disclose.

Medical Editor

Lanny Garth Close, MD, Chair, Professor, Department of Otolaryngology-Head and Neck Surgery, Columbia University College of Physicians and Surgeons
Lanny Garth Close, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Physicians, American Laryngological Association, American Society for Head and Neck Surgery, and New York Academy of Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Stephen G Batuello, MD, Consulting Staff, Colorado ENT Specialists
Stephen G Batuello, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Physician Executives, American Medical Association, and Colorado Medical Society
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown

 
 
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