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.
Sonmez G, Uzun G, Mutluoglu M, Toklu AS, Mutlu H, Ay H, et al. Paranasal sinus mucosal hypertrophy in experienced divers. Aviat Space Environ Med. Oct 2011;82(10):992-4. [Medline].
Prasad BK. ENT morbidity at high altitude. J Laryngol Otol. Feb 2011;125(2):188-92. [Medline].
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].
Vaughan WC. Review of balloon sinuplasty. Curr Opin Otolaryngol Head Neck Surg. Feb 2008;16(1):2-9. [Medline].
Hanna HH, Tarington CT. Otolaryngology in aerospace medicine. In: DeHart RL, ed. Fundamentals of Aerospace Medicine. Philadelphia: Lippincott Williams & Wilkins; 1985:520-530.
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].
Setliff RC 3rd. Minimally invasive sinus surgery: the rationale and the technique. Otolaryngol Clin North Am. Feb 1996;29(1):115-24. [Medline].
Sonmez G, Uzun G, Mutluoglu M, Toklu AS, Mutlu H, Ay H, et al. Paranasal sinus mucosal hypertrophy in experienced divers. Aviat Space Environ Med. Oct 2011;82(10):992-4. [Medline].
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