eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Nasal & Sinus Diseases
Barosinusitis
Updated: Nov 11, 2008
Introduction
Background
Barotrauma of the paranasal sinuses is a risk factor for anyone exposed to ambient pressure changes. These pressure changes most often result from travel through mountainous regions, flying, or diving. Barosinusitis is characterized by inflammation of one or more of the paranasal sinuses. Inflammation is caused by a pressure gradient, almost always negative, between the sinus cavity and the surrounding ambient environment.
Pathophysiology
The paranasal sinuses have rigid walls with relatively small ostia for gas exchange and mucus transport. Physical gas laws, particularly Boyle's Law, apply to this space. Boyle's Law states that at constant temperature, the volume of a gas is inversely proportional to the pressure placed upon it.
To show how Boyle's Law affects the sinuses, consider the case of an individual with normal sinuses exposed to pressure changes while flying in an unpressurized aircraft. As the individual transitions to higher altitude, the ambient pressure surrounding the sinus cavity decreases, and the air in the sinuses expands and equalizes through the natural ostium. Upon descent, ambient air pressure increases, the air in the sinuses contracts, and air moves into the sinus cavity, preventing a pressure gradient from developing.
Now consider the same flight in someone who has an upper respiratory tract infection (URTI) with tissue edema and secretions blocking the natural sinus ostia. In this individual, tissue edema and debris will not allow free pressure equalization. Again, as the individual moves up in altitude, the ambient pressure decreases, and volume in the sinus cavity increases. A positive pressure develops in the sinus. With this positive pressure, tissue edema gradually decreases enough to allow debris and air to escape the natural ostium. Air pressure then equalizes. When the individual descends, the ambient pressure increases. Pressure cannot equalize across the nasal cavity to the sinus because of blockage at the ostium. Air volume decreases in the sinus cavity, creating a negative pressure.
At this point, a condition exists in which the volume of the sinus must be filled if the pressure gradient is to be eliminated. In mild-to-moderate cases, vascular engorgement and generalized submucosal edema occur. Over time, transudate and mucus fill the volume, reducing negative pressure and decreasing symptoms. In severe cases, especially with rapid onset, the sinus mucosa is stripped from the subjacent bone, resulting in severe pain and hematoma formation.
Frequency
United States
Prevalence is approximately 3-4 episodes per 100,000 exposures in a generally healthy population.
- In contrast, middle ear barotrauma (aerotitis media) is approximately 6-10 times more prevalent than barosinusitis.
- Frontal sinuses are most often affected, followed by maxillary sinuses.
- Ethmoid sinuses are infrequently affected as isolated events.
- Data are heavily skewed toward people who participate in activities subject to rapid pressure changes.
Race
Race predilection is not widely reported.
Sex
Sex predilection is not widely reported.
Age
Barosinusitis is not typically reported in children. Frontal sinuses are most frequently affected, and these do not fully develop until late adolescence. In addition, children do not routinely participate in activities that lend themselves to rapid pressure changes.
Clinical
History
Differentiate sinus barotrauma from other causes of facial pain and headache. The history is particularly important in shortening the differential. In sinus barotrauma, a condition of barometric pressure change always exists either during or shortly after onset of symptoms.
- With mild sinus barotrauma, the patient reports the following:
- Mild pressure or pain over 1 or more of the sinuses that develops after return to sea level or starting point
- Worsening congestion
- Occasional epistaxis
- With more severe sinus barotrauma, the patient notes the following possibly incapacitating symptoms:
- Sudden onset of typically severe and sharp pain and pressure
- Pain is typically in the forehead, mid face, or retro orbital.
- Epistaxis
Physical
Physical findings may be relatively sparse in mild cases of barosinusitis. In severe cases, the patient may have marked pain in the forehead, face, and upper teeth. This pain is typically unilateral. Erythema, edema, congested mucous membranes, epistaxis, and tenderness to palpation of the face may occur.
Causes
The following activities and conditions place individuals at particular risk for barosinusitis:
- Scuba and sport diving
- Sky diving
- Flying in military/high-performance aircraft
- URTI or sinusitis in persons exposed to pressure changes
- Poorly controlled allergies or anatomic abnormalities of the nose and paranasal sinuses
More on Barosinusitis |
 Overview: Barosinusitis |
| Differential Diagnoses & Workup: Barosinusitis |
| Treatment & Medication: Barosinusitis |
| Follow-up: Barosinusitis |
| References |
| Next Page » |
References
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].
Further Reading
Keywords
barosinusitis, sinusitis, sinus, sinus barotrauma, sinus squeeze, sinus inflammation, paranasal sinus barotrauma, barotrauma
