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:
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Mild pressure or pain over 1 or more of the sinuses that develops after return to sea level or starting point
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Worsening congestion
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Occasional epistaxis
With more severe sinus barotrauma, the patient notes the following possibly incapacitating signs and symptoms:
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Sudden onset of typically severe and sharp pain and pressure - Pain is typically in the forehead, midface, or retro-orbital area
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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:
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Scuba and sport diving [7]
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Sky diving
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Flying in military/high-performance aircraft
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URTI or sinusitis in persons exposed to pressure changes
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Poorly controlled allergies or anatomic abnormalities of the nose and paranasal sinuses
Wang et al found that out of 605 cases of aviatic nasal disorders among air-crew members, 55 (9%) involved sinus barotrauma. [8]
A study by Smerz of 400 Hawaiian scuba divers did not find a significant association between the use of vasoconstrictive sympathomimetic decongestants by scuba divers to avoid otic and sinus barotrauma and the development of decompression sickness (DCS), even though vasoconstriction is considered to be an important factor in DCS. [9]
