Sinus barotrauma
Background
- Also known as "sinus squeeze"
- Occurs during scuba diving or air flight due to changes in pressure within a non-draining sinus.
Barotrauma Types
- Otic barotrauma
- Pulmonary barotrauma
- Sinus barotrauma
- Mask squeeze
- Barodentalgia (trapped dental air causing squeeze)
Diving Physiology
- Pascals Law applies to the diving body (without air filled areas such as lungs) states that the pressure applied to any part of the enclosed liquid will be transmitted equally in all directions through the liquid.
- Boyles Law applies to the diving body's air filled areas such as lungs, sinuses, middle ear, and states that the volume and pressure of a gas at a given temperature are inversely related.
- At 2 ATA (10m/33ft) a given gas would be 1/2 it's volume, at 3 ATA (20m/66ft) it would be 1/3 it's volume and so on.
Clinical Features
- Pain over affected sinus, possible bleeding from nares
- Ascent can cause expulsion of blood and mucous into nares and mask.
- Front sinus most commonly affected, followed by maxillary sinus
- Infraorbital branch of fifth cranial nerve runs along base of maxillary sinus, and can have neuropraxia involving lip and cheek.
- Teeth pain can occur.
- Ethmoid sinus can dissect air through lamina papyracea and cause periorbital emphysema.
Differential Diagnosis
Diving Emergencies
- Barotrauma of descent
- Otic barotrauma
- Pulmonary barotrauma
- Sinus barotrauma
- Mask squeeze
- Barodentalgia (trapped dental air causing squeeze)
- Barotrauma of ascent
- Pulmonary barotrauma (pulmonary overpressurization syndrome)
- Decompression sickness (DCS)
- Arterial gas embolism
- Alternobaric vertigo
- Facial baroparesis (Bells Palsy)
- At depth injuries
- Oxygen toxicity
- Nitrogen narcosis
- Hypothermia
- Contaminated gas mixture (e.g. CO toxicity)
- Caustic cocktail from rebreathing circuit
Barotrauma Types
- Otic barotrauma
- Pulmonary barotrauma
- Sinus barotrauma
- Mask squeeze
- Barodentalgia (trapped dental air causing squeeze)
Evaluation
- Usually clinical
Management
- Decongestants (pseudoephedrine, oxymetazoline)
- Consider antibiotics
Disposition
- Generally discharge