Aerosinusitis
Aerosinusitis | |
---|---|
Other names | Sinus barotrauma |
Paranasal sinuses. | |
Specialty | Emergency medicine, diving medicine |
Treatment | medicine |
Aerosinusitis, also called barosinusitis, sinus squeeze or sinus
Presentation
Typically, sinus barotrauma is preceded by an upper respiratory tract infection or allergy. The affected person has a sudden sharp facial pain or headache during descent, which increases as the aircraft approaches ground level. The pain can ultimately become disabling unless the ambient pressure is reversed.
The pressure difference causes the mucosal lining of the sinuses to become swollen and submucosal bleeding follows with further difficulties ventilating the sinus, especially if the orifices are involved. Ultimately fluid or blood will fill the space.
In most cases of sinus barotrauma, localized pain to the frontal area is the predominant symptom. This is due to pain originating from the frontal sinus, it being above the brow bones. Less common is pain referred to the temporal, occipital, or retrobulbar region. Epistaxis or serosanguineous secretion from the nose may occur. Neurological symptoms may affect the adjacent fifth cranial nerve and especially the infraorbital nerve.
Pathology
The pathology of sinus barotrauma is directly related to Boyle's law, which states that the volume of a gas is inversely proportional to the pressure on it, when temperature is constant (P1 × V1 = P2 × V2). Two types of acute barotrauma are observed: squeeze and reverse squeeze.
On ascent, the
If the outlet is blocked during ascent, the situation is reversed and "reverse squeeze" appears.[7] Pressure inside the sinus increases, affecting the walls of the sinus and producing pain or epistaxis.
Location
The majority of episodes of sinus barotrauma occur in the frontal sinuses with pain localized over the frontal area. Possible explanations for this might be the relatively long and delicate
Barotrauma located in the
Diagnosis
Most cases occur in scuba divers and fliers, and is easily diagnosed when presented to physicians immediately after exposure.[2][3] On the other hand, the problem may remain undiagnosed when the history fails to relate the symptoms to exposure to environmental pressure changes or if the focus is on other etiologies.[4]
Grades
Weissman defined three grades of sinus barotraumas according to symptomatology.[8][9]
- Grade I includes cases with mild transient sinus discomfort without changes visible on X-ray.
- Grade II is characterized by severe pain for up to 24 h, with some mucosal thickening on X-ray.
- Patients with grade III have severe pain lasting for more than 24 h and X-ray shows severe mucosal thickening or opacification of the affected sinus; epistaxis or subsequent sinusitis may be observed.
Treatment
Mild cases of barotrauma are readily treated by topical decongestants and painkillers.[5] In severe cases or cases resistant to local treatment, functional endoscopic sinus surgery is indicated in order to re-establish drainage and ventilation of the sinuses. This treatment has shown good results in aviators who have recurrent sinus barotrauma. Computer-aided surgery has re-established the drainage of affected sinuses, especially with regard to the sphenoid sinuses.[10] When the sphenoids were entered endoscopically, mucosal petechia and hematoma were clearly seen.
History
Sinus barotrauma or aerosinusitis has been known since the early development of aviation medicine. However, it was during World War II that the subject first received serious attention and the pathogenesis of the disease was understood to be due to exposure to high altitude flights. Rapid altitude changes with accompanying changes in ambient pressure exposed the aircrews to an increasing number of episodes of sinus barotrauma.
Referred
Although the environment of fighter pilots produces the most stressful barometric changes, commercial flying has changed the picture of the disease.See also
- Barodontalgia – Tooth pain caused by ambient pressure change
- Barotrauma – Injury caused by pressure
References
- ^ US Navy Diving Manual, 6th revision. United States: US Naval Sea Systems Command. 2006. Archived from the original on 2008-05-02. Retrieved 2008-07-19.
- ^ ISBN 978-0-7020-2571-6.
- ^ ISBN 978-0-7817-2898-0.
- ^ PMID 10642071. Archived from the original on 2011-08-11. Retrieved 2008-07-19.)
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: CS1 maint: unfit URL (link - ^ PMID 18225779.
- PMID 19132029.
- OCLC 16986801. Archived from the original on February 18, 2009. Retrieved 2008-07-19.)
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: CS1 maint: unfit URL (link - S2CID 5331981.
- PMID 4120015.
- PMID 12602451. Retrieved 2008-07-19.
- PMID 17571660. Retrieved 2008-07-16.
- PMID 19345791.