What Is Barosinusitis?
Barosinusitis is the inflammation of the lining of the paranasal sinuses, which is caused due to the pressure difference between the sinus and the surrounding air. This can happen to people who may experience an ambient pressure difference, like traveling through mountains, flying in an airplane, and diving.
What Causes Barosinusitis?
The following activities can put an individual at risk of developing barosinusitis, such as:
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Skydiving.
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Scuba diving.
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Flying in high-performance aircraft or military aircraft.
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Patients with poorly controlled allergies and anatomic abnormalities of the nose and the paranasal sinuses.
How Is Barosinusitis Formed?
There are tiny pores present in the walls of the sinus, which allow gas exchange and mucus transport between them. A law such as Boyle’s law can be applied to this space. Boyle’s law states that when the temperature is constant, the volume of a gas is inversely proportional to the pressure exerted by the gas.
When an individual is traveling in an unpressurized airplane, the sinus is exposed to pressure changes. When the airplane reaches a high altitude, the ambient pressure that is surrounding the sinus decreases, which leads to the expansion of air inside the sinus cavity through the natural ostium present in the sinus wall. And when the airplane is on descent, ambient air pressure increases, which will lead to the contraction of air inside the sinus, and hence air moves into the sinus cavity, which will prevent the pressure gradient formation. This is the scenario when a healthy individual travels.
Now consider the same scenario when a person with an upper respiratory tract infection with tissue edema and secretions blocking the pores on the sinus is traveling in an airplane. In this condition, the edema and secretions will prevent the gas exchange through the ostia present in the sinus walls and will not allow free pressure equalization as the airplane is in the ascent, the ambient pressure decreases, and the volume in the sinus cavity increases which will result in a positive pressure development. Because of this positive pressure, the tissue edema will gradually decrease enough to allow debris and air to escape the naturalization of the sinus wall, and the air pressure will equalize. When the individual is in descent, the ambient pressure increases, but the pressure cannot be equalized across the nasal cavity and the sinus because of the blocked ostium. As a result, air volume decreases in the sinus cavity and creates negative pressure. So at this point, to eliminate the pressure gradient, the volume of the sinus must be filed.
In mild to moderate cases, vascular engorgement and generalized submucosal edema occur. With time transudate and mucus fills the sinus, reducing negative pressure and decreasing symptoms. Whereas in severe cases such as rapid onset, the mucosa is stripped from the subjacent bone and will result in severe pain and hematoma formation.
What Are the Symptoms of Barosinusitis?
The presenting symptoms of barosinusitis will vary from mild to moderate to severe. In this barosinusitis, a condition of barometric pressure changes always exists either during or shortly after the onset of symptoms.
Mild Barosinusitis:
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Patients will feel mild pressure or pain over one or more sinuses which will develop after returning to sea level.
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The already existing nose congestion gets worsened.
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These patients can also experience occasional nose bleeds.
Severe Barosinusitis:
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Patients will have sudden onset of severe and sharp pain and pressure, typically in the forehead, retro-orbital, or midface region. The pain will usually be in only one side of the face.
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These patients will also present nosebleeds.
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These patients will have pain in the face even on touching.
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There will be worsening congestion seen in these patients.
How Is Barosinusitis Treated?
The treatment should be started immediately at the first symptom of barosinusitis itself. At first, the patient should be brought to the altitude at which the symptoms occurred. While descending itself applies decongestants. Immediate treatment is always not possible, and in most cases, the treatment will begin when the patient is brought to the surface level.
The aim of medical therapy is to address pain, establish ventilation and prevent infection
Pain:
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Painkillers can be given.
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In case of severe pain, Narcotics can be given.
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Medicines with Aspirin as content should be avoided as they can worsen hematoma formation
Establishing Ventilation:
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Topical Decongestants can be applied. They contain 0.005 % Oxymetazoline and 0.5-1 % Phenylephrine.
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Oral decongestants can be given.
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Antihistamines are avoided as they tend to dry the mucosa and thicken the secretion, but they can be given in case of uncontrolled allergies.
Preventing Infections:
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Blood and other transudate form a compatible environment for the growth of bacteria. This environment, along with damaged mucosa and altered oxygen tension, increases the vulnerability of developing a secondary infection.
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Antibiotic therapy can be started in order to treat the secondary infection and fasten the recovery.
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In acute conditions, the first line of treatment will be Amoxicillin, and patients who are allergic to Penicillin can be treated with antibiotics like Cephalosporins, Clindamycin, Quinolones, and Extended-spectrum macrolides.
Surgical Management:
Surgical management is done to retrieve ventilation. There are various surgical methods to restore sinus ventilation like septoplasty, turbinectomy, antral windows, external or transantral ethmoidectomy, nasal polypectomy, and frontal sinus trephination. Other than that, endoscopic sinus surgery can be done, and they have shown faster recovery than other conventional surgical methods.
If pain and pressure are not relieved by using oral medications within 24 hours, then antral puncture or washout to rapidly equilibrate pressure and clear out the sinus of debris and other collections can be carried out. This technique has minimal effect on the meatus and may not clear out symptoms from ethmoid and frontal sinuses. Septoplasty and turbinectomy can be done as preventive measures depending on clinical presentation.
How to Prevent Barosinusitis?
The best way to prevent barosinusitis from exposure to ambient pressure changes is applicable, especially when one has an upper respiratory tract infection, cold, sinusitis, or poorly controlled nasal allergy. So avoid doing activities such as skydiving and scuba diving while one has the above-said conditions. Repeated attacks of acute barosinusitis can result in permanent damage to the paranasal sinuses' mucosa, leading to recurrent barosinusitis.
Conclusion
Barosinusitis, also known as sinus barotrauma, aerosinusitis, or sinus squeeze, is a painful condition caused by inflammation of the mucosa lining the paranasal sinuses resulting from ambient pressure difference. The patients can present with pain in the sinus region, nosebleeds, and nasal congestion. This condition is often seen when people with an already existing upper respiratory tract infection or sinusitis do activities that will expose them to the pressure difference, such as skydiving or scuba diving. The treatment should be started at the first appearance of symptoms. Consult a doctor if you are planning for activities like skydiving and scuba diving and you already have some issues related to the respiratory system so as to avoid any complications.
