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.
The four facial sinuses
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
See Also
External Links
References
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