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

• Barotrauma