Plain radiographs are usually not indicated for the routine evaluation of sinus disease nowadays 1. Barosinusitis related to ascent with decreased ambient pressure and elevated intrasinus pressure is known as reverse squeeze, which occurs less frequently 1,3. The phenomena of decompression are associated with descent and increase gravity, resulting in a vacuum effect known as the squeeze, which is the most common cause of sinus barotrauma 1,3,4. These abnormal conditions can impede the flow of air through the ostia, impairs the ability to equilibrate and provide adequate pressure exchange, resulting in mucosal damage with edema and the mucosal's rupture with transudation of serosanguinous fluid, submucosal hemorrhage, or hematoma formation 1-4.ĭifferences in atmospheric pressure can trigger inflammatory changes within the sinus cavities, resulting in sinus barotrauma 1-3. In abnormal conditions, the ostia are narrowed or obstructed due to either anatomic stenosis or reversible obstruction such as mucosal inflammatory thickening and nasal polyposis 1-4. Usually, this movement of air entering and leaving the sinus cavities is asymptomatic 1,2. There is recompression of gases, and negative pressure is formed inside the sinuses, with the progressive movement of air into the paranasal cavities, until it establishes a new balance 2.

These air passages between the central nasal cavity and the paranasal sinuses compensate for changes in the volume of gas inside the sinus cavities, which allows for pressure equalization 1,2.ĭuring an ascent on a flight or after diving, the ambient pressure decreases, and the air in paranasal sinuses increases in volume, exiting through the ostia until it reaches a balance at that certain altitude 1,2.

Air pressure in the paranasal sinuses normally remains balanced due to the surrounding nasal passages through openings in the sinuses i.e. Sinus barotrauma is due to a pressure-related change in sinus cavities 1-4. Gases found in the various cavities of the human organism obey this law. The pathophysiological mechanism of the condition is explained by Boyle-Mariotte's law, which postulates that 'if the temperature is constant, the volume of a gas varies inversely proportional to the pressure it supports' 1,2,4.

Sinus barotrauma most often affects the frontal sinuses, followed by the maxillary, ethmoid, and more rarely the sphenoid sinuses 1,2. Neurological manifestations can include cranial trigeminal nerve dysfunction or dysesthesias 1-4 The symptoms of barosinusitis range from a slight sensation of congestion, pressure, or pain with facial tenderness on palpation over the involved area 1-4 to headache, odontalgia, lacrimation, rhinorrhagia, epistaxis, fever 1,2 and even symptoms of neurological involvement in some cases. acute or chronic upper respiratory tract infectionsĪ history of exposure to atmospheric pressure variations provides fundamental data for diagnosis 1,3.obstruction of sinus ostia with mucous or fungus ball.Concomitant sinus inflammation increases the prevalence of barosinusitis in pilots, with rates of 34% in fighter pilots and 55% in commercial pilots 1. Barosinusitis is most common in aviation travelers, deep-sea divers, and patients after altitude chamber accidents 1-4. The prevalence of sinus barotrauma ranges from 19.5% in pilots to 34% in divers 1.