Presentation
Emergency physicians should strongly consider a diagnosis of sinus barotrauma in patients who present with symptoms of sinusitis and a history of recent flight. [ncbi.nlm.nih.gov]
Entire Body System
- Dentist
Regular checkups with your dentist avoid this unnecessary risk of incapacitation. [pilotfriend.com]
Should I come in and see you guys or go to the dentist? This is an unusual story but similar cases have been reported in the past. The explanation is probably this. [londondivingchamber.co.uk]
Gastrointestinal
- Nausea
Inflow of cold water to the middle ear may result in vertigo, nausea, and disorientation while submerged. [merckmanuals.com]
If a migraine develops, the dive should be terminated because of the potential for nausea, emesis and alteration of consciousness. [aafp.org]
- Vomiting
Vertigo is characterized by a spinning sensation and is usually accompanied by nausea and vomiting, while dizziness is a sensation of loss of balance. [alertdiver.com]
Inner ear barotrauma often involves rupture of the round or oval window, which causes tinnitus, sensorineural hearing loss, vertigo, nausea, and vomiting. The resulting labyrinthine fistula and perilymph leakage can permanently damage the inner ear. [merckmanuals.com]
Effect of condition on aviation Severe acute onset symptoms causing potential for overt incapacitation acute pain ear or sinuses acute deafness tinnitus acute haemorrhage acute dizziness, disorientation and loss of situational awareness nausea and vomiting [casa.gov.au]
Cardiovascular
- Hypertension
HAH often awakened the study participants from sleep or occurred upon wakening and was exacerbated by bending, coughing, or sneezing, suggesting the possibility of intracranial (meaning within the cranium or skull) hypertension as a contributing factor [migrainetrust.org]
Eyes
- Eye Pain
If you are having eye pain, this is potentially serious (some of the sinuses are right next to the eyes) and you should NOT push through this to dive. [scubaboard.com]
Neurologic
- Tingling
Referred pain to the maxillary teeth was due to pressure on the posterior superior alveolar branch and paresthesia with numbness and tingling of the lip and cheek was caused from pressure on the infraorbital nerve prior to its emergence through the infraorbital [ncbi.nlm.nih.gov]
Severe symptoms can include: Numbness and tingling in your arms and legs. Dizziness. Trouble breathing. Staggering or other trouble walking. Trouble seeing. Confusion. Chest pain. Passing out (losing consciousness). [northshore.org]
The most severe presentation is partial myelopathy referable to the thoracic spinal cord. 10, 15 Patients complain of paresthesias and sensory loss in the trunk and extremities, a tingling or constricting sensation around the thorax, ascending leg weakness [aafp.org]
- Frontal Headache
Abstract An amateur scuba (Self Contained Underwater Breathing Apparatus) diver experienced an acute frontal headache following a low-depth dive. [ncbi.nlm.nih.gov]
A mass lesion in the frontal sinus, consistent with submucosal hematoma secondary to barotrauma, was thought to be the cause of the headache. [ajnr.org]
Look for: Suspicion of intracranial spread - severe frontal headache, frontal swelling, symptoms or signs of meningitis or focal neurological signs. Suspicion of spread to the orbit - see separate article Orbital and Preseptal Cellulitis. [patient.info]
- Agitation
Hearing loss (temporary) Bleeding from the ear (rare) Sinus Barotrauma Sinus pressure and/or pain Nasal bleeding Headaches Tooth pain Pulmonary Barotrauma Symptoms from an air embolism to the brain include reactions similar to a stroke: Headache Confusion Agitation [knowyourdisease.com]
Workup
With more severe sinus barotrauma, the patient notes the following possibly incapacitating signs and symptoms: Sudden onset of typically severe and sharp pain and pressure - Pain is typically in the forehead, midface, or retro-orbital area Epistaxis Workup [emedicine.medscape.com]
Treatment
Before treatment, divers who required surgery reported significantly more symptoms than divers who were treated conservatively. Post treatment there were no significant differences between the medical and surgical group. [ncbi.nlm.nih.gov]
Guidelines for treatment are suggested. Type Clinical Records Copyright Copyright © JLO (1984) Limited 1991 References Campbell, P. A. (1944) Aerosinusitis—Its cause, course and treatment. [cambridge.org]
Prognosis
Prognosis All but the acute invasive form carry a good prognosis once the diagnosis is made and treatment completed. Fulminant fungal sinusitis is associated with a 50% mortality rate, even with aggressive surgical and medical treatment. [patient.info]
Outlook (Prognosis) Barotrauma is usually noncancerous ( benign ) and responds to self-care. Hearing loss is almost always temporary. When to Contact a Medical Professional Try home care measures first. [mountsinai.org]
T1: submucosal hemorrhage, hyperintensity T1 C+ (Gd): submucosal hemorrhage, without enhancement T2: submucosal hemorrhage, hyperintensity Treatment and prognosis Most sinus barotrauma injuries are self-limiting and resolve spontaneously within a few [radiopaedia.org]
The condition of consciousness may be a risk factor for cognitive sequelae, which may affects the prognosis of CO-poisoning [37]. [journals.plos.org]
Etiology
This case illustrates a potential confusion between a decompression sickness etiology and a barotraumatic etiology for the observed sensory deficit. [ncbi.nlm.nih.gov]
Acute sinusitis is usually initiated by an acute respiratory tract infection of viral etiology. 急性鼻窦炎常常是由病毒性病因的急性呼吸道感染而发生。 [hujiang.com]
Etiology hyperbaric oxygen therapy submarine decompression prolonged high-altitude exposure vigorous Valsalva maneuver nasal blowing The pathophysiological mechanism of the condition is explained by Boyle-Mariotte's law, which postulates that "if the [radiopaedia.org]
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. [medigoo.com]
[…] 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 [en.wikipedia.org]
Epidemiology
Epidemiology Frequency United States Prevalence is approximately 3-4 episodes per 100,000 exposures in a generally healthy population. [emedicine.medscape.com]
Epidemiology Although this is less common than acute sinusitis, it remains a reasonably common entity in itself, accounting for about 25 cases per 10,000 person-years in an average UK GP practice [ 2 ]. [patient.info]
Pathophysiology
The pathophysiology and treatment of frontal sinus barotrauma are reviewed. Emergency physicians should strongly consider a diagnosis of sinus barotrauma in patients who present with symptoms of sinusitis and a history of recent flight. [ncbi.nlm.nih.gov]
Otology 464 Downloads 28 Citations Abstract The pathophysiology, differential diagnosis, and currently available management of barotrauma affecting the ears and sinuses after scuba diving are reviewed, along with medical standards for resuming scuba diving [link.springer.com]
Related Articles Update on Middle Ear Barotrauma after Hyperbaric Oxygen Therapy--Insights on Pathophysiology. [connection.ebscohost.com]
In 1942, during World War Two, Campbell described the mechanism of the pathophysiology of barotrauma 1,2,4. [radiopaedia.org]
Prevention
Prevention There are a number of measures that you should be familiar with in order to prevent the condition including refraining from diving or travelling by plane when having an infection involving the upper respiratory tract or even severe congestion [firstaidcprmississauga.ca]
Prevention Obviously, it's best to be aware of the potential for barotrauma and avoid it all together, if possible. [ent.about.com]
Prevention To prevent yourself from experiencing an uncomfortable vacation this summer try taking precautions before you travel to your favorite vacation spot. [share.upmc.com]