What is Barosinusitis?
Barosinusitis is a disease that harms and inflames the nasal sinuses due to sudden changes in pressure within the nose. This can cause damage to the tissues lining the inside of your nose and can lead to facial pain or pressure over the affected sinuses (92% of cases), headaches, toothaches, cloudy mucus, and nosebleeds. Of all the sinus areas in the face, it most often affects the paired frontal sinuses, then the maxillary sinuses, with it very rarely affecting the sphenoid sinuses. No cases of barosinusitis in the ethmoid sinuses, possibly due to their location and structure, have been reported.
The condition was first reported in 1942, in a pilot during the World War Two, and the first case related to diving was reported in 1965. Since then, other causes have been identified, such as hyperbaric oxygen chambers, chinook winds, general anesthesia, blowing the nose hard, vigorous Valsalva maneuvers, and long exposure to high altitudes.
Despite people spending more time traveling at high altitudes or diving deep into the oceans, there’s still not a lot of information available about barosinusitis. The researchers of this study aim to provide information for doctors and the public to better recognize this disease. By recognizing barosinusitis more effectively, it can be reported more often, which can help in improving treatment results and avoiding the issue in the first place.
What Causes Barosinusitis?
Barosinusitis is a condition that causes symptoms like facial pain, headaches, tearing up, and sometimes nosebleeds. These symptoms come about as a result of inflammation and damage to the lining of the sinuses, which follows a type of injury called barotrauma. Barotrauma refers to the injuries your body can sustain when the pressure around it changes quickly.
This condition often occurs when there are sudden changes in your surrounding pressure, and your sinuses can’t adjust or balance this force properly. It’s seen frequently in activities like diving and flying, where changes in pressure are common. Studies have shown that descending and experiencing increased gravity can cause sinus barotrauma twice as much as going up, or dealing with compression and reverse squeeze.
Things that could increase your risk of sinus barotrauma, especially in diving and flying situations, include anything that could narrow or block the natural openings of your sinuses. This could be due to factors like nasal polyps; narrowed sinus openings; blockages due to mucus or fungal masses; or sinusitis, which is another type of sinus inflammation.
Risk Factors and Frequency for Barosinusitis
Barosinusitis, a condition often reported in deep-sea divers and aviators, occurs more often during diving ascents and most frequently during descents. However, it can also occur due to various other factors. These can include
- car travel,
- gas-based anesthesia,
- exposure to Chinook winds,
- high-altitude exposure for a long time,
- submarine decompression,
- blowing your nose,
- performing a forceful Valsalva maneuver (a specific breathing technique).
- receiving hyperbaric oxygen therapy.
It is found that 34% of divers and between 19.5% to 25% of pilots suffer from this condition. Inflammation in the sinuses, in conjunction with other factors, can heighten the frequency of cases among pilots, seen in 34% of fighter pilots and 55% of commercial pilots. Hyperbaric oxygen treatment is associated with up to 3% of annual barosinusitis cases.
The most common reason for developing Barosinusitis is a problem in the upper respiratory tract. The second most common is having a history of barosinusitis. Divers who have had middle-ear issues or sinusitis in the past could potentially have a higher risk of barosinusitis. A pre-dive examination of divers suggested factors like alcohol, gender, tobacco, decongestant use, a minor deviation of the nasal septum, or the capability to perform certain breathing maneuvers, do not relate to the occurrence of the condition.
Signs and Symptoms of Barosinusitis
Patients with sinus barotrauma often report feeling pain and pressure in their face. This generally starts over the forehead area then moves upwards, often spreading to areas behind and between the eyes, and sometimes into the upper jaw area. On top of this, they may have excessive watery eyes, particularly on the side where the symptoms are most severe. Nosebleeds are another common symptom and, in some cases, may be the only symptom.
- Pain and pressure in face
- Pain starts in the forehead area and moves upwards
- Pain can spread to behind and between the eyes
- Excessive watery eyes
- Nosebleeds
Other symptoms can include headaches, cloudy nasal discharge, or dental pain due to changes in pressure (barodontalgia). If the sphenoid sinuses, which are located near the optic nerve and internal carotid artery, are involved, there may be an increased risk of complications involving the eyes and more severe headaches.
- Headaches
- Cloudy nasal discharge
- Dental pain due to pressure changes
- Possible complications involving the eyes and severe headaches if sphenoid sinuses are affected
During an episode of sinus barotrauma, a physical examination of the nose may not reveal any notable changes to the mucus membrane. However, bleeding or fluid discharge from the upper or middle nasal passage may occur later on. There have been cases where black-colored blood was discharged up to eight days after the initial episode of sinus barotrauma was experienced. This condition might take more than a month to completely clear, as there can be issues like haziness in the forehead sinus area.
Testing for Barosinusitis
If you keep experiencing symptoms or start developing complications linked to barosinusitis, your doctor might recommend a non-contrast computed tomography (CT) scan of the sinuses. This will help them better understand what’s going on and how to treat it. Another helpful diagnostic tool is a nasal endoscopy.
According to one study, signs of irregularities turned up in over 75% of the individuals who were scanned. In the major number of these instances, it was the maxillary sinus (the one located in your cheekbone) that was afflicted. For the rest, about 25% had their frontal sinuses (located in your forehead) affected while less than 20% had issues with their ethmoidal sinuses (located behind your nose).
An interesting fact to note is that even though patients mostly dealt with symptoms in their frontal sinuses, the changes seen on X-rays were most common in the maxillary sinuses. An X-ray may sometimes reveal issues such as fluid levels, but a CT scan is considered the best, most definitive test to detect problems.
Treatment Options for Barosinusitis
If someone is experiencing a blocked nose, there are several possible treatment options. These could include pain relief, decongestant nasal sprays or tablets, steroid nasal sprays, nasal irrigation, and antibiotics. The cause of the blockage will determine the types of treatment used. For example, antibiotics could be used as a preventive measure if bacterial sinusitis is suspected, or to treat damaged areas of the nasal lining that could be prone to infection. Fluoroquinolones are typically the first choice in these situations.
If the person is experiencing allergies, a medication called azelastine may be used to reduce swelling in the nasal passages and lining. Preventative pain relief can help manage headache and facial pain in some cases. Nasal decongestants like oxymetazoline may be used to constrict blood vessels in the nasal lining to help reduce swelling and obstruction. Nasal irrigation with saline can also help by washing away allergens or particles that may be causing the blockage. Steroid nasal sprays may also be used to reduce swelling, and can also be used to help manage nasal polyps if these have been an issue in the past.
If these treatments aren’t effective, surgery may be considered. Functional endoscopic sinus surgery (FESS) has a high success rate of 92-95%. This might involve removing nasal polyps, parts of the sinus lining, creating new openings into the sinuses, and clearing the passages in the forehead sinuses. Surgery to correct a deviated septum or to remove an enlarged nasal concha may also be helpful for some patients. A newer technique called Balloon Sinuplasty (BSP) uses a high-pressure balloon to widen the openings of the sinuses without interrupting the overlying lining and preserving its normal function. This helps to improve the natural clearing mechanism of the sinuses, relieving symptoms of sinusitis.
Preventative measures could involve avoiding activities like flying or diving during head colds or periods of allergic rhinitis or sinusitis, as these can worsen symptoms. Following an evaluation by an ear, nose, and throat specialist, an appropriate treatment plan can be developed.
What else can Barosinusitis be?
When a patient comes in with symptoms like a headache, pressure in the face, a runny or stuffy nose, nosebleeds, or congestion, doctors specializing in the ear, nose, and throat have to think of several possible diseases that may be causing these symptoms. These conditions could appear very similar to barosinusitis. They include acute bacterial sinusitis (an infection in the sinus), chronic sinusitis (long-term inflammation of the sinuses), allergic rhinosinusitis (inflammation due to allergies), non-allergic sinus inflammation with a high white blood cell count, irritation of the nasal septum, Vasomotor rhinitis (chronic sneezing or runny nose not caused by allergies or infection), or fungal sinusitis (a fungal infection in the sinus).
The doctor has to carefully study the patient’s previous medical history and conduct a physical examination to tell the difference between barosinusitis and other potential causes. It’s important to know that people already diagnosed with one or more of these conditions are more likely to develop barosinusitis.
What to expect with Barosinusitis
This illness’s symptoms usually come and go because they depend on balancing pressure. In general, people tend to do well, especially if they take preventative steps themselves. The treatment depends on what’s causing the nose blockage. Swelling and irritation of the nose lining can be treated with steroid nasal sprays and decongestant nose drops. Preventative antibiotics can help reduce nose lining swelling and stop thick, infected nose discharge. Surgery like balloon sinuplasty or functional endoscopic sinus surgery can open up or widen the sinus openings and remove excessive nose lining tissue covering a drainage pathway.
Possible Complications When Diagnosed with Barosinusitis
Complications from barosinusitis, whether it’s a long-term issue or not, can be quite serious. Some of the reported issues are pneumocephalus, which is air trapped in the brain, meningitis, which is an infection of the protective membranes covering the brain and spinal cord, and in one unusual instance, a condition known as Potts puffy tumor.
Preventing Barosinusitis
Steps to prevent a condition called barosinusitis involve advising people to avoid drastic changes in altitude during periods of a severe upper respiratory infection or allergies affecting the nose. If avoiding such changes in altitude isn’t feasible, then people should consider preemptive medication treating associated risks. Notably, barosinusitis can potentially affect flight safety and it may be a reason for medically grounding aircrew members.
Again, a good way to prevent barosinusitis is to steer clear from rapid altitude changes when suffering from a severe upper respiratory infection, uncontrolled polyps, or nasal allergies. If that’s not possible, using nasal decongestants, nasal corticosteroids, or taking oral antihistamines before the anticipated change in altitude could be beneficial.
