What is Sinus Squeeze?
Sinus squeeze, also known as barosinusitis or aerosinusitis, is a condition that occurs when the lining of the sinuses (spaces in the bones around your nose) becomes irritated. This irritation stems from an inability to balance the pressure inside your sinuses with the pressure in your surrounding environment. Sinus squeeze commonly happens due to rapid changes in depth while scuba diving, quick changes in altitude during flights, or during treatments that use increased pressure, such as hyperbaric therapies.
The symptoms of sinus squeeze include pain, nosebleeds, tearing, and a runny nose. Pain is the most frequent symptom and typically affects the frontal sinuses (located in the forehead) the most. In certain cases, when the maxillary sinuses (near the upper teeth) are affected, it may lead to referred tooth pain, which is discomfort perceived in the teeth but originating from the sinuses.
What Causes Sinus Squeeze?
Most injuries that happen underwater are due to what’s called barotrauma, essentially injuries caused by changes in air or water pressure. Barosinusitis, a condition where sinuses get inflamed or infected due to these pressure changes, tends to happen twice as often during a rapid descent or when the pressure increases quickly, compared to a gradual ascent.
This kind of injury tends to happen more easily in people who already have certain infections or conditions that affect their upper respiratory system, such as the nose and throat. Also, people who’ve had barotrauma affecting their middle ear or sinuses in the past are more likely to experience it again along with its associated symptoms.
Some conditions that increase the risk of barosinusitis include allergic rhinitis (an allergic reaction that affects the nose), bacterial sinusitis (infection of the sinuses), viral upper respiratory infections, nasal polyps (unusual growths in the nasal passages), and idiopathic sinus congestion (unexplained sinus blockages).
It’s worth mentioning that there’s no proven link between this type of injury and a deviated septum (a condition where the thin wall between your nostrils is displaced to one side), or the use of alcohol or tobacco.
Risk Factors and Frequency for Sinus Squeeze
Sinus squeeze, also known as barosinusitis, impacts quite a few people, particularly divers and pilots. About 34% of divers and 20-25% of pilots experience this condition. Interestingly, fighter pilots seem to experience it less than commercial pilots. When a commercial pilot has a cold or another upper respiratory infection, their chances of getting sinus squeeze go up to 55%. Additionally, around 3% of barosinusitis cases each year are due to hyperbaric oxygen treatments, which are often used by divers. If a person already has a sinus infection of any kind, they are also more likely to develop sinus squeeze.
- About 34% of divers and 20-25% of pilots suffer from sinus squeeze.
- Fighter pilots have fewer sinus squeeze cases than commercial pilots.
- The proportion of barosinusitis among commercial pilots rises to 55% when they have a cold or another upper respiratory infection.
- Hyperbaric oxygen treatments, often used by divers, contribute to about 3% of annual sinus squeeze cases.
- People already suffering from any kind of sinus infection have a higher risk of getting sinus squeeze.
Signs and Symptoms of Sinus Squeeze
People suffering from sinus squeeze often complain about localized pain in the frontal region of their head. Pain coming from the maxillary and ethmoid sinuses is less common and occurs less frequently. The pain can spread upwards, covering the top of the head, and can often be felt behind the eyes. In these instances, tear production often increases. In addition to the pain, patients also have nosebleeds – noted to be more common after a rapid ascent rather than a descent.
Upon examining the patient, the nasal lining might appear normal or show signs of the condition. A clear or blood-tainted fluid can be observed up to a week after the onset of the condition. This discharge is usually seen coming from an area located between the middle and the lower ridges in the nasal cavity, known as the middle meatus.
Testing for Sinus Squeeze
If your doctor thinks there might be complications, like a burst sinus or pneumocephalus (air or gas in the skull), or if you’ve dealt with this problem before, then you might need an imaging test. The go-to test is a CT scan of your sinuses with a contrast dye. This dye helps areas inside your body show up better in the images.
Seeing an ear, nose, and throat specialist for a nasal endoscopy could also help. This procedure involves inserting a thin, flexible tube with a light down your nose to check for any issues. Through these tests and checks, your doctor can identify causes like polyps (small growths in the nose), air-fluid levels, and fractures that might be responsible for your symptoms.
Treatment Options for Sinus Squeeze
Pain from this condition is typically managed well with nonsteroidal anti-inflammatory drugs, known as NSAIDs. These are medications like ibuprofen that can decrease inflammation and reduce pain. Rinsing the nasal passage and using medicated sprays or pills that help unblock the nose can assist in balancing the pressure. Protective antibiotics, which are drugs that fight infections, may be needed as the nasal tissue might be damaged. The first choice for treatment is usually a type of antibiotic called amoxicillin. If you’re allergic to amoxicillin, an alternative antibiotic called trimethoprim/sulfamethoxazole could be used. Cephalosporins, another type of antibiotics, can also be an option.
To help prevent this, it would be wise to avoid diving if you have a running nose or are experiencing an allergy flare-up. Medications that help decongest your nose such as oxymetazoline spray, pseudoephedrine, and steroid nasal sprays can also be helpful for prevention.
What else can Sinus Squeeze be?
There are many different conditions and treatments related to the sinuses. Here are some examples:
- Acute Frontal Sinusitis Surgery
- Chronic Sinusitis
- Fungal Sinusitis
- Malignant Tumors of the Nasal Cavity
- Malignant Tumors of Sinuses
- Medical Treatment of Acute Sinusitis
- Nasal Polyp Surgery
- Non-Surgical Treatment of Acute Sinusitis
- Surgical Treatment of Acute Maxillary Sinusitis
- Surgical Treatment of Acute Sphenoid Sinusitis
Surgical Treatment of Sinus Squeeze
If you’re dealing with chronic or frequently returning barosinusitis, which is an inflammation of the sinus cavities caused by changes in air pressure, it could be helpful to see an ear, nose, and throat specialist. This specialist, also known as an otolaryngologist, can check for physical issues that may be corrected through surgery. Some of the surgical treatments that may be suggested include osteotomy (cutting and reshaping of the bone), nasal polypectomy (removal of polyps in the nose), septoplasty (straightening of the nasal septum), turbinate reduction (shrinking the size of the nasal turbinates – structures within the nose that help warm, filter, and humidify air), uncinectomy (removal of the uncinate process, a part of the anatomy of the nose), concha bullosa reduction (draining or removing inflated nasal structures that can block sinus drainage), or sinus surgery.
Severe cases of an acute barosinusitis, which can happen suddenly usually due to a fast air pressure change, might require surgery only if there are complications. For instance, these complications might include pneumocephalus (air or gas in the cranial cavity) and orbital fractures (fractures of the eye socket). Here’s what happens – if a sinus opening gets blocked when the air pressure drops, like during a descent in an airplane, this creates a low-pressure environment inside the sinus. If the pressure outside the body, then increases too quickly, like during a rapid ascent, the low pressure within the sinus can cause it to expand. If the pressure difference between the inside of the sinus and the outside environment is too great, a sinus can rupture. This rupture can lead to an orbital fracture or pneumocephalus.
What to expect with Sinus Squeeze
The outlook for sinus squeeze, which is discomfort or pain caused by a change in air pressure, is usually positive after treatment. This treatment often includes NSAIDs (non-steroidal anti-inflammatory drugs), decongestants, and preventative antibiotics.
Possible Complications When Diagnosed with Sinus Squeeze
Underwater diving can sometimes lead to complications, with sinus squeeze being the second most common issue. The primary problem for divers is ear damage due to the changing pressure, known as ear barotrauma. When a diver goes deeper underwater, the pressure around them increases, which can cause their sinus lining to swell and retain fluids. This blockage prevents normal fluid drainage from the sinus cavity, increasing the pressure within the sinuses.
The frontal sinus, located above the eyebrows, experiences this problem most often due to its long and complicated duct. Typical symptoms are headaches, nosebleeds, and pain localized to the sinus area. If the blockage occurs while a diver is descending, it can further escalate during ascent due to volume expansion within the sinus. This can create a significant enough pressure difference to rupture the sinus itself, a very serious diagnosis known as pneumocephalus.
Doctors treat this condition by monitoring patients carefully and prescribing antibiotics to prevent a type of brain infection called meningitis. These antibiotics are usually of the penicillin or cephalosporin categories.
Common Symptoms:
- Headache
- Nosebleeds
- Pain localized to the sinus area
Precautions and Treatment:
- Careful monitoring of the condition
- Prophylactic antibiotics to prevent meningitis
- Antibiotics usually from penicillin or cephalosporin categories
Preventing Sinus Squeeze
Patients should be informed to avoid diving if they are currently dealing with allergic rhinitis (a form of allergies that affects the nasal passages) or upper respiratory infections (commonly known as a cold). However, if they really need to dive, they can take preventive measures to manage their symptoms. This includes using treatments like decongestants, specifically an oxymetazoline spray which helps clear a stuffy nose, and over-the-counter pain relievers known as NSAIDS (Non-Steroidal Anti-Inflammatory Drugs) to reduce inflammation and pain.