What Is Sinus Barotrauma (Sinus Squeeze)?

Deep divers may experience barotrauma
Stijn Dijkstra /EyeEm/Getty Images

Barotrauma of the sinuses goes by several different names. Scuba divers sometimes refer to it as "sinus squeeze," while medical professionals might call it aerosinusitis or barosinusitis. It is most common in divers but can occur under any conditions in which you descend or ascend too quickly for your body to adjust (like in an airplane). You can also get "sinus squeeze" while undergoing hyperbaric oxygen therapy for another medical condition.

Causes 

The sinuses are hollow spaces in the face and skull. Like the middle ear, the sinuses are filled with air. The pressure in these cavities is normally equal to the ambient pressure (pressure of the environment). However, if the ambient pressure suddenly changes and the body is unable to equalize the pressure in the sinuses, barotrauma will occur. This can actually cause bleeding into the sinuses.

Obstructions in the sinuses make it harder for the body to equalize pressure, and people with a history of sinus infections, current sinus or upper respiratory infections, allergies, nasal polyps, enlarged turbinates, or any other condition involving the nasal passageways and sinuses are at a higher risk for developing barotrauma of the sinuses. In fact, while it is not impossible to get sinus barotrauma without an underlying sinus condition, it is unlikely.

Symptoms

The term "sinus squeeze" was likely coined by a diver who had experienced this condition and was describing the facial pain he had.

The severity of symptoms depends on the severity of barotrauma, but a shooting pain in the face or severe headache seems to be pretty universal. Additional symptoms may include a bloody nose, toothache, or ear pain (which may be a precursor to a ruptured eardrum).

While an upper respiratory infection can cause sinus barotrauma, the opposite can also be true.

Treatment

If you experience symptoms of sinus barotrauma, it is important not to panic. If you're diving, your first instinct may be to get to the surface immediately. But remember that by ascending too quickly will be painful and put you at risk for more serious conditions, such as decompression sickness or barotrauma to other parts of the body, like the ears and lungs. The only exception to the "slow ascension" rule is if you are bleeding profusely (so much that your mask is filling up with blood).

Once you're on dry land, if necessary, follow basic first aid to stop nosebleeds. The pain should go away shortly after returning to sea level; regardless, you should see a doctor and soon. If you are bleeding uncontrollably or if severe pain doesn't subside, go to an emergency room.

Barotrauma of the sinuses can usually be treated successfully by an ENT doctor without long-term damage. It is important that all divers receive training on the prevention of all types of barotrauma and decompression sickness. 

Remember: Sinus barotrauma is an indicator of other sinus problems that need to be treated surgically or with medication, such as antibiotics, decongestants, or antihistamines. 

Prevention

Obviously, it's best to be aware of the potential for barotrauma and avoid it all together, if possible.

There are several things you can do to prevent sinus barotrauma, including abstaining from diving or flying in an airplane when you have an upper respiratory infection or severe congestion from allergies.

You can also take decongestants—such as Afrin (oxymetazoline) or pseudoephedrine, or antihistamines (if your sinus problems are caused by allergies)—beforehand. But, if overused, decongestant medications can cause rebound congestion.

Treat allergies and underlying sinus conditions before diving or flying, and make sure you descend and ascend slowly using valsalva manuevers (swallowing or yawning on an airplane) to equalize pressure.

Sources:

Medscape. Diving Medicine: A Review of Current Evidence: Ear and Sinus Barotrauma. Accessed: January 30, 2012 from http://www.medscape.com/viewarticle/710379_3

Pubmed. Aerosinusitis: pathophysiology, prophylaxis, and management in passengers and aircrew. Accessed: January 30, 2012 from http://www.ncbi.nlm.nih.gov/pubmed/18225779

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