Sinus barotrauma (also called aerosinusitis or barosinusitis) can be a
serious problem for people who must fly. My younger brother used to
suffer from this almost every time he flew. Even within the
pressurized cabins of modern aircraft, air pressure can increase and
decrease rapidly with changes in the plane's altitude, and people
whose sinus cavities are unusually vulnerable can suffer pain and/or
bleeding as a result.
"Barotrauma of the paranasal sinuses is a risk factor for anyone
exposed to ambient pressure changes. These pressure changes most often
result from travel through mountainous regions, flying, or diving.
Barosinusitis is characterized by inflammation of one or more of the
paranasal sinuses. Inflammation is caused by a pressure gradient,
almost always negative, between the sinus cavity and the surrounding
ambient atmosphere... Frequency: In the US, incidence is approximately
3-4 episodes per 100,000 exposures in a generally healthy population.
"
eMedicine
http://www.emedicine.com/ent/byname/barosinusitis.htm
"The damage that is done by the pressure change leads to a series of
changes within the sinuses consisting of air absorption, decreased
pressure in the sinus; swelling, engorgement, inflammation and fluid
collection in the sinus cavity. This decrease becomes greater with
descent (as with flying) the changes become greater, more painful and
often associated with bleeding into the sinus cavity. On ascent, there
is one-way valve blockage of the ostia, resulting in more barotrauma.
The next step after all this is usually infection, which increases the
blockage by causing it's own swelling and purulent discharge.
Common causes of all this include, allergy; chronic irritation, such
as smoking, diesel fumes, chemicals, prolonged use of nose drops or
nasal sprays; mechanical blockage; vasomotor problems from chronic
tension, stress or anxiety."
Diving Medicine Online
http://www.scuba-doc.com/otherent.htm
Sinus barotrauma can sometimes be alleviated or prevented by treatment
of underlying sinusitis, using antihistamines, decongestants, and
sometimes steroid drugs. Endoscopic surgery on the sinuses is another
option:
"Chronic sinusitis can be relatively asymptomatic, and may only come
to the attention of the flight surgeon because the member suffers an
episode of sinus barotrauma. On the other hand, there may be no
history of barotrauma, but there may be persistent cough, purulent
postnasal drainage, facial pressure, nasal congestion, and low-grade
malaise for many months before the flight surgeon is consulted. The
symptoms may date back to a particularly severe upper respiratory
infection, or even to an episode of acute sinusitis. The symptoms may
be dismissed as allergic (although sneezing, clear rhinorrhea, and
lacrimation are usually absent) and the patient may have been treated
for allergies on multiple occasions, usually with little or no relief.
By definition, chronic sinusitis is a condition that is present for
more than three months, although in reality most patients have a
considerably longer history of waxing and waning symptoms that often
are mistakenly treated as multiple episodes of acute sinusitis. Broad
spectrum antibiotic therapy with activity against anaerobes is
recommended for three weeks. Decongestants, mucolytics, nasal saline
and topical steroid sprays are often prescribed, but there is no
consensus as to their effectiveness in shortening the course of
chronic sinusitis. If antibiotics fail to eliminate the symptoms, and
the X-rays don't improve, surgery is often the next step. Surgery may
be done sooner in aircrew than in others because flying personnel are
unable to do their jobs until the disease is eliminated... Although
early surgery may seem a bit extreme, it is quite effective in
eliminating disease and returning aircrew to flying."
Naval Operational Medicine Institute
http://www.nomi.med.navy.mil/Nami/WaiverGuideTopics/ent.htm
"Barosinusitis is indicated by pain in the cheeks, between the eyes,
alongside the nose and in the upper teeth. The diver should
discontinue diving. Treatment by an otolaryngologist usually consists
of oral antibiotics and decongestants. Sometimes relief with nasal
spray and alternating hot washcloths and ice packs on the cheeks to
open drainage pathways help the diver obtain relief. The physician may
also recommend pain medicine."
SCUBA Dream
http://www.geocities.com/scuba_dream/pdf/2_53a.pdf
"Recurrent sinus barotrauma in an aviator is difficult to treat
successfully. Exacerbations frequently result in marked aviator
discomfort, cycles of temporary restriction from aviation duties, or
even permanent disqualification from flying duties. Medical management
and standard sinus operations are often ineffective, seldom curative,
and have a disappointing record in returning the aviator to flying
duties. Detailed computerized tomographic scanning of the paranasal
sinuses coupled with the functional endoscopic sinus surgery approach
directs treatment at the causative pathology. Sinus ventilation is
improved while making possible a return to active flight status
without recurrence of sinus barotrauma."
Sinus America
http://www.sinusamerica.com/pdf/article6.pdf
"Recurrent sinus barotrauma is an uncommon condition but it may
terminate the career of an aviator. Sinus barotrauma occurs almost
exclusively on descent and probably results from occlusion of the
sinus ostia through a combination of mucosal disease and anatomical
abnormalities. After surgery, most patients can resume their full
career in diving or aviation."
Indegene
http://www.indegene.com/Ent/FeatArt/indEntFeatArt7.html
Your friend may want to consult a physician who specializes in
treating disorders of this sort. The medical specialty that deals with
sinus conditions such as barotrauma is called "Otorhinolaryngology."
Although surgery may sound like an extreme option, the results can be
remarkable. This kind of surgery is often done on an outpatient basis,
and the patient is typically able to return to most normal activities
almost immediately. After my brother underwent functional endoscopic
sinus surgery, he never suffered another bleeding episode on an
airplane, and he was truly able to "breathe easy" under all
conditions.
Google search strategy:
Google Web Search: "sinus" + "barotrauma"
://www.google.com/search?hl=en&ie=UTF-8&oe=UTF-8&q=sinus+barotrauma
I hope this helps! Please keep in mind that Google Answers is not a
source of authoritative medical assistance; the material I've
presented above is not intended as a diagnosis, nor as a substitute
for the services of a qualified medical professional.
If anything is unclear, or if a link does not function, please request
clarification; I'll gladly offer further assistance before you rate my
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Best wishes,
pinkfreud |
