Barosinusitis: Comprehensive Review and Proposed New Classification System

Abstract

Background:Barosinusitis, or sinus barotrauma, may arise from changes in ambient pressure that are not compensated by force equalization mechanisms within the paranasal sinuses. Barosinusitis is most commonly seen with barometric changes during flight or diving. Understanding and better classifying the pathophysiology, clinical presentation, and management of barosinusitis are essential to improve patient care.Objectives:To perform a comprehensive review of the available literature regarding sinus barotrauma.Methods:A comprehensive literature search that used the terms “barosinusitis,” “sinus barotrauma,” and “aerosinusitis” was conducted, and all identified titles were reviewed for relevance to the upper airway and paranasal sinuses. All case reports, series, and review articles that were identified from this search were included. Selected cases of sinus barotrauma from our institution were included to illustrate classic signs and symptoms.Results:Fifty-one articles were identified as specifically relevant to, or referencing, barosinusitis and were incorporated into this review. The majority of articles focused on barosinusitis in the context of a single specific etiology rather than independent of etiology. From analysis of all the publications combined with clinical experience, we proposed that barosinusitis seemed to fall within three distinct subtypes: (1) acute, isolated barosinusitis; (2) recurrent acute barosinusitis; and (3) chronic barosinusitis. We introduced this terminology and suggested independent treatment recommendations for each subtype.Conclusion:Barosinusitis is a common but potentially overlooked condition that is primed by shifts in the ambient pressure within the paranasal sinuses. The pathophysiology of barosinusitis has disparate causes, which likely contribute to its misdiagnosis and underdiagnosis. Available literature compelled our proposed modifications to existing classification schemes, which may allow for improved awareness and management strategies for barosinusitis.

A Case of Pott's Puffy Tumor Associated With Barosinusitis From Scuba Diving

“… 1 Barotrauma is common and is estimated to be experienced by 30% to 50% of divers. 1 – 3 Novice scuba divers are more vulnerable to barotrauma and middle ear disorders because of their inexperience in equalization techniques. Furthermore, children may be more at risk of middle ear pressure equalization problems because of immature Eustachian tube function.…”

“…Blocked ostia or difficulty with equilibration can lead to uncompensated changes in the intrasinus pressure, which can result in varying degrees of sinonasal mucosal injury and inflammation. 3 Divers experience great pressure variation over a short interval, which can lead to a cascade of changes directly impacting the ears and sinuses, as they are rigid air-filled cavities.…”

“… 4 This decreased gaseous volume causes a decompression or sinus squeeze, which can result in pulling forces and lead to mucosal edema, submucosal hematoma formation, and subsequent tissue, fluid, and blood accumulation. 3 The reduction in gas volume has to be equilibrated through the Eustachian tube and the sinus ostia to avoid barotrauma of the ear and sinuses. During ascent, this accumulated tissue and blood may be expelled because of gaseous expansion against the sinuses walls with decrease in pressure, resulting in epistaxis in a “reverse squeeze.” Any remaining tissue and blood products, in combination with necrotic or inflamed mucosa (secondary to allergies, upper respiratory tract infections, or preceding sinus inflammation), act as a medium for the propagation of bacteria, setting the patient up for the development of bacterial sinusitis.…”

Sinonasal Symptoms and Outcomes in Aircrew

“…This phenomenon is known as sinus barotrauma of aerosinusitis and is aggravated if it is preceded by an upper respiratory tract infection or an allergic episode. Ultimately, facial pain, nasal discharge, and possibly epistaxis can result [8][9][10]. The pathophysiology of sinus barotrauma is explained by Boyle's Law, which states that the volume of a gas is inversely proportional to the pressure exerted upon it when the temperature is constant [6,11].…”

Health effects of hyperbaric exposure on chamber attendants: a literature review

“…Barotrauma are known among recreational divers [8]. The most common barotrauma are located in the thorax, but other locations are possible, especially on the eardrums and sinus [9,10].…”