Frequent Valsalva maneuvers or prophylaxis with nonsteroidal anti-inflammatory drugs may aide in preventing sinus barotrauma in future flights.De Camargo RA, Nicodemo AC, Sumi DV, et al. In recurrent moderate or severe cases with chronic discomfort, endoscopic sinus surgery may be required to enlarge the natural ostium to regain appropriate sinus ventilation. Treatment of barosinusitis is aimed at reestablishing sinus ventilation and decreasing mucosal inflammation with analgesics and nasal decongestants. Grade III, like in our case, exhibits severe pain lasting for more than one day. Grade II is characterized by localized pain lasting up to 24 hours. Grade I causes a mild transient sinus discomfort. Absence of remodelling or erosion of the surrounding bone, clinical history, and spontaneous resolution of the mass favors submucosal hemorrhage secondary to barotrauma in our case.Ĭampbell and Weissman described three clinical grades of this entity. Differential diagnosis of a nonenhancing, T1 and T2 hyperintense polypoid sinusal mass include mucocele and exceptionally cholesterol granuloma. Pain and epistaxis are the most common symptoms rarely, neurological manifestations may occur due to irritation of the facial or infraorbital nerve. Other possible causes of obstruction include deviated nasal septum, nasal polyps, chronic sinusitis, neoplastic disease, or other anatomic deformities.Ī blocked sinus ostium during a flight descent causes a relative negative intrasinusal pressure, resulting in mucosal edema, hemorrhage, or transudation of serosanguinous fluid to compensate for the decreased volume. This inflammation was possibly initiated after an upper respiratory tract infection or allergic rhinitis. In our case, the tortuous and narrow right nasofrontal duct to the middle meatus in the nasal cavity was obstructed due to mucosal inflammatory changes illustrated on CT (Figure (FigureC). Normally, the ostium of each sinus opens into the nasal cavity, allowing equalization of air pressure. It postulates the absolute pressure of an ideal gas being inversely proportional to the volume it occupies if the temperature remains unchanged within a closed system. The pathophysiology of sinus barotraumas is related to Boyle-Mariotte’s law. This pathologic condition occurs most commonly in scuba divers and flight passengers subjected to abrupt pressure changes. Sinus barotrauma is a tissue injury caused by a rapid change in barometric pressure difference between the intrasinusal air and the surrounding atmosphere. Conservative treatment with oral decongestants and analgesics resulted in satisfactory symptom relief. Considering the clinical history and MRI appearance, the diagnosis of submucosal hematoma secondary to barotrauma was made. A polypoid mass was noted in the right frontal sinus, hyperintense on T1- and T2-weighted images, without enhancement after contrast administration (Figures (FiguresA A and andB). No intracranial mass, hemosiderin deposits, or arteriovenous malformation were observed. Because of the atypical and persistent headache, MRI imaging was performed to exclude underlying pathology. The pain was nothing like previous migraine headaches she had experienced.Ī noncontrast CT scan was performed which showed no apparent abnormal findings, except for a soft tissue density in the right frontal sinus, initially interpreted as an inflammatory mucosal swelling. Only a minor respiratory tract infection was noted two weeks before this episode, and she had no history of sinus problems. There were no visual or hearing deficits, head trauma, or epistaxis, and she experienced no difficulty clearing her ears during the flight. The pain started during the descent of a jet airplane on a holiday trip. A 58-year-old woman visited our hospital’s emergency department because of a severe and increasing pain over the right occipital region, irradiating over the right frontal area.
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