EpistemisBarosinusitis
Specialty: Otolaryngology.
Why it occurs
- Rapid changes in barometric pressure on commercial or military flights with obstructed sinus ostium
- Autonomous diving or apnea with inability to compensate for pressure in the paranasal cavities
- Concomitant allergic or infectious rhinitis that generates mucosal edema and prevents pressure equalization
- High septal deviations that physically block the middle meatus and frontal recess
Initial workup
Nasal endoscopic examination to rule out meatal edema or polyps, CT of the paranasal sinuses to assess the presence of mucosal thickening, sinus subperiosteal hematoma or air-fluid levels within the cavities, and associated tympanometry if there are simultaneous otic symptoms.
red flags
Profuse bilateral epistaxis of sudden onset during flight or immersion, unbearable orbital or facial pain that does not subside when the pressure stabilizes, progressive ipsilateral visual disturbance, or appearance of persistent paresthesias in the territory of the maxillary (V2) or ophthalmic (V1) branch of the trigeminal nerve.
Standard management
- Fast-acting topical nasal vasoconstrictors such as oxymetazoline 0.05% — 2 sprays per nostril applied 30 minutes before takeoff/landing or diving, limited to sporadic use
- Short-acting systemic corticosteroids such as methylprednisolone — 40 mg orally initially if there is severe obstructive edema of the ostium
- Analgesics such as dexketoprofen or paracetamol for the management of acute pain.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Otolaryngology
- Listed causes
- 4
- Treatment options
- 3