Barotrauma of the paranasal sinuses

What is Paranasal Sinus Barotrauma?


Paranasal sinus barotrauma, or sinus barotrauma, is the second most common pathology in recreational diving, following otic problems.

It occurs due to the pressure difference generated during immersion between the cavities of the paranasal sinuses and the environment, caused by poor permeability of the ventilation and drainage channels of the sinuses, called ostia. It mainly affects the frontal sinuses, followed by the maxillary sinuses.

Dibujo esquemático de los senos paranasales en visión anterior.Dibujo esquemático de los senos paranasales en visión lateral.







It is more common during descent (implosive barotrauma) than during ascent (explosive barotrauma).

Any situation that compromises the ventilation of the paranasal sinuses can predispose to sinus barotrauma during a dive, such as colds, allergies, chronic rhinitis with or without polyps, or certain nasal septum deviations.

Symptoms of Paranasal Sinus Barotrauma

The characteristic symptoms of sinus barotrauma are local pain (frontal and/or maxillary headache) and epistaxis or nosebleed, usually starting during immersion.

Complications are rare and are generally related to the escape of pressurized air into surrounding spaces, either due to rupture of a sinus wall or because it was previously dehiscent, as in the case of some malformations or previous surgeries. Air escape into the subcutaneous tissue of the face can cause subcutaneous emphysema, typically palpebral, characterized by edema, crepitation, and hematoma of the area. Other complications, such as pneumoorbit or pneumocephalus, are very rare and are usually related to previous endonasal surgery.

The treatment of sinus barotrauma is mainly medical, based on vasoconstrictors, corticosteroids, and antibiotics, and rarely requires surgical treatment. However, surgical intervention may be necessary to correct some predisposing factors, such as certain nasal septum deviations or nasosinusal polyposis.

To prevent sinus barotrauma, avoid diving in situations of nasal congestion or obstruction. In some cases, nasal irrigation and the use of nasal decongestants prior to immersion may be advisable.

For further information, you can contact our otolaryngology clinic in Madrid or directly request an appointment online.