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What Is Sinus Barotrauma (Sinus Squeeze)?

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Updated May 14, 2014

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What Is Sinus Barotrauma (Sinus Squeeze)?

"Sinus Squeeze" is most common in divers

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Question: What Is Sinus Barotrauma (Sinus Squeeze)?
Answer:

Barotrauma of the sinuses goes by several different names. SCUBA divers sometimes refer to this as "sinus squeeze" while medical professionals might call it aerosinusitis. I've also heard it called barosinusitis. No matter what you call it it's all the same condition. It is most common in divers but can occur under any conditions in which you descend or ascend too quickly for your body to adjust (like in an airplane). You can also get "sinus squeeze" while undergoing hyperbaric oxygen therapy for another medical condition, which is worth noting since hyperbaric chambers are now being sold for home use. This is actually how my husband got it; when he was evaluated by the doctor we discovered that he had severe obstructions in every single sinus cavity and needed sinus surgery. This was not a result of the barotrauma but the cause of it.

What Causes Barotrauma of the Sinuses?

The sinuses are hollow spaces in the face and skull. Like the middle ear the sinuses are filled with air. The pressure in these cavities is normally equal to the ambient pressure (pressure of the environment), but if the ambient pressure suddenly changes and the body is unable to equalize the pressure in the sinuses, barotrauma will occur. This can actually cause bleeding into the sinuses. Obstructions in the sinuses make it harder for the body to equalize pressure and people with a history of sinus infections, current sinus or upper respiratory infections, allergies, nasal polyps, enlarged turbinates, or any other condition involving the nasal passageways and sinuses are at a higher risk for developing barotrauma of the sinuses. In fact, while it is not impossible to get sinus barotrauma without an underlying sinus condition it is unlikely.

Symptoms

The term "sinus squeeze" was likely coined by a diver who had experienced this condition and was describing the facial pain he had. The severity of symptoms depends on the severity of barotrauma but a shooting pain in the face or severe headache seems to be pretty universal. Additional symptoms may include a bloody nose, toothache or ear pain (which may be a precursor to a ruptured eardrum). While an upper respiratory infection can cause sinus barotrauma, sinus barotrauma also can cause an upper respiratory infection.

Treatment

Sinus barotrauma is an indicator of other sinus problems that need to be treated surgically or with medication, such as antibiotics, decongestants or antihistamines. Anyone who experiences sinus barotrauma should be evaluated by an ENT (ear, nose, throat) doctor.

Prevention

There are several things you can do to prevent sinus barotrauma, including abstaining from diving or riding in an airplane when you have an upper respiratory infection or severe congestion from allergies. You can also take decongestants such as Afrin (oxymetazoline) or pseudoephedrine or antihistamines (if your sinus problems are caused by allergies) beforehand. But, if overused, decongestant medications can cause rebound congestion. Treat allergies and underlying sinus conditions before diving or flying, and make sure you descend and ascend slowly using valsalva manuevers (swallowing or yawning on an airplane) to equalize pressure.

What Should I do if I'm Diving and Get "Sinus Squeeze?"

If you experience symptoms of sinus barotrauma while diving it is important not to panic. Your first instinct will be to get to the surface immediately, (it hurts!), but remember that by ascending too quickly you risk more serious conditions like decompression sickness or barotrauma to other parts of the body like the ears, and lungs. The only exception to this rule is if you are bleeding profusely (so much that your mask is filling up with blood). Once you're on dry land, if necessary, follow basic first aid to stop nosebleeds. The pain should go away shortly after returning to sea level; regardless you should see a doctor and soon. If you are bleeding uncontrollably or if severe pain doesn't subside go to an emergency room. It is also important to know the symptoms of all kinds of barotrauma so you can determine if other parts of your body have been affected.

Barotrauma of the sinuses can usually be treated successfully by an ENT doctor without long-term damage. It is important that all divers receive training on the prevention of all types of barotrauma and decompression sickness.

Sources:

Medscape. Diving Medicine: A Review of Current Evidence: Ear and Sinus Barotrauma. Accessed: January 30, 2012 from http://www.medscape.com/viewarticle/710379_3

Pubmed. Aerosinusitis: pathophysiology, prophylaxis, and management in passengers and aircrew. Accessed: January 30, 2012 from http://www.ncbi.nlm.nih.gov/pubmed/18225779

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