Aerosinusitis , also called barosinusitis , sinus squeeze or sinus barotrauma is painful inflammation and sometimes paranasal sinus membrane haemorrhage , usually the frontal sinus. This is caused by differences in air pressure inside and outside the cavity.
Video Aerosinusitis
Presentation and diagnosis
Most cases occur in scuba divers and leaflets, and are easily diagnosed when presented to a doctor immediately after exposure. On the other hand, problems may remain undiagnosed when history fails to associate symptoms with exposure to changes in environmental stress or if the focus is on other etiologies.
Usually, barotrauma sinuses are preceded by upper respiratory tract infections or allergies. People suffering from sudden sharp facial pain or headache during a downturn, which increases as the plane approaches the ground. The pain can eventually become paralyzing unless the ambient pressure is reversed.
The pressure difference causes the mucosal layer of the sinus to become swollen and submucosal hemorrhage followed by further difficulty for sinus ventilation, especially if the orifices are involved. In the end the fluid or blood will fill the space.
In most cases of barotrauma sinus, local pain to the frontal area is the dominant symptom. This is because of the pain that comes from the frontal sinus, it is above the brow bone. Less common are pain that refers to the temporal, occipital, or retrobulbar regions. Epistaxis or serosanguinous secretions from the nose may occur. Neurological symptoms can affect the adjacent fifth cranial nerves and especially the infraorbital nerves.
Barotrauma sinus or aerosinusitis has been known since the early development of aviation drugs. However, during World War II that subjects first received serious attention and the pathogenesis of the disease was understood due to high altitude flight exposure. The altitude of rapid change with the accompanying changes in ambient pressure exposes aircrews to an increase in the number of episodes of sinus barotrauma.
The pain referred to from the maxillary barosinusitis comprises about one fifth of barodontalgia in flight (ie, pain in the oral cavity caused by changes in barometric pressure).
Although the fighter pilot environment produces the most pressing barometric changes, commercial flying has changed the picture of the disease.
The pathology of the barotrauma sinus is directly related to Boyle's law, which states that the volume of gas is inversely proportional to the pressure above it, when the temperature is constant (P1 Æ' € "V1 = P2 Æ'V2). Two types of acute barotrauma are observed: extortion and reverse squeeze.
On the ascent, the air in the paranasal sinuses will evolve according to Boyle's law, contracting as it descends. Usually, the sinus flows into the nasal cavity through a small ostia, allowing mucociliary cleansing and ventilation to balance the pressure. However, when the opening is blocked by inflammation, polyps, mucosal thickening, anatomical abnormalities, or other lesions, equilibrium pressure is not possible. Squeeze is produced when it falls when the air trapped in the sinuses contracts and produces negative pressure. The pressure difference directed to the sinus center results in mucosal edema, transudation, and mucosa-or submucosal hematoma, leading to further occlusion of the sinus ostium. The sinus will be filled with fluid or blood unless the pressure difference is neutralized.
If the outlet is blocked during the climb, the situation is reversed and "reverse squeeze" appears. The pressure inside the sinus increases, affecting the sinus wall and producing pain or epistaxis.
Maps Aerosinusitis
Value
Weissman defines three levels of sinus barotraumas according to symptomatology.
- Level I includes cases with mild sinus inconvenience while no visible changes in X-rays.
- Grade II is characterized by severe pain up to 24 hours, with some mucosal thickening in X-rays.
- Patients with level III have severe pain lasting more than 24 hours and X-rays show severe mucosal thickening or exposed sinus opacities; epistaxis or subsequent sinusitis can be observed.
Locations
The majority of barotrauma sinus episodes occur in the frontal sinus with localized pain in the frontal area. A possible explanation for this may be the relatively long, smooth nasofrontal channel that connects the narrow frontal recess with the frontal sinus.
Barotrauma located in maxillary, ethmoidal, or sphenoid sinuses are observed less frequently and occur when ostia is blocked; most cases may be caused by acute upper respiratory infections. The amount of pressure difference required to produce barotrauma may indicate large individual variation and is related to the size of the sinus ostium and the rate of change in ambient pressure. Because of this, even commercial flying can produce severe cases of barotraumas, although most cases are observed in high performance aircraft with lower pressure cabins.
Treatment
The mild cases of barotrauma are readily handled by topical decongestants and pain relievers. In severe cases or cases resistant to local treatment, functional endoscopic sinus surgery is indicated to rebuild drainage and sinus ventilation. This treatment has shown good results on aviators suffering from recurrent barotrauma sinuses. Computer-assisted surgery has recovered the affected sinus drainage, especially with regard to sphenoid sinuses. When the sphenoid enters endoscopically, petechia mucosa and hematoma are clearly visible.
See also
- Barodontalgia
- Barotrauma
References
Source of the article : Wikipedia
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