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Kramer N, Manthei S. An Unusual Case of Sinusitis in a Flight Attendant. Cureus 2024; 16:e55639. [PMID: 38586646 PMCID: PMC10995749 DOI: 10.7759/cureus.55639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2024] [Indexed: 04/09/2024] Open
Abstract
Foreign body sinusitis is a rare but important condition that should be taken into account when considering differential diagnoses. In this case report, we present a unique case of sinusitis caused by a foreign body originating from a dental procedure. Additionally, the complexity of the case was compounded by the patient's occupation as a flight attendant. A 49-year-old female flight attendant presented with a two-month history of facial pressure exacerbated by flying. A computed tomography (CT) of her paranasal sinuses confirmed the presence of a radiopaque foreign body near the left maxillary infundibulum, with minimal left ethmoid sinus mucosal thickening. Initially, she elected for non-operative management due to schedule conflicts. Upon follow-up over the next year, she complains of recurring severe facial swelling and congestion. A repeat CT scan shows that she has a dental amalgam that migrated from her left maxilla to the ethmoid infundibulum, lodged between her uncinate process and ethmoid bulla. The patient subsequently underwent foreign body removal. The patient recovered well, and a follow-up CT confirmed the complete removal of the foreign body. This case provides excellent insight into the mechanism of foreign body migration and sinusitis complicated by the unique circumstances of barotrauma associated with regular air travel.
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Affiliation(s)
| | - Scott Manthei
- Otolaryngology, Nevada Ear and Sinus Institute, Las Vegas, USA
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Chen T, Pathak S, Hong EM, Benson B, Johnson AP, Svider PF. Diagnosis and Management of Barosinusitis: A Systematic Review. Ann Otol Rhinol Laryngol 2022; 132:50-62. [PMID: 35130739 DOI: 10.1177/00034894211072353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To perform a systematic review to investigate the common presenting symptoms of barosinusitis, the incidence of those findings, the methods for diagnosis, as well as the medical and surgical treatment options. METHODS A review of PubMed/MEDLINE, EMBASE, and Cochrane Library for articles published between 1967 and 2020 was conducted with the following search term: aerosinusitis OR "sinus squeeze" OR barosinusitis OR (barotrauma AND sinusitis) OR (barotrauma AND rhinosinusitis). Twenty-seven articles encompassing 232 patients met inclusion criteria and were queried for demographics, etiology, presentation, and medical and surgical treatments. RESULTS Mean age of patients was 33.3 years, where 21.7% were females and 78.3% were males. Causes of barotrauma include diving (57.3%), airplane descent (26.7%), and general anesthesia (0.4%). The most common presentations were frontal pain (44.0%), epistaxis (25.4%), and maxillary pain (10.3%). Most patients received topical steroids (44.0%), oral steroids (28.4%), decongestants (20.7%), and antibiotics (15.5%). For surgical treatment, most patients received functional endoscopic sinus surgery (FESS) (49.6%). Adjunctive surgeries include middle meatal or maxillary antrostomy (20.7%), septoplasty (15.5%), and turbinate surgery (9.1%). The most efficacious medical treatments are as follows: 63.6% success rate with oral steroids (66 treated), 50.0% success rate with topical steroids (102 treated), and 50.0% success rate analgesics (10 treated). For surgical treatments received by greater than 10% of the sample, the most efficacious was FESS (91.5% success rate, 108 treated). CONCLUSION Oral and topical steroids should be first line therapies. If refractory, then functional endoscopic sinus surgery is an effective treatment.
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Affiliation(s)
- Tiffany Chen
- Hackensack Meridian School of Medicine at Seton Hall University, Nutley, NJ, USA
| | - Shivani Pathak
- Department of Otolaryngology - Head and Neck Surgery, University of Colorado, Aurora, CO, USA
| | - Ellen M Hong
- Hackensack Meridian School of Medicine at Seton Hall University, Nutley, NJ, USA
| | - Brian Benson
- Hackensack Meridian School of Medicine at Seton Hall University, Nutley, NJ, USA.,Hackensack University Medical Center, Hackensack, NJ, USA
| | - Andrew P Johnson
- Department of Otolaryngology - Head and Neck Surgery, University of Colorado, Aurora, CO, USA
| | - Peter F Svider
- Hackensack University Medical Center, Hackensack, NJ, USA.,Bergen Medical Associates, Emerson, NJ, USA
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Swain S. Scuba Diver Presenting with a Giant Sphenoid Sinus Mucocele. JOURNAL OF MARINE MEDICAL SOCIETY 2022. [DOI: 10.4103/jmms.jmms_32_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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The surgical management of recurrent acute and chronic barosinusitis in sports self-contained underwater breathing apparatus (scuba) divers. Eur Arch Otorhinolaryngol 2020; 277:2475-2484. [PMID: 32409859 DOI: 10.1007/s00405-020-06034-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/02/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The aim of this retrospective study is to evaluate the feasibility of functional endoscopic sinus surgery (FESS) with supplementary surgical procedures in scuba divers with recurrent acute barosinusitis (RABS) and chronic barosinusitis (CBS). METHODS In this retrospective study, 25 divers were classified into RABS (n:11) and CBS (n:14) groups. The presentation of divers have been reviewed. The PNS CT images were scored according to Lund-Mackay (L-M) system. A score has been assigned to the extent of endoscopic procedures performed. The outcome of surgery and life quality were determined by SNOT-22 and dive-related questions (DRQ) tests. RESULTS The average L-M score was 3.8 ± 2 for RABS and 12.2 ± 3.4 for CBS groups. L-M score of CBS group was found to be statistically higher than RBS group (p < 0.05). The FESS score of CBS group (8.7 ± 2.4) was higher than RABS group (5.6 ± 2) which showed that the endoscopic sinus procedures were performed more extensively in CBS group (p < 0.05). The difference between the preoperative and postoperative SNOT-22 scores indicates that the degree of sinus symptoms improved better in RABS group than CBS group (p < 0.05). When DRQ test was evaluated, RABS group showed a better improvement in diving performance symptoms than the CBS group (p < 0.05). CONCLUSION Our study demonstrated that divers with RABS and CBS can be managed successfully with FESS and supplementary surgical procedures. The improvement in the RABS group was superior to the CBS group, a difference attributed to the severity of chronic inflammation in CBS.
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Livingstone DM, Lange B. Rhinologic and oral-maxillofacial complications from scuba diving: a systematic review with recommendations. Diving Hyperb Med 2019; 48:79-83. [PMID: 29888379 DOI: 10.28920/dhm48.2.79-83] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 04/28/2018] [Indexed: 12/13/2022]
Abstract
Rhinologic and oral maxillofacial complications from scuba diving are common, representing approximately 35% of head and neck pathology related to diving. We performed a systematic and comprehensive literature review on the pathophysiology, diagnosis, and treatment of rhinologic and oral maxillofacial pathology related to diving. This included complications due to sinus barotrauma, barodontalgia, odontocrexis, temporomandibular joint dysfunction, partially dentulous patients, and considerations for patients following major head and neck surgery. Of 113 papers accessed, 32 were included in the final synthesis. We created a succinct summary on each topic that should inform clinical decision making by otolaryngologists, dive medicine specialists and primary care providers when faced with pathology of these anatomic sub-sites.
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Affiliation(s)
- Devon M Livingstone
- Corresponding author: Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Calgary, 7th floor, 4448 Front Street SE, Calgary, Alberta, Canada, T3M 1M4.
| | - Beth Lange
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery; University of Calgary, Calgary, Alberta, Canada
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Mallen JR, Roberts DS. SCUBA Medicine for otolaryngologists: Part I. Diving into SCUBA physiology and injury prevention. Laryngoscope 2019; 130:52-58. [PMID: 30776099 DOI: 10.1002/lary.27867] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 01/18/2019] [Accepted: 01/28/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Introduce pertinent self-contained underwater breathing apparatus (SCUBA) physiology and corresponding terminology. Appreciate the scope of diving and related otolaryngological injury. Illustrate pathophysiologic mechanisms for diving injuries. Summarize strategies for ear, paranasal sinus, and lung barotrauma prevention, including medical optimization and autoinsufflation techniques. METHODS We conducted a review of the available medical and diving literature in English, German, Spanish, Italian Turkish, and French to determine the degree of evidence or lack thereof behind recommendations for treating SCUBA divers. The databases of PubMed, Ovid Medline, and the Cochrane library, as well available textbooks, were queried for relevant data. RESULTS Divers are subjected to large pressure gradients within the first few meters of descent. This can lead to gas embolism formation as well as barotrauma secondary to gas expansion/compression in potential closed spaces such as the middle ear, paranasal sinuses, and lungs. Physicians can minimize the risk of injury by counseling patients regarding proper equalization and descent/ascent techniques, and optimizing sinonasal and eustachian tube function. The use of decongestants is controversial. CONCLUSIONS Diving is an increasingly popular sport with predominantly otolaryngologic manifestations of injury and disease. Treating SCUBA divers requires a firm understanding of how physiology is altered underwater. This review presents the relevant background information using illustrations to understand the environmental forces acting on divers and how to prevent injury. Laryngoscope, 130:52-58, 2020.
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Affiliation(s)
- Jonathan R Mallen
- Department of Surgery, Division of Otolaryngology, University of Connecticut Health, Farmington, Connecticut, U.S.A
| | - Daniel S Roberts
- Department of Surgery, Division of Otolaryngology, University of Connecticut Health, Farmington, Connecticut, U.S.A
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Vaezeafshar R, Psaltis AJ, Rao VK, Zarabanda D, Patel ZM, Nayak JV. Barosinusitis: Comprehensive review and proposed new classification system. ALLERGY & RHINOLOGY 2017; 8:109-117. [PMID: 29070267 PMCID: PMC5662535 DOI: 10.2500/ar.2017.8.0221] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Barosinusitis, or sinus barotrauma, may arise from changes in ambient pressure that are not compensated by force equalization mechanisms within the paranasal sinuses. Barosinusitis is most commonly seen with barometric changes during flight or diving. Understanding and better classifying the pathophysiology, clinical presentation, and management of barosinusitis are essential to improve patient care. Objectives: To perform a comprehensive review of the available literature regarding sinus barotrauma. Methods: A comprehensive literature search that used the terms “barosinusitis,” “sinus barotrauma,” and “aerosinusitis” was conducted, and all identified titles were reviewed for relevance to the upper airway and paranasal sinuses. All case reports, series, and review articles that were identified from this search were included. Selected cases of sinus barotrauma from our institution were included to illustrate classic signs and symptoms. Results: Fifty-one articles were identified as specifically relevant to, or referencing, barosinusitis and were incorporated into this review. The majority of articles focused on barosinusitis in the context of a single specific etiology rather than independent of etiology. From analysis of all the publications combined with clinical experience, we proposed that barosinusitis seemed to fall within three distinct subtypes: (1) acute, isolated barosinusitis; (2) recurrent acute barosinusitis; and (3) chronic barosinusitis. We introduced this terminology and suggested independent treatment recommendations for each subtype. Conclusion: Barosinusitis is a common but potentially overlooked condition that is primed by shifts in the ambient pressure within the paranasal sinuses. The pathophysiology of barosinusitis has disparate causes, which likely contribute to its misdiagnosis and underdiagnosis. Available literature compelled our proposed modifications to existing classification schemes, which may allow for improved awareness and management strategies for barosinusitis.
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Affiliation(s)
- Reza Vaezeafshar
- From the Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Alkis J Psaltis
- Division of Surgery, Department of Otolaryngology Head and Neck Surgery, Queen Elizabeth Hospital, The University of Adelaide, Adelaide, Australia
| | - Vidya K Rao
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - David Zarabanda
- From the Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Zara M Patel
- From the Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Jayakar V Nayak
- From the Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
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Schipke JD, Cleveland S, Drees M. Sphenoid sinus barotrauma in diving: case series and review of the literature. Res Sports Med 2017; 26:124-137. [PMID: 28797173 DOI: 10.1080/15438627.2017.1365292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
About 50% of scuba divers have suffered from barotrauma of the ears and about one-third from barotrauma of paranasal sinuses. The sphenoid sinuses are rarely involved. Vital structures, as internal carotid artery and optic nerve, adjoin the sphenoid sinus. Thus, barotrauma could lead to serious neurologic disorders, including blindness. After searching the literature (Medline) and other sources (Internet), we present some cases of sphenoid sinus barotrauma, because these injuries may be underreported and misdiagnosed due to the lack of awareness and knowledge. Therefore, information is provided, e.g. on anatomical and pathophysiological features. Divers and physicians should have in mind that occasional headache during or after diving sometimes signals serious neurological disorders like vision loss. We show that injuries can develop from both negative and positive pressures in the sinuses. Because visual recovery depends on prompt diagnosis and proper therapy, physicians like otolaryngologists, ophthalmologists and neurologists need to closely collaborate.
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Affiliation(s)
- Jochen D Schipke
- a Research Group Experimental Surgery , University Hospital Düsseldorf , Düsseldorf , Germany
| | - Sinclair Cleveland
- b Institute of Neuro- and Sensory Physiology , Heinrich Heine Universität Düsseldorf , Düsseldorf , Germany
| | - Markus Drees
- c Medical Office for Otorhinolaryngology and Diving Medicine , Wetzlar , Germany
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10
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Erratum zu „Aerosinusitis –Teil 1: Grundlagen, Pathophysiologie und Prophylaxe“. HNO 2014. [DOI: 10.1007/s00106-014-2860-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
The relevance of aerosinusitis stems from the high number of flight passengers and the impaired fitness for work of the flight personnel. The frontal sinus is more frequently affected than the maxillary sinus and the condition generally occurs during descent. Sinonasal diseases and anatomic variations leading to obstruction of paranasal sinus ventilation favor the development of aerosinusitis. This Continuing Medical Education (CME) article is based on selective literature searches of the PubMed database (search terms: "aerosinusitis", "barosinusitis", "barotrauma" AND "sinus", "barotrauma" AND "sinusitis", "sinusitis" AND "flying" OR "aviator"). Additionally, currently available monographs and further articles that could be identified based on the publication reviews were also included. Part 1 presents the pathophysiology, symptoms, risk factors, epidemiology and prophylaxis of aerosinusitis. In part 2, diagnosis, conservative and surgical treatment will be discussed.
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Wang P, Zhang XM, Zhai ZH, Li PL. MRI findings of otic and sinus barotrauma in patients with carbon monoxide poisoning during hyperbaric oxygen therapy. PLoS One 2013; 8:e65672. [PMID: 23776523 PMCID: PMC3680481 DOI: 10.1371/journal.pone.0065672] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 04/27/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND PURPOSE To study the MRI findings of otic and sinus barotrauma in patients with carbon monoxide(CO) poisoning during hyperbaric oxygen (HBO) therapy and examine the discrepancies of otic and sinus abnormalities on MRI between barotrauma and acute otitis media with effusion. MATERIALS AND METHODS Eighty patients with CO-poisoning diagnosed with otic and sinus barotrauma after HBO therapy were recruited. Brain MRI was performed to predict delayed encephalopathy. Over the same period, 88 patients with acute otitis media with effusion on MRI served as control. The abnormalities of the middle ear and paranasal sinuses on MRI were noted and were compared between groups. Nine patients with barotrauma were followed up by MRI. RESULTS In the barotrauma group, 92.5% of patients had bilateral middle ear abnormalities on MRI, and 60% of patients had both middle ear cavity and mastoid cavity abnormalities on MRI in both ears. Both rates were higher than those in the control group (p = 0.000). In the two groups, most abnormalities on MRI were observed in the mastoid cavity. The rate of sinus abnormalities of barotrauma was 66.3%, which was higher than the 50% in the control group (p = 0.033). In the nine patients with barotrauma followed up by MRI, the otic barotrauma and sinus abnormalities had worsened in 2 patients and 5 patients, respectively. CONCLUSION MRI is able to depict the abnormalities of otic and sinus barotrauma in patients with CO-poisoning during HBO therapy and to differentiate these from acute otitis media with effusion.
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Affiliation(s)
- Ping Wang
- Sichuan Key Laboratory of Medical Imaging, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Shunqing District, Nanchong, Sichuan, China
| | - Xiao-Ming Zhang
- Sichuan Key Laboratory of Medical Imaging, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Shunqing District, Nanchong, Sichuan, China
- * E-mail:
| | - Zhao-Hua Zhai
- Sichuan Key Laboratory of Medical Imaging, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Shunqing District, Nanchong, Sichuan, China
| | - Pei-Ling Li
- Sichuan Key Laboratory of Medical Imaging, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Shunqing District, Nanchong, Sichuan, China
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Nasal dysfunction amongst divers during bounce and saturation diving. Indian J Otolaryngol Head Neck Surg 2012; 52:140-2. [PMID: 23119653 DOI: 10.1007/bf03000332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
5O divers were subjected to detailed pre and post dive examination to study the effect of barotrauma. The various sinunasal pathologies which were detected are discussed and the significant difference seen between bounce divers, saturation divers and control group of diving recruits is highlighted.
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Lee E, Yang JW, Kwon JD. The Effect of Breath-Hold Diving on Intraocular Pressure, Optic Nerve, Visual Field in Korean Haenyeo (Female Divers). JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2012. [DOI: 10.3341/jkos.2012.53.10.1480] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Eung Lee
- Department of Ophthalmology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jae Wook Yang
- Department of Ophthalmology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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Skevas T, Baumann I, Bruckner T, Clifton N, Plinkert PK, Klingmann C. Medical and surgical treatment in divers with chronic rhinosinusitis and paranasal sinus barotrauma. Eur Arch Otorhinolaryngol 2011; 269:853-60. [PMID: 21901337 DOI: 10.1007/s00405-011-1742-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2011] [Accepted: 08/01/2011] [Indexed: 10/17/2022]
Abstract
Aim of the study is to evaluate the effects of medical and surgical treatment in divers with paranasal sinus barotrauma (PSB) secondary to chronic rhinosinusitis (CRS). In this retrospective, cross-sectional, descriptive study 40 adult divers with CRS were included. Treatment of divers implied a 5-day course of a systemic steroid and a 6-week course of saline nasal irrigations and topical nasal steroid with mometasone in maximal dosage. If symptoms persisted, functional endoscopic sinus surgery (FESS) was performed. Questionnaires included the Sinonasal Outcome Test-20 German Adapted Version (SNOT-20 GAV), dive-related questions (DRQ) and general questions. Questionnaires were completed retrospectively by recalling the symptoms before and after therapy. Forty of 82 divers completed the questionnaires. Mean follow-up was 42 months (range 13-95 months). There was a statistically significant improvement of the Total score (TS) and of every subscore, except the General Quality of Life score, in the SNOT-20 GAV as well as of the TS in the DRQ. Before treatment, divers who required surgery reported significantly more symptoms than divers who were treated conservatively. Post treatment there were no significant differences between the medical and surgical group. Overall, 35 divers could resume diving after therapy even though PSB still occurred but without complications. Divers with sinus problems can successfully be managed medically and if conservative treatment fails, FESS shows a statistically significant improvement of symptoms and no serious long-term hazards for diving.
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Affiliation(s)
- Theodoros Skevas
- Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Mutterhaus der Borromäerinnen, Academic Teaching Hospital of University of Mainz, Trier, Germany.
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Bourolias C, Gkotsis A. Sphenoid sinus barotrauma after free diving. Am J Otolaryngol 2011; 32:159-61. [PMID: 20022669 DOI: 10.1016/j.amjoto.2009.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Revised: 10/05/2009] [Accepted: 10/20/2009] [Indexed: 10/20/2022]
Abstract
We report 2 cases of a 29- and a 37-year-old male patient both having sphenoid sinus barotrauma associated with free diving at about 12-m depth. A unilateral occupation of the sphenoid sinus was revealed in both cases by computed tomography and magnetic resonance imaging examination of the paranasal sinuses.
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Abstract
BACKGROUND People suffer unique health problems in high altitude areas, due to such factors as elevation, aircraft ascent and descent, extreme cold, hypoxia, hypobaria, and low relative humidity. This study was conducted to evaluate ENT morbidity at high altitude. METHODS Serving soldiers introduced to a high altitude environment who presented with various ENT symptoms were examined to identify ENT disease. In addition, patients undergoing hyperbaric chamber therapy, tracheostomy and treatment of cold injuries were also examined for ENT problems. RESULTS The following were detected: 13 cases of otic barotrauma, 11 cases of sinus barotrauma, three cases of vertigo, six cases of pinna frostbite, three cases of barotrauma caused by hyperbaric chamber therapy, an unusually high incidence of epistaxis, and innumerable patients with high altitude pharyngitis. CONCLUSION Diseases of the ear, nose and throat contribute significantly to high altitude morbidity. In a military context, health education of troops is necessary to avoid such problems.
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Affiliation(s)
- B K Prasad
- Department of ENT and Head and Neck Surgery, Command Hospital (Eastern Command (EC)), Kolkata, West Bengal, India.
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Jeoung SM, Kim SG, Kwon JD. The Changes of Intraocular Pressure, Optic Nerve and Visual Field in SCUBA Diving. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2010. [DOI: 10.3341/jkos.2010.51.12.1598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sang Moon Jeoung
- Department of Ophthalmology, Wallace Memorial Baptist Hospital1, Busan, Korea
| | - Sung Gil Kim
- Department of Ocean Physical Education, Korea Maritime University, Busan, Korea
| | - Jeong Do Kwon
- Department of Ophthalmology, Wallace Memorial Baptist Hospital1, Busan, Korea
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Paranasal sinus barotrauma in sports self-contained underwater breathing apparatus divers. The Journal of Laryngology & Otology 2008; 123:80-4. [PMID: 18501035 DOI: 10.1017/s0022215108002739] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE TO evaluate potential pre-dive parameters in relation to paranasal sinus barotrauma in sports self-contained underwater breathing apparatus divers. STUDY DESIGN The pre-dive and follow-up records of 46 healthy sports self-contained underwater breathing apparatus divers were analysed. METHODS In the routine pre-dive examination of diving candidates with no symptoms of rhino-sinus disease, rhinoscopy, sinus radiography and nasal endoscopy indicated no signs of rhinitis and/or sinusitis. Any signs of paranasal sinus barotrauma were noted, and several parameters were evaluated in relation to occurrence of barotrauma. RESULTS Of the studied parameters, a history of sinusitis and of middle-ear barotrauma was significantly more frequent in divers in the barotrauma group (p < 0.05). CONCLUSIONS In divers undergoing a routine pre-dive examination, paranasal sinus barotrauma was not related to sex, alcohol consumption, smoking, decongestant use, mild nasal septal deviation, or inability to perform the Valsalva or Toynbee manoeuvres. However, divers with a history of sinusitis or middle-ear barotrauma may be more prone to paranasal sinus barotrauma. A more detailed pre-dive examination may be useful for such individuals.
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Affiliation(s)
- Ki-Jun Kim
- Department of Anesthesiology and Pain Medicine, and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Abstract
AbstractThis case report illustrates an unusual hazard of underwater sports: vagal neuropathology secondary to early poliomyelitis which resulted in residual palato-pharyngeal paresis. Gag and swallowing reflexes appeared to function adequately but in fact were not normal. When stressed, during water aspiration, they were inadequate, resulting in great risk to the underwater enthusiast. A history of early viral myelitis must be considered as a potential hazard in underwater sports.
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Abstract
Self-contained underwater breathing apparatus (scuba) diving has grown in popularity, with nearly 9 million sport divers in the United States alone. Approximately 7% of the population has been diagnosed with asthma, which is similar to the percentage of divers admitting they have asthma. Numerous concerns exist regarding subjects with asthma who choose to participate in recreational diving. Among these concerns are pulmonary barotrauma, pneumomediastinum, pneumothorax, arterial gas embolism, ear barotrauma, sinus barotrauma, and dental barotrauma. Despite these concerns, a paucity of information exists linking asthma to increased risk of diving complications. However, it has long been the norm to discourage individuals with asthma from participating in recreational scuba diving. This article examines the currently available literature to allow for a more informed decision regarding the possible risks associated with diving and asthma. It examines the underlying physiological principles associated with diving, including Henry's law and Boyle's law, to provide a more intimate understanding on physiological changes occurring in the respiratory system under compressive stress. Finally, this article offers a framework for guiding the patient with asthma who is interested in scuba diving. Under the right circumstances, the patient with asthma can safely participate in recreational diving without apparent increased risk of an asthma-related event.
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Affiliation(s)
- Michael J Davies
- Department of Asthma, Allergy, and Immunology, The Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, PA, USA
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Salvinelli F, Rinaldi V, D'Ascanio L. Paranasal sinus barotrauma in general anesthesia: special attention. J Clin Anesth 2005; 17:323. [PMID: 15950861 DOI: 10.1016/j.jclinane.2004.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2004] [Accepted: 12/16/2004] [Indexed: 11/25/2022]
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Abstract
Apnea diving is a fascinating example of applied physiology. The record for apnea diving as an extreme sport is 171 meters, 8:58 minutes. The short time beneath the surface induces profound cardiovascular and respiratory effects. Variations of blood-gas tensions result from the interaction of metabolism and the rapid sequence of compression and decompression. Decompression sickness is possible. Apnea divers can reach depths beyond the theoretic physiologic limit by using the lung-packing maneuver. Apnea divers exhibit a fall in heart rate, which can be trained and is an oxygen-conserving effect, but increases the incidence of ventricular arrhythmia.
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Affiliation(s)
- Claus-Martin Muth
- Sektion Anaesthesiologische Pathophysiologie und Verfahrensentwicklung, Universitaetsklinikum, Parkstrasse 11, D-89073 Ulm (Donau), Germany.
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Abstract
Headache occasionally occurs during or after scuba diving. Although its significance often is benign, headache may signal a serious neurological disorder in some circumstances. In addition to the usual causes of headache, the diagnostic evaluation should consider otic and paranasal sinus barotrauma, arterial gas embolism, decompression sickness, carbon dioxide retention, carbon monoxide toxicity, hyperbaric-triggered migraine, cervical and temporomandibular joint strain, supraorbital neuralgia, carotid artery dissection, and exertional and cold stimulus headache syndromes. Focal neurologic symptoms, even in the migraineur, should not be ignored, but rather treated with 100% oxygen acutely and referred without delay to a facility with a hyperbaric chamber.
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Abstract
Self-Contained Underwater Breathing Apparatus (SCUBA) diving popularity is increasing tremendously, reaching a total of 9 million people in the US during 2001, and 50,000 in the UK in 1985. Over the past 10 years, new advances, equipment improvements, and improved diver education have made SCUBA diving safer and more enjoyable. Most diving injuries are related to the behaviour of the gases and pressure changes during descent and ascent. The four main pathologies in diving medicine include: barotrauma (sinus, otic, and pulmonary); decompression illness (DCI); pulmonary edema and pharmacological; and toxic effects of increased partial pressures of gases. The clinical manifestations of a diving injury may be seen during a dive or up to 24 h after it. Physicians living far away from diving places are not excluded from the possibility of encountering diver-injured patients and therefore need to be aware of these injuries. This article reviews some of the principles of diving and pathophysiology of diving injuries as well as the acute treatment, and further management of these patients.
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Jones SE, Yung M, Norris A. Frontal recess surgery for diving-related frontal pain: Case report. EAR, NOSE & THROAT JOURNAL 2001. [DOI: 10.1177/014556130108000313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We report the case of a professional scuba diver who was unable to dive because he began experiencing severe frontal pain on descent. Following endoscopic surgery to open the frontal recess, the man was able to resume diving unrestricted by pain. We discuss the causes and treatment of this complaint, and we suggest that this might be considered a new indication for surgery in a limited number of cases.
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Affiliation(s)
| | - Matthew Yung
- From the Department of ENT Surgery, Ipswich Hospital, Suffolk, England
| | - Andrew Norris
- From the Department of ENT Surgery, Ipswich Hospital, Suffolk, England
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29
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Abstract
The increasing popularity of scuba diving has added a new category to the differential diagnosis of headache. Headache in divers, while uncommon and generally benign, can occasionally signify serious consequences of hyperbaric exposure such as arterial gas embolism, decompression sickness, and otic or paranasal sinus barotrauma. Inadequate ventilation of compressed gases can lead to carbon dioxide accumulation, cerebral vasodilatation, and headache. Other types of headache encountered in divers include exertional headache, cold stimulus headache, migraine, tension-type headache, acute traumatic headache, cervicogenic headache, carbon monoxide poisoning headache, and headache associated with envenomation. Correct diagnosis and appropriate treatment require a careful history and neurologic examination as well as an understanding of the unique physiologic stresses of the subaquatic environment.
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Affiliation(s)
- W P Cheshire
- Department of Neurology, Mayo Clinic, Jacksonville, FL 32224, USA
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Abstract
Diving is a high-risk sport. There are approximately between 1 to 3 million recreational scuba divers in the USA (with over a quarter-million learning scuba annually); there are about 1 million in Europe and over 50,000 in the United Kingdom. In this population 3-9 deaths/100,000 occur annually in the US alone, and those surviving diving injuries far exceeds this. Diving morbidity can be from near-drowning, from gas bubbles, from barotrauma or from environmental hazards. In reality, the most common cause of death in divers is drowning (60%), followed by pulmonary-related illnesses. The mean number of annual diving fatalities in the USA from 1970 to 1993 was 103.5 (sd 24.0) and the median was 106. This article will focus primarily upon pressure effects on the health of a diver. There are two principle ways pressure can affect us: by direct mechanical effects and by changing the partial pressures of inspired gases. Dysbarism is a general term used to describe pathology from altered environmental pressure, and has two main forms: barotrauma from the uncontrolled expansion of gas within gas-filled body compartments and decompression sickness from too rapid a return to atmospheric pressure after breathing air under increased pressures. Greater than 90% of the human body is either water or bone, which is incompressible; the areas directly affected by pressure changes thus are those that are filled with air or gas. These sites include the middle ear, the eustachian tube, the sinuses, the thorax, and the gastrointestinal tract. Air in these cavities is compressed when the ambient pressure rises because the pressure of inhaled air must equilibrate with the ambient pressure.
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Affiliation(s)
- A Spira
- The Travel Medicine Center, Beverly Hills, California 90211, USA
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31
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Affiliation(s)
- Y Melamed
- Israeli Naval Medical Institute, Haifa
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Murrison AW, Smith DJ, Francis TJ, Counter RT. Maxillary sinus barotrauma with fifth cranial nerve involvement. J Laryngol Otol 1991; 105:217-9. [PMID: 2019813 DOI: 10.1017/s0022215100115415] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A case of neurapraxia of the infraorbital nerve occurring as a result of maxillary sinus barotrauma in a diver is presented. Existing reports of a similar nature are reviewed and the pathogenesis of cranial nerve involvement in barotrauma is discussed. Guidelines for treatment are suggested.
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BOVE ALFREDA, APPENZELLER OTTO. Medical Aspects of Diving. EXERCISE MEDICINE 1983. [DOI: 10.1016/b978-0-12-119720-9.50024-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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