The following activities and conditions place individuals at particular risk for barosinusitis:
- Flying in military/high-performance aircraft
- Scuba and sport diving
- URTI (upper respiratory tract infection) or sinusitis in persons exposed to pressure changes
- Poorly controlled allergies or anatomic abnormalities of the nose and paranasal sinuses
Les conditions suivantes sont associ�es � la barosinusite
- le vol � haute altitude et � vitesse �lev�e
- le plongeon � profondeur mod�r�e ou grande
- une infection aigue ou chronique des voies respiratoires sup�rieures chez des personnes qui connaissent un changement d'altitude
- enfin et, vraisemblablement, le cas de ce patient, une allergie mal control�e ou une anomalie anatomique (d�viation de la cloison nasale ou/et autres) du nez ou des sinus paranasaux
Medical Care:
Begin treatment at the first sign of barotrauma. Treatment is accomplished most simply by returning to the altitude at which symptoms occurred, or, in the case of diving, returning to the surface. Decongest the nose with liberally applied topical agents, and then gradually descend to ground level. Unfortunately, immediate treatment is not always possible, and treatment often begins after the fact.
Medical therapy:
It is generally directed toward pain control, establishing ventilation, and preventing infection.
Pain control:
Oral agents usually are effective. Severe pain may require narcotics.
Establishing ventilation:
- Topical decongestants include 0.05% oxymetazoline and 0.5-1% phenylephrine.
- Oral decongestants include pseudoephedrine and phenylpropanolamine (recalled from US market).
In general, antihistamines are avoided because they tend to dry mucosa and inspissate secretions, although they may be useful if the underlying disease process includes poorly controlled allergies.
Preventing infection
Blood and transudate from traumatized mucosa provide a rich medium for bacterial growth.
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This environment, combined with damaged mucosa, inability to clear secretions, and altered oxygen tension, sets the stage for secondary bacterial infection (if not already present as the underlying cause of URTI).
A course of antibiotics may prevent secondary infection and hasten recovery.
The first-line antibiotic is amoxicillin. In patients who are allergic to penicillin, trimethoprim/sulfamethoxazole is the first-line medication. Other choices include cephalosporin, clindamycin, extended-spectrum macrolides, and quinolones.
Surgical Care:
Surgical therapy is designed to restore sinus ventilation. Conventional therapy with septoplasty, turbinectomy, antral windows, Caldwell-Luc operation, external or transantral ethmoidectomy, nasal polypectomy, and frontal sinus trephination has had variable efficacy. Endoscopic sinus surgery has substantially increased the chance of returning the patient to full activities.
If oral agents fail to relieve pain and pressure, or if pain and pressure do not resolve over 24 hours, consider antral puncture/washout to rapidly equilibrate pressure and to clear sinus blood and other debris. This has minimal affect on the middle meatus and may not clear symptoms from ethmoid and frontal disease. Septoplasty and turbinectomy may help, depending upon the clinical presentation.
Endoscopic sinus surgery
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Ref.: emedicine.com_Instant Acces to the Minds of Medicine: Medical Textbooks by Specialties