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American Journal of OtolaryngologyHead and Neck Medicine and Surgery 33 (2012) 477 480
www.elsevier.com/locate/amjoto
Abstract
We report the case of an 18-year-old male patient operated on for sphenoid sinus barotrauma after
scuba diving. The patient attended our emergency department because of intractable headache but
did not improve with conservative treatment. After computed tomography and magnetic resonance
imaging examination, he was diagnosed with sphenoid sinusitis that extended to the nasal septum.
He therefore underwent surgery for sinus ventilation and abscess drainage.
2012 Elsevier Inc. All rights reserved.
1. Introduction
Barotrauma is tissue injury associated with rapid pressure
change [1]. Most cases of barotrauma are related to air travel
and cause middle ear and inner ear injury, but sometimes,
barotrauma of the paranasal sinus is reported after air travel
[2]. Reports of sinus barotrauma related to marine sports
such as scuba diving or diving are uncommon, and sinus
barotrauma caused by diving generally involves the frontal
sinus or maxillary sinus [3].
Recently, we encountered a case of barotrauma of the
sphenoid sinus after scuba diving, which progressed to a
septal abscess and was treated by surgical management.
Sinus barotrauma is thought to have increased significantly
with the diversification of leisure activities and greater public
involvement in marine sports.
2. Case
A previously healthy 18-year-old male patient visited
our hospital emergency department because of a bilateral
temporo-occipital area headache that had gradually worsened. The headache had been caused by scuba diving
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J.H. Jeong et al. / American Journal of OtolaryngologyHead and Neck Medicine and Surgery 33 (2012) 477480
Fig. 1. PNS CT and brain MRI. Sinusitis in the bilateral sphenoid and posterior ethmoid sinuses demonstrated by CT scan (A). The MRI shows that the sinusitis
extends to the right septal area (B, arrow).
sinus
spheAfter
clinic
Fig. 2. Endoscopic findings. The right nasal cavity shows septal mucosal bulging in the posterior portion of the nasal septum (A). The left nasal cavity shows
septal deviation to the left (B).
J.H. Jeong et al. / American Journal of OtolaryngologyHead and Neck Medicine and Surgery 33 (2012) 477480
479
Fig. 3. Operative findings. Pus was expelled during septoplasty (A). Necrotic detached mucosal debris (arrow) was expelled from the widened left sphenoid sinus
ostium during irrigation (B). Edematous mucosa of the left sphenoid sinus may be noted (C).
3. Discussion
Sinus barotrauma is an inflammatory disease of the
paranasal sinus related to rapid pressure change and
associated with obstruction of the sinus opening due to
upper airway infection, allergy, nasal polyp, or chronic
sinusitis[1]. This disease readily occurs in professional pilots
and divers but can also affect airplane passengers and people
who enjoy scuba diving as a leisure sport.
The frontal sinus is the most commonly involved sinus,
and if the frontal sinus is affected, headache occurs in the
frontal area. If the maxillary sinus is affected, toothache of
the maxilla can occur, and if the sphenoid sinus is affected,
there can be pain around the retro-orbital or occipital areas.
Sinus barotrauma can be easily diagnosed when examined by an otorhinolaryngologist soon after exposure [4,5].
Plain x-ray, CT, and MRI can be helpful in the diagnosis.
Fig. 4. Follow-up endoscopic findings. A small septal perforation can be seen in the posterior portion of the nasal septum (A). The left sphenoid sinus ostium (B)
and well-healed sinus mucosa (C) are evident.
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J.H. Jeong et al. / American Journal of OtolaryngologyHead and Neck Medicine and Surgery 33 (2012) 477480
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