Overview

Sinonasal barotrauma, often called “sinus squeeze” or barosinusitis, is a condition that happens when the air pressure inside your sinus cavities cannot balance with the pressure of the environment around you. Your sinuses are air-filled spaces located behind your forehead, cheeks, and eyes. Under normal circumstances, air moves freely in and out of these spaces through tiny openings called ostia (the small, natural drainage channels that connect your sinuses to your nose).

When you experience a rapid change in pressure—such as when you are scuba diving, flying in an aircraft, or undergoing hyperbaric oxygen therapy—the air inside these spaces needs to expand or contract to match the outside pressure. If these tiny openings are blocked, the air becomes trapped. This creates a painful pressure difference, similar to how a sealed plastic bottle might crumple or expand if the air pressure inside it changes rapidly while the cap is screwed on tight. This condition most commonly affects people who participate in diving or aviation, but it can happen to anyone exposed to significant, quick changes in ambient pressure.

Symptoms and Causes

When your sinuses cannot equalize pressure, the lining of the sinus becomes irritated and inflamed. This is because the trapped air creates a vacuum or, conversely, too much pressure, which pulls on or pushes against the delicate tissues inside your sinus walls.

Symptoms

The symptoms of sinonasal barotrauma can range from mild discomfort to quite severe pain. You might notice:

• Facial pain: This is the most common sign. You may feel a sharp or dull ache in your forehead, around your eyes, or in your cheeks.
• Headache: A pressure-like headache is very common.
• Nosebleeds: You might see blood when you blow your nose, as the pressure changes can cause small blood vessels in the nasal lining to burst.
• Toothache: Because the nerves that supply your upper teeth run very close to the maxillary sinuses (the spaces in your cheekbones), you might feel pain in your upper jaw or teeth.
• Congestion and runny nose: You may feel like you have a heavy cold, with watery eyes or a blocked nose.
• Facial sensitivity: In some cases, the skin on your face may feel tender or tingly to the touch.

Causes

The root cause is almost always a blockage of the sinus ostia. When these tiny channels are narrowed or closed, air cannot move to equalize the pressure. Common triggers include:

• Colds and flu: Viral infections cause the lining of your nose and sinuses to swell, which naturally narrows the drainage channels.
• Allergies: Hay fever or other allergic reactions cause inflammation and mucus production, which can plug the openings.
• Nasal polyps: These are small, soft growths in the nose that can physically block the path for air.
• Existing sinusitis: If you already have an infection, your sinuses are likely already inflamed and less able to handle pressure changes.
• Anatomy: Some people have naturally narrower sinus openings, making them more prone to these issues during travel or diving.

Diagnosis and Investigations

If you suspect you have experienced barotrauma, it is important to speak with a healthcare professional, especially if the pain is severe or does not go away quickly.

Diagnosis

A doctor will typically diagnose this condition by talking to you about your recent activities. They will ask if you have been flying or diving recently and if you had a cold or allergy symptoms at the time. They will perform a physical examination, looking inside your nose with a small light to check for signs of swelling, mucus, or bleeding. They may also gently press on your forehead and cheeks to see if those areas are tender.

Investigations

In most cases, a physical exam is all that is needed. However, if your symptoms are persistent or if the doctor is worried about a more serious injury, they might suggest further tests:

• Transillumination: This involves shining a bright light against your skin near the sinuses to see if the light passes through clearly. If a sinus is blocked or filled with fluid, it will look darker than usual.
• CT Scan: This is a special type of X-ray that creates detailed pictures of your sinuses. It is usually reserved for people who have frequent, recurring problems or if the doctor suspects there is a structural issue or a more serious injury.

Management and Treatment

The good news is that most cases of sinonasal barotrauma get better on their own with a little time and care. The goal of treatment is to reduce swelling and manage pain so that your sinuses can open up and drain naturally.

Your doctor may recommend:

• Decongestants: These are medicines (available as sprays or tablets) that help shrink the swollen tissues in your nose, making it easier for your sinuses to open.
• Nasal corticosteroids: These are sprays that help reduce long-term inflammation in the nasal passages.
• Pain relief: Simple over-the-counter painkillers, such as ibuprofen or paracetamol, are usually very effective at managing the discomfort.
• Nasal lavage: Using a saline (salt water) rinse can help clear out mucus and soothe the irritated lining of your nose.
• Antibiotics: If your doctor suspects that the pressure damage has led to a bacterial infection, they may prescribe a short course of antibiotics to help you heal.

If you have severe or recurring problems that do not respond to these treatments, you may be referred to an ENT specialist. In rare cases, a minor surgical procedure might be suggested to widen the sinus openings and help them drain more effectively.

Prevention

Prevention is the best way to manage this condition, especially if you are a frequent flyer or a diver.

• Avoid travel when congested: If you have a cold, a sinus infection, or a bad allergy flare-up, try to avoid flying or diving until you are fully recovered.
• Use caution with decongestants: If you must travel while slightly congested, speak to your doctor about using a decongestant spray before your flight or dive. Be aware that the effect of these sprays can wear off, which might cause problems during the return trip or as you ascend.
• Equalization techniques: If you are a diver, ensure you are using proper equalization techniques. If you feel pain while descending, stop and ascend slightly to let the pressure equalize before trying again. If you cannot equalize, do not force it; it is safer to end the dive.
• Manage allergies: If you suffer from hay fever, keeping your allergies well-controlled with daily medication can prevent the swelling that leads to blockages.

Outlook / Prognosis

For the vast majority of people, the outlook for sinonasal barotrauma is excellent. Most people recover fully within a few days once the pressure is relieved and the inflammation subsides. By following your doctor’s advice and avoiding activities that trigger your symptoms while you are congested, you can usually prevent this from happening again.

If left untreated, or if you continue to expose yourself to pressure changes while your sinuses are blocked, you may develop chronic (long-term) sinusitis. This can lead to persistent facial pain, ongoing congestion, and a reduced quality of life. However, with proper care and by listening to your body when you feel congested, you can manage this condition effectively and continue to enjoy your activities safely.