Sinus Squeeze

Sinus squeeze, a condition where pressure inside a sinus cavity causes pain, commonly occurs when a scuba diver cannot equalize sinus pressure due to nasal congestion. This is also called (sinus) barotrauma. There are four pairs of sinuses in the skull. Each sinus has a narrow connection (air passageway) into the nasal cavity, which allows air to move back and forth and keep the pressure equal between the inside of the sinus and the outside surrounding area. If air pressure cannot equalize during a divers descent then a vacuum develops in the sinus cavity. The frontal sinus is most commonly affected; sinus squeeze can occur in other conditions that cause rapid changes in pressure such as sky diving or in individuals that enter pressure chambers (for example, hyperbaric oxygen chambers).

Any change in altitude, such as climbing or taking an airline flight, can have a similar effect. Sometimes, this is called "aerosinusitis," and most people that are affected experience frontal sinus pain on the airplane's descent for landing.

The presence of a "cold" or upper respiratory tract infection increases the risk of developing sinus squeeze. Also, those with nasal polyps or a deviated septum (the wall that divides the nostrils) can increase the chances of developing sinus squeeze.

• Pressure or pain in the forehead or around the teeth, cheeks, or eyes may occur.
• The nose may bleed.
• Pressure and pain increase with increased diving depth due to swelling of the lining of the sinus (mucosal lining) and also bleeding into the sinus.
• When a diver ascends (goes back to the surface) the remaining air in the sinus expands and may force blood or mucus into the nose and mask.
• For airline passengers, pain is usually felt during landing.

The following guidelines are suggested in treating sinus squeeze:

• Apply warm compresses to the face.
• Pain medications such as acetaminophen (or stronger if prescribed by a health care professional) may be needed to treat symptoms.
• Avoid diving until recovery is complete.
• Oral pseudoephedrine and topical nasal sprays (such as Afrin) should be used. Oral steroids (such as prednisone) for 3 to 5 days can help to improve symptoms.
• Relieve pain with acetaminophen tablets or ibuprofen tablets (Advil, Motrin), taken as recommended by the manufacturer.
• People with upper respiratory infections or chronic sinus problems should take an oral decongestant prior to flight and a nasal decongestant spray just prior to descent.

Oral antibiotics are usually recommended only if sinus pressure persists or if thick, infected discharge from the ear, nose, or mouth develops. If a patient uses antibiotics and needs to be exposed to sunlight, the person should use sunscreen (15 SPF or higher) because the antibiotics may make the skin sensitive to sunlight.

• Seek medical treatment as soon as possible.
• Consult a doctor or health care professional about treatment with available medications.