Treatment of sinus barotrauma

An Unusual Case of Sinusitis in a Flight Attendant

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.

[Aerosinusitis: part 1: Fundamentals, pathophysiology and prophylaxis]

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.