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2017 ; 8
(3
): 109-117
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Barosinusitis: Comprehensive review and proposed new classification system
#MMPMID29070267
Vaezeafshar R
; Psaltis AJ
; Rao VK
; Zarabanda D
; Patel ZM
; Nayak JV
Allergy Rhinol (Providence)
2017[Oct]; 8
(3
): 109-117
PMID29070267
show ga
BACKGROUND: Barosinusitis, or sinus barotrauma, may arise from changes in ambient
pressure that are not compensated by force equalization mechanisms within the
paranasal sinuses. Barosinusitis is most commonly seen with barometric changes
during flight or diving. Understanding and better classifying the
pathophysiology, clinical presentation, and management of barosinusitis are
essential to improve patient care. OBJECTIVES: To perform a comprehensive review
of the available literature regarding sinus barotrauma. METHODS: A comprehensive
literature search that used the terms "barosinusitis," "sinus barotrauma," and
"aerosinusitis" was conducted, and all identified titles were reviewed for
relevance to the upper airway and paranasal sinuses. All case reports, series,
and review articles that were identified from this search were included. Selected
cases of sinus barotrauma from our institution were included to illustrate
classic signs and symptoms. RESULTS: Fifty-one articles were identified as
specifically relevant to, or referencing, barosinusitis and were incorporated
into this review. The majority of articles focused on barosinusitis in the
context of a single specific etiology rather than independent of etiology. From
analysis of all the publications combined with clinical experience, we proposed
that barosinusitis seemed to fall within three distinct subtypes: (1) acute,
isolated barosinusitis; (2) recurrent acute barosinusitis; and (3) chronic
barosinusitis. We introduced this terminology and suggested independent treatment
recommendations for each subtype. CONCLUSION: Barosinusitis is a common but
potentially overlooked condition that is primed by shifts in the ambient pressure
within the paranasal sinuses. The pathophysiology of barosinusitis has disparate
causes, which likely contribute to its misdiagnosis and underdiagnosis. Available
literature compelled our proposed modifications to existing classification
schemes, which may allow for improved awareness and management strategies for
barosinusitis.