1

Introduction

Barotrauma is tissue injury related to pressure change in body compartment gas volume . We present 2 cases of sphenoid sinus barotrauma during free diving at about 12-m depth.

2

Case 1

A 29-year-old male patient was admitted to our department presented with acute headache associated to free diving at about 13-m depth. The episode occurred during the patient’s ascent. The rest of his symptoms consisted of orbital pain accompanied by pain radiating to the occipital region and absence of rhinorrhea or nasal obstruction.

Neither any history of paranasal sinus nor nasal disease was reported. Moreover, no other pathologic cause was admitted from the physical examination. An opacification of the right sphenoid sinus and a small primary mucous cyst of the maxillary sinus were demonstrated by nasal computed tomography (CT) and magnetic resonance imaging ( Fig. 1 ). An outflow of hemorrhagic fluid was revealed through the right sphenoid sinus ostium under rigid nasal endoscopy ( Fig. 2 ). Conservative treatment was selected including nasal decongestants, intravenous administration of antibiotics (amoxicillin/clavulanic acid), and analgesics with a positive and satisfactory outcome.

Opacification of the right sphenoid sinus demonstrated by axial CT scan.

Endoscopic view of the right nasal cavity revealing drainage of hemorrhagic fluid through the right sphenoid sinus ostium under rigid nasal endoscopy.

2

Case 1

A 29-year-old male patient was admitted to our department presented with acute headache associated to free diving at about 13-m depth. The episode occurred during the patient’s ascent. The rest of his symptoms consisted of orbital pain accompanied by pain radiating to the occipital region and absence of rhinorrhea or nasal obstruction.

Neither any history of paranasal sinus nor nasal disease was reported. Moreover, no other pathologic cause was admitted from the physical examination. An opacification of the right sphenoid sinus and a small primary mucous cyst of the maxillary sinus were demonstrated by nasal computed tomography (CT) and magnetic resonance imaging ( Fig. 1 ). An outflow of hemorrhagic fluid was revealed through the right sphenoid sinus ostium under rigid nasal endoscopy ( Fig. 2 ). Conservative treatment was selected including nasal decongestants, intravenous administration of antibiotics (amoxicillin/clavulanic acid), and analgesics with a positive and satisfactory outcome.

Opacification of the right sphenoid sinus demonstrated by axial CT scan.

Endoscopic view of the right nasal cavity revealing drainage of hemorrhagic fluid through the right sphenoid sinus ostium under rigid nasal endoscopy.

3

Case 2

A 37-year-old man visited our department also experiencing abrupt headache associated with free diving at about 12-m depth. The patient during the commencement of his descent experienced a sudden incapacitating sharp pain that continued throughout his obligatory, due to his symptoms, ascent. Pain was typically located in the retro-orbital and the occipital area. Minor epistaxis was noted by the patient without significant nasal obstruction. Presence of hemorrhagic fluid was observed as well unilaterally under endoscopic view. The rest of his physical examination was within normal findings. Partial opacification of the right sphenoid sinus was demonstrated by CT. The patient followed the same conservative treatment with adequate results.