Abstract
We report the case of an 18-year-old male patient operated on for sphenoid sinus barotrauma after scuba diving. The patient attended our emergency department because of intractable headache but did not improve with conservative treatment. After computed tomography and magnetic resonance imaging examination, he was diagnosed with sphenoid sinusitis that extended to the nasal septum. He therefore underwent surgery for sinus ventilation and abscess drainage.
1
Introduction
Barotrauma is tissue injury associated with rapid pressure change . Most cases of barotrauma are related to air travel and cause middle ear and inner ear injury, but sometimes, barotrauma of the paranasal sinus is reported after air travel . Reports of sinus barotrauma related to marine sports such as scuba diving or diving are uncommon, and sinus barotrauma caused by diving generally involves the frontal sinus or maxillary sinus .
Recently, we encountered a case of barotrauma of the sphenoid sinus after scuba diving, which progressed to a septal abscess and was treated by surgical management. Sinus barotrauma is thought to have increased significantly with the diversification of leisure activities and greater public involvement in marine sports.
2
Case
A previously healthy 18-year-old male patient visited our hospital emergency department because of a bilateral temporo-occipital area headache that had gradually worsened. The headache had been caused by scuba diving without a pressure control device 3 weeks previously, and immediately, after the scuba diving, mild epistaxis had occurred. As the patient’s symptoms improved after symptomatic treatment, he was discharged without admission. After returning home, his headache worsened, so he was admitted to the department of neurology. He had been treated with oral antibiotics and analgesics for a week before admission, but the treatment was not effective. Past history and family history were unremarkable, and there were no symptoms except for bilateral temporo-occipital headache. Brain computed tomography (CT) taken the previous week in the emergency department showed no abnormal findings except for soft tissue density of the bilateral sphenoid sinus. Paranasal sinus (PNS) CT and brain magnetic resonance imaging (MRI) were performed after admission to the neurology department. Because there were no abnormal findings other than the sphenoid sinus lesion, the patient was transferred to the department of otorhinolaryngology ( Fig. 1 ). Left-sided nasal septal deviation and bulging of the mucosa in the posterior portion of the right nasal septum were observed on endoscopic examination ( Fig. 2 ). Aspiration was performed at the bulging portion of the right nasal septum, and bloody pus was aspirated. There were no polyps or postnasal drips around the openings of the bilateral sphenoid sinus.
We performed the surgery immediately after transfer to our department because of the nasal septal abscess. The submucosal pus collected in the posterior portion of the right nasal septum was drained with septoplasty, and the deviated nasal septum was corrected. Then, the pus and necrotic soft tissue inside both sphenoid sinuses were removed by bilateral sphenoidotomy ( Fig. 3 ) via endoscopic sinus surgery. Biopsy of the necrotic soft tissue inside the sphenoid sinus revealed acute inflammatory exudates. After discharge, the patient failed to attend our outpatient clinic and only visited 2 months after discharge. Endoscopic examination at that time revealed a small septal perforation in the area where pus had collected. The openings of the sphenoid sinus were well maintained with well-healed sinus mucosa and no mucosal swelling ( Fig. 4 ). The headache of which the patient had complained no longer occurred, and there were no other symptoms.
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