Current RMA Instruments
| Reasonable Hypothesis SOP | 23 of 2019 |
| Balance of Probabilities SOP | 24 of 2019 |
Changes from previous Instruments
ICD Coding
- ICD-9-CM Codes: 993.1
- ICD-10-AM Codes: T70.1
Brief description
Barotrauma literally means pressure related trauma, with the pressure referring to atmospheric pressure. Barotrauma occurs when a pressure difference develops across a gas containing structure, causing damage to the structure. For sinus barotrauma the structures are the paranasal sinuses (ethmoid, maxillary, sphenoid, frontal). Most cases occur in scuba divers and fliers.
Normally atmospheric pressure changes are transmitted to the paranasal sinuses by communicating pathways (ostia), leading to equalisation of the pressure. However, if the atmospheric pressure changes are too rapid or if the ostia are inadequate, a pressure difference can cause mucosal engorgement, edema, and inflammation. The frontal sinus is most commonly affected.
Confirming the diagnosis
Diagnosis is made based on the history and clinical presentation. Paranasal sinus imaging may be undertaken. The diagnosis may be made by a GP or other doctor with diving and hyperbaric medicine accreditation or aviation medicine accreditation.
The relevant medical specialist is an Ear, Nose and Throat surgeon.
Additional diagnoses covered by SOP
- Aerosinusitis
- Barosinusitis
- Sinus squeeze
Conditions not covered by SOP
- Decompression sickness*
- Dysbaric osteonecrosis*
- Otitic barotrauma*
- Pulmonary barotrauma*
* Another SOP applies
Clinical onset
This is an injury. Clinical onset is at the time of the event causing the pressure difference to occur. Symptoms may not be noticed immediately in some circumstances, so some SOP factors allow 24 hours for clinical manifestations to develop. Common symptoms include localised sinus pain, epistaxis, and headache.
Clinical worsening
The usual course for sinus barotrauma is for the condition to resolve. Treatment is with topical decongestants and painkillers. In severe cases surgery may be required to restore ventilation and drainage of the sinus. Recurrent sinus barotrauma generally indicates an underlying pathology or abnormality.