Frontal Sinus Barotrauma in an Airliner Passenger with Undiagnosed Allergic Rhinitis.

Abstract

Background: Sinus barotrauma, or aerosinusitis, occurs during rapid atmospheric changes in aviation, primarily affecting the frontal sinus. Mucosal swelling from a cold or allergic rhinitis (AR) can obstruct pressure equalization, leading to mucosal tears, cranial pain, and nasal bleeding. Despite its significance in aerospace medicine, high-quality imaging, nasal endoscopy, long-term outcomes, and the impact of AR management on sinus barotrauma remain inadequately documented in the literature.

Case report: A 29-yr-old healthy male healthcare provider experienced severe frontal sinus barotrauma during aircraft descent, presenting with intense frontal headache, ocular pain, and left epistaxis, with head computed tomography revealing a fully opacified left frontal sinus. Despite experiencing persistent severe AR symptoms daily, he had never been diagnosed or treated for AR, and his symptoms worsened during the flight. The clinical presentations and image findings suggested a diagnosis of frontal sinus barotrauma. His initial treatment included oral decongestants, antihistamines, and acetaminophen. Remarkably, follow-up computed tomography/magnetic resonance images over 2 wk, 1 mo, and 1 yr demonstrated the spontaneous resorption of the submucosal hemorrhage in the frontal sinus. Furthermore, though concurrently diagnosed with perennial AR due to house dust mite and cat fur sensitization, the patient's effective pharmacological management of AR symptoms led to an uneventful flight 1 yr later.

Discussion: This case demonstrates that submucosal hemorrhages in the affected sinus generally resolve spontaneously within a year. Also, it highlights the critical need for diagnosing and managing sinonasal disorders in symptomatic individuals before flights to prevent sinus barotrauma. Park MJ, Kang SJ, Kim GT, Kim S. Frontal sinus barotrauma in an airliner passenger with undiagnosed allergic rhinitis. Aerosp Med Hum Perform. 2025; 96(7):581-585.