Aerosinusitis, also known as sinus barotrauma, is a condition causing pain and inflammation in the sinuses caused by rapid changes in air pressure during air travel or diving. This discomfort arises when the air pressure inside the sinus cavities cannot equalize with the ambient air pressure outside the body. This article provides proactive measures and active techniques to help travelers achieve a comfortable and pain-free journey.
The Pressure Dynamics of Aerosinusitis
Aerosinusitis occurs because the gas inside the body’s air-filled cavities, including the paranasal sinuses, follows Boyle’s Law. This law dictates that the volume of a gas is inversely proportional to the surrounding pressure. As an aircraft descends, the ambient atmospheric pressure increases, causing the volume of air trapped in the sinuses to decrease.
If the small drainage openings of the sinuses, called ostia, are blocked by inflammation, fluid, or anatomical abnormalities, the air cannot pass freely to equalize the pressure. This trapped air contracts, creating a relative negative pressure, or “squeeze,” inside the sinus cavity compared to the outside air. The resulting pressure differential pulls on the sinus lining, causing mucosal swelling, pain, and sometimes bleeding. A “reverse squeeze” can also happen during ascent when trapped air expands but cannot escape, putting outward pressure on the sinus walls.
Proactive Measures Before Travel
Preparation before a flight significantly reduces the risk of a pressure-related incident by ensuring the sinus passages are open. If you have symptoms from a cold or allergies, treat these conditions several days in advance to reduce mucosal swelling. If you have chronic sinus issues, consult a physician, as underlying conditions may require specific management before flying.
Strategic timing of over-the-counter medications is beneficial for maintaining open ostia during pressure changes. Oral decongestants, such as pseudoephedrine, should be taken about one hour before the flight so the medication is active during descent. Note that these are not suitable for individuals with certain health conditions like high blood pressure or heart problems, and medical consultation is advised before use.
A topical nasal decongestant spray, such as oxymetazoline, provides localized relief by shrinking swollen tissues in the nasal passages. Use the nasal spray approximately 30 minutes before takeoff and again before the final descent to maximize its effect during the critical pressure-change periods. Because medicated nasal sprays can cause a rebound effect (rhinitis medicamentosa), they should be used sparingly and for no more than three days. Staying well-hydrated by drinking water frequently is also helpful, as it thins mucus and counteracts the drying effect of the cabin air.
Active Pressure Equalization Techniques
Once airborne, travelers must actively engage physical techniques, especially during descent, to encourage the free flow of air. The Valsalva maneuver gently forces air into the sinuses and middle ear. To perform it, pinch your nostrils closed, keep your mouth shut, and attempt to exhale softly through your nose, applying just enough pressure to feel a change without straining.
A gentler alternative is the Toynbee maneuver, which involves pinching the nose shut and swallowing repeatedly. Swallowing helps pull open the Eustachian tubes, and the tongue movement compresses air against the openings to aid equalization. The Frenzel maneuver is another method where you pinch your nose and then tense the back of your throat, making a soft “K” sound to use the tongue as a piston to compress air.
Chewing gum, sucking on hard candy, or simply yawning can also promote pressure equalization by activating the muscles that open the Eustachian tubes. Start these maneuvers early and perform them frequently, ideally before any significant pressure or pain is felt. If equalization fails, ascending slightly (if possible in a small aircraft or during diving) and trying a different technique can sometimes resolve the blockage.
Situations Requiring Travel Avoidance
In high-risk scenarios, travel should be postponed, as no amount of preparation can safely override the danger of pressure barotrauma. Flying with an active, severe upper respiratory infection (such as a cold, the flu, or acute sinusitis) carries a high risk of severe pain and complications. The inflammation and mucus associated with these infections create a near-total blockage of the ostia, making equalization almost impossible.
A history of recent nasal or sinus surgery also requires a period of strict travel avoidance to prevent complications. Surgeons typically recommend waiting at least seven to fourteen days after procedures like endoscopic sinus surgery or septoplasty before flying. Cabin pressure changes can worsen swelling, cause nosebleeds, or delay the healing process significantly. Individuals with chronic, severe blockages, such as large nasal polyps or significant anatomical issues that do not respond to medication, should consult their physician. In these cases, the risk of barotrauma may be too high, making a temporary delay the safest course of action.