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Chapter 10 — 5
PREVENTION
Active and frequent middle ear equalisation, using positive pressure techniques such as the
Valsalva, fortuitously assists by forcing air into the sinuses during descent and preventing
barotrauma of descent. The “equalising ahead of the dive” technique is applicable (Chapter 8).
Diving should be avoided if the diver is suffering from any upper respiratory tract infection, to
reduce both the risk of barotraumas and the infection complications. Smoking and allergic nasal
congestion (hay fever) increases the risk of sinus barotrauma by obstructing the sinuses. A
deviated nasal septum may also contribute to the development of sinus barotrauma, and if so, it
can be surgically corrected.
Not all patients with chronic sinusitis need avoid diving. If the ostia is open and there are no
polyps or other obstructions, the sinuses may get a good “washout” with air travelling into and
out of the sinuses as the diver descends and ascends. This medical procedure is free to divers.
Nasal decongestants used at the time of diving tend to reduce the congestion of the sinus ostia
(at least at the nasal end), but may not prevent sinus barotrauma of ascent. For this reason they
should be avoided. It is better for the diver to be prevented from descending (sinus barotrauma
of descent) than to be prevented from ascending (sinus barotrauma of ascent). See Chapter 37,
last page, for a discussion on the effects of drugs used to prevent sinus barotrauma.
Repeated minor sinus barotraumas can result in progressive scarring of the ostia, causing
obstruction and intractable sinus barotrauma. Then the diver has to choose between ceasing his
diving career or problematic endoscopic surgery.
Fig. 10.4