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symptoms are unrelenting in an operational setting that precludes descent.
Patient Education
General: Whenever possible do not fly while suffering from acute dental disease.
Prevention: Good dental hygiene and regular check-ups with dentist.
Follow-up Actions
Return evaluation: Dental exam for diagnosis and treatment of underlying pathology.
Consultation Criteria: For severe cases, when symptoms not relieved upon descent, or when underlying
pathology is the cause.
NOTES: Barodontalgia should temporarily restrict personnel from special duty involving flight operations until
cleared by a Flight Surgeon.
Aerospace Medicine: Barosinusitis
LTC Brian Campbell, MC, USAIntroduction: The paranasal sinuses are bony structures with a fixed volume, containing air, mucus, and
water vapor. The pressure within the sinuses is normally equal to ambient air pressure and equalizes as
ambient pressure changes. When the pressure cannot be equalized due to malformations or swelling of the
sinus outflow tract, pain results. This is more likely to occur when descent from altitude results in a sinus
"squeeze." Upper respiratory tract infections (URIs), smoking, and untreated seasonal allergic conditions
greatly increase the risk of developing barosinusitis during flight. Barosinusitis is also seen with diving. See
Dive Medicine chapter.
Subjective: Symptoms
Acute onset of sharp, stabbing sinus pain on descent is classic. This pain can be quite severe and will
increase in severity with continued descent. Symptoms will abate with decreasing ambient pressure resulting
from return to altitude. Patients will bleed into the sinus in severe cases, thereby relieving the pressure
differential and significantly reducing the pain. Symptoms of sinus congestion and facial pressure akin to
that with a URI will then result.
Focused History: When did symptoms start? (Acute onset associated with change in altitude is a key
factor in differentiating from infectious etiology.) Have you had a fever or other signs of illness prior to this
flight? (History of recent illness can illuminate risk factors and/or provide clues to make differential diagnosis.)
Have you had any dental problems or dental treatments recently? (Affirmative answer may lead toward
barodontalgia as diagnosis, although maxillary tooth pain may occur with any sinusitis.)
Objective: Signs
Using Basic Tools: Patient is generally in obvious distress. Some redness and swelling of the face in the
affected area may be noted though not to the degree one would expect with purulent sinusitis. Increased
lacrimation is also possible. Bloody/mucoid nasal discharge may be seen from affected sinus in severe cases.
Transillumination of the sinus should reveal this.
Using Advanced Tools: X-ray: Sinus series X-rays (looking for air/fluid levels) are helpful if available.
Assessment:
Differential Diagnosis
Barodontalgia - caused by air trapped under a crown or amalgam or within a tooth cavity; may be suggested by
maxillary sinus symptoms present on ascent
Pulpitis or periapical abscess of the tooth - if maxillary sinus symptoms associated with a diseased tooth
are present on ascent