- Grade II is characterized by severe pain for up to 24 h, with some mucosal thickening on X-ray.
- Patients with grade III have severe pain lasting for more than 24 h and X-ray shows severe mucosal thickening or opacification of the affected sinus; epistaxis or subsequent sinusitis may be observed.
Aerosinusitis diagnosis:Radiologic assessment is usually necessary to establish the diagnosis but may help to indicate location and to search for underlying causes. Plain films are useful to isolate location. The usual finding is mucosal edema, which can range from slight thickening to total opacification of one or more sinuses. There may be air-fluid (i.e., blood) levels. Hematoma formations, usually in the frontal sinus, are smooth and oval; they may be small or may nearly fill the sinus. CT scans are considered the criterion standard for imaging assessment of aerosinusitis. Obtain coronal and axial views. CT scanning accurately defines involved sinuses, extent of any hematoma, and mucosal thickening. The study can suggest predisposing factors (e.g., septal deviation, middle meatus and turbinate abnormalities, nasal polyposis, underlying mass). CT scanning is an excellent tool for surgical planning. MRI is similar to CT scanning in predicting involved sinuses, but it does not provide bony detail. MRI is better than CT scanning in differentiating paranasal sinus masses, although it is not as useful as CT scanning in surgical planning and can be more time consuming to obtain. Other tests (e.g., ultrasound) are atypically used to aid in diagnosis or treatment. Transillumination of the sinuses may provide some additional information on location of barotrauma, but it is unreliable and does not change treatment. Treatment: Management of this condition is based on the Weissman stage. Stage I or II lesions are generally treated conservatively with a 1-week course of topical sprays, analgesics, a tapering course of steroids, and oral decongestants. Use of antibiotics is reserved for those cases initiated by bacterial sinusitis. Additionally, antihistamines are reserved for cases where allergies were the inciting cause. Stage III lesions are rarely seen in civilian air travelers due to the relatively low fluctuations in ambient air pressure. Air-crew that suffer Stage III aerosinusitis are at risk for recurrent sinus barotrauma that may require an expertly performed functional endoscopic sinus surgery to successfully manage it. NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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