Campbell1 stated that infection occurs only rarely, and his series may be equitable, in terms of selection, with the initial Australian survey6. If, however, one considers the second Australian survey, with its more serious cases, then the infection complications are more frequent.
Acute sinusitis developed some hours after the dive and extended into subsequent days, in 28 per cent of the severe cases, usually with an exacerbation of pain over the affected area, a purulent nasal discharge and generalized systemic symptoms.
The patients with sinus barotrauma who subsequently developed a sinus infection possibly did so because of the haemorrhage and effusion in the sinus. This condition becomes a culture medium for organisms introduced by the flow of air into the sinus during descent. An occasional case of orbital cellulitis may extend from the ethmoidal or maxillary sinusitis, and it is a medical emergency. One case proceeded to blindness (Case Report 8.2). It is for this reason that the authors of this text now vigorously treat with antibiotics any persistence of symptoms following sinus barotrauma, i.e. commencing hours after the dive or continuing into the following day.
CASE REPORT 8.2: A 24-year-old professional trainee diver descended to 40 msw for 30 minutes despite an upper respiratory tract infection and descent-induced pain over his right maxilla and orbit. He slowed his descent to reduce these symptoms, but re-developed a sudden severe pain over his right cheek on ascent. Bleeding was evident after ascent, in his face mask. Three days later he complained of persistent right facial pain, blocked nose and epistaxis. The next day he had swollen right eyelids, mucopurulent nasal discharge and mild pyrexia. X-ray studies confirmed right maxillary and ethmoidal sinusitis. Antral washout and antibiotics were administered but did not prevent an extension of the orbital cellulitis and retinal artery thrombosis with permanent and total right-sided blindness. (From Bellini MJ. Blindness in a diver following sinus barotrauma. Journal of Laryngology and Otology 1987;101:386–389.)