Decompression Sickness Does Not Cause Intractable Sinus Disease
Decompression sickness ("the bends") does not cause intractable or chronic sinus disease. The relationship between diving and sinus problems is primarily related to acute barotrauma during pressure changes, not decompression illness itself.
Understanding the Distinction
The confusion here stems from conflating two separate diving-related conditions:
Barotrauma (Not Decompression Sickness)
Sinuses are affected by barotrauma, not decompression illness. Barotrauma occurs when gas-filled cavities cannot equalize pressure during descent or ascent 1. The sinuses are explicitly listed as organs at risk for barotrauma due to compression or expansion of gas-filled spaces 1.
- Mechanism: During descent or ascent, if sinus ostia are blocked (by congestion, polyps, anatomical obstruction), pressure cannot equalize, causing mucosal injury, hemorrhage, and pain
- Timing: Occurs during the dive itself, particularly during descent
- Nature: Acute injury, not chronic disease
Decompression Sickness (The Bends)
Decompression sickness results from bubble formation in tissues and blood when dissolved inert gas comes out of solution during ascent 1. The documented manifestations of decompression sickness include 1:
- Limb pains ("the bends")
- Fatigue and malaise
- Neurological symptoms (ranging from paresthesias to paralysis)
- Pulmonary symptoms when severe ("the chokes")
- Cardiovascular collapse in extreme cases
Notably absent from this list: chronic sinus disease.
Clinical Reality
The 2026 Malta Consensus on paranasal sinus disorders in diving 2 addresses sinus problems in divers but frames them as:
- Pre-existing anatomical obstructions that increase barotrauma risk
- Acute barotrauma requiring conservative management per EPOS guidelines
- Conditions requiring surgical correction (FESS) when refractory, followed by 8-week diving restriction
This consensus does not describe decompression sickness causing sinus pathology.
Key Caveat
While decompression sickness doesn't cause intractable sinus disease, divers with chronic sinus disease or anatomical obstruction are at increased risk for sinus barotrauma 2. This is the reverse causality: pre-existing sinus disease makes diving dangerous, not diving causing chronic sinus disease through decompression illness.
Bottom Line
If a patient presents with chronic sinus problems after diving, consider:
- Acute sinus barotrauma from the dive itself (pressure-related injury)
- Pre-existing chronic rhinosinusitis that may have been asymptomatic
- Other causes unrelated to diving
Do not attribute chronic sinus disease to decompression sickness, as this misdiagnosis could lead to inappropriate hyperbaric treatment and miss the actual pathology requiring standard ENT management 2.