How do I treat a sinus injury caused by flying?

Treatment for Sinus Injury from Flying (Aerosinusitis)

For sinus pain caused by flying, use analgesics like acetaminophen (1000mg) combined with nasal decongestants and saline nasal irrigation as first-line treatment. 1

Understanding Aerosinusitis

Aerosinusitis (sinus barotrauma) occurs due to pressure changes during air travel, particularly during descent, causing pain when air cannot equalize between the sinuses and cabin pressure. This condition affects approximately 1-2% of air travelers and typically presents as:

• Unilateral fronto-orbital pain (often severe)
• Jabbing, stabbing, or pulsating pain
• Pain lasting less than 30 minutes
• Pain occurring primarily during landing/descent

Immediate Treatment

1. Pain Management:

   • Acetaminophen 650-1000mg every 6 hours as needed 2
   • NSAIDs like ibuprofen can also be effective 1

2. Nasal Decongestants:

   • Topical decongestant sprays (oxymetazoline) 15-30 minutes before descent
   • Oral decongestants like pseudoephedrine can help maintain sinus drainage

3. Nasal Irrigation:

   • Saline nasal irrigation to clear sinus passages
   • Can be performed before flight and after landing

4. Physical Maneuvers During Flight:

   • Compression of the pain region
   • Valsalva maneuver (gently blowing nose while pinching nostrils)
   • Chewing gum or yawning to help equalize pressure 1

Prevention for Future Flights

1. Pre-Flight Preparation:

   • Begin oral decongestants 1 hour before flight
   • Use nasal decongestant spray 30 minutes before descent
   • Consider prophylactic analgesics before flight 1

2. During Flight:

   • Stay well-hydrated (avoid alcohol and caffeine)
   • Use saline nasal spray periodically to maintain moisture
   • Perform Valsalva maneuver during ascent and descent

3. For Recurrent Cases:

   • Consider prophylactic antibiotics if there's evidence of underlying sinusitis
   • Triptans have shown effectiveness for prevention in severe cases 1

When to Seek Further Medical Attention

Seek medical care if:

• Pain persists more than 24 hours after flying
• Symptoms include fever, purulent nasal discharge, or severe headache
• You have history of chronic sinusitis or recent sinus surgery

Special Considerations

• For Asthma Patients: Continue using prescribed inhalers and ensure asthma is well-controlled before flying 1, 2
• Post-Sinus Surgery: Delay air travel for at least 2 weeks after uncomplicated sinus procedures 1
• Chronic Sinusitis: May require more aggressive pre-flight preparation with antibiotics if infection is suspected 2

Common Pitfalls to Avoid

1. Overuse of Decongestants: Using nasal decongestants for more than 3 days can cause rebound congestion
2. Flying with Active Sinus Infection: Significantly increases risk of severe barotrauma
3. Ignoring Symptoms: Untreated sinus barotrauma can lead to complications including hearing loss or chronic sinusitis
4. Inadequate Hydration: Low cabin humidity worsens sinus symptoms; stay well-hydrated

Remember that while most cases of aerosinusitis resolve spontaneously within 24 hours, persistent symptoms warrant medical evaluation to rule out complications or underlying conditions.