![]() The most serious form of ascent barotrauma is pulmonary injury. Barotrauma on ascent may similarly result in the ear, sinus, and dental trauma (tooth explosion). ![]() Sinus squeeze can be excruciating, usually in the setting of chronic sinusitis with occluded ostia. Ear squeeze can occur in the ear canal or middle ear. Sinus barotrauma skin#Mask squeeze can cause skin ecchymosis imprinting the mask pattern on the face, conjunctival hemorrhage, and rarely, orbital hemorrhage. Dental squeeze can cause an implosion of carious teeth. The ‘squeezes’ are caused by the inability to equalize pressure on the descent, classically across the face mask, sinuses, teeth, or ear. Barotrauma occurs most commonly while scuba diving, but also may occur during flying, mountain climbing, or skiing. During scuba diving, barotrauma may be caused by descending or ascending too rapidly. Due to the density of water, pressure during a dive increases one additional 1 Atm for every 33 feet of seawater depth. Both of these measurements are equivalent to one atmosphere (1 Atm or 1 Barr). This is also measured in millimeters of mercury as 760mmHg. Atmospheric pressure at mean sea level is 14.7 psi. Similarly, the compressed air held in a diver’s lung, if he holds his breath, will expand as the surrounding water pressure decreases on the ascent. A balloon that rises in the atmosphere will expand in volume as the ambient pressure decreases. EtiologyĪccording to Boyle’s Law of Gases, if the temperature of a gas is held constant, there is an inverse relationship between the volume of the gas and its pressure. This causes embolic blockage of the circulation at distant sites or interferes with normal organ function. Tears in pulmonary tissue can allow gas to enter the circulation. Barotrauma most usually causes sinus injury or middle-ear injury, but may also cause facial injury, tooth injury, gastrointestinal (GI) rupture, pneumothorax, pulmonary hemorrhage, mediastinal and subcutaneous emphysema. The damage is due to compressive/ expansive forces and shear, leading to overstretching of tissues.
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