A diver with sinus pain, congestion, and nasal discharge after diving has which diagnosis and what is its pathophysiology?

A diver with sinus pain, congestion, and nasal discharge after diving has which diagnosis and what is its pathophysiology?

• A. Acute sinusitis due to infection
• B. Sinus barotrauma; obstruction causing pressure difference
• C. Allergic rhinitis
• D. Sinusitis due to trauma

Answer: (B)

The key idea is that changing ambient pressure during a dive must be equalized with the air-filled sinuses through their drainage openings. If those ostia are blocked by congestion or swelling, air cannot move in or out, so a pressure difference builds up between the sinus and the surrounding air. This pressure mismatch injures the sinus mucosa, causing facial pain, congestion, and nasal discharge after the dive. That’s the scenario described here—sinus barotrauma from obstruction impeding pressure equalization. Infectious acute sinusitis isn’t typically triggered directly by a dive and usually presents with persistent facial pain, fever, and purulent discharge over days. Allergic rhinitis would show sneezing, itching, and chronic nasal symptoms without a dive-related pressure mechanism. Sinusitis from trauma would require a facial injury. The diving context with pain and nasal symptoms points to barotrauma due to blocked drainage pathways causing a pressure difference.

The key idea is that changing ambient pressure during a dive must be equalized with the air-filled sinuses through their drainage openings. If those ostia are blocked by congestion or swelling, air cannot move in or out, so a pressure difference builds up between the sinus and the surrounding air. This pressure mismatch injures the sinus mucosa, causing facial pain, congestion, and nasal discharge after the dive. That’s the scenario described here—sinus barotrauma from obstruction impeding pressure equalization.

Infectious acute sinusitis isn’t typically triggered directly by a dive and usually presents with persistent facial pain, fever, and purulent discharge over days. Allergic rhinitis would show sneezing, itching, and chronic nasal symptoms without a dive-related pressure mechanism. Sinusitis from trauma would require a facial injury. The diving context with pain and nasal symptoms points to barotrauma due to blocked drainage pathways causing a pressure difference.