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Full text of "Diseases Of The Nose Throat And Ear"

CHAPTER 16

MISCELLANEOUS AFFECTIONS OF
THE SINUSES

AERO-SINUSITIS

Aero-sinusitis, or barotrauma, is still met with despite pressurization of
aircraft as greater altitudes and greater speeds of ascent and descent are
achieved. It is also found in deep diving and under-water swimming. The body
cavities, including the middle ears and sinuses, are affected directly by
changes in barometric pressure if their communicating passages to the outside
are obstructed. If obstruction occurs during ascent the pressure inside the
sinus becomes greater than that outside with consequent expansion of
enclosed air to the limit of the lining walls and resultant pain. During descent
the opposite effect occurs and the mucosal lining may even be torn from the
walls with submucosal haemorrhage. Pus in the nose may be sucked into the
sinuses with pain in the frontal region, the cheek or the ear. The treatment is
largely preventive in that any anatomical obstruction to airway from a
deflected nasal septum or polypi or allergic oedema should be corrected
before flying or deep diving. Pilots with such defects should not be accepted
until these have been corrected, and patients should be discouraged from
flying if they suffer from coryza or known sinus infection.

INJURY TO THE SINUSES

Frontal Sinus. Direct violence may cause a fracture of the anterior wall of the
sinus with depression of the fragments which may be elevated into place. A
fracture involving the posterior wall of the sinus may cause a tear in the dura
mater and is thus potentially serious. It may be diagnosed on lateral radio-
graphy which will show the presence of air in the anterior fossa, and from a
discharge of cerebrospinal fluid from the nose. If the condition does not
resolve on antibiotic treatment the dural defect must be closed at an external
operation either by means of an osteoplastic flap approach or by access being
gained directly through the frontal sinus if the anterior wall is also fractured.
Maxillary Sinus. A direct blow to the face may fracture the frontal process of
the maxilla, the fracture line extending from the lower rim of the orbit at the
infra-orbital foramen down the anterior wall of the sinus. A more lateral blow
may fracture the malar bone and even the lateral wall of the antrum. The
malar bone is elevated into place by a lever inserted through an incision over
the temporal fossa. Diplopia suggests an involvement of the orbital wall of the
antrum, and fragments may have to be repositioned through a Caldwell-Luc
approach.

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