The submucosal pus collected in the posterior portion of the right nasal septum was drained with septoplasty, and the deviated nasal septum was corrected.

We performed the surgery immediately after transfer to our department because of the nasal septal abscess. The left nasal cavity shows septal deviation to the left (B). The right nasal cavity shows septal mucosal bulging in the posterior portion of the nasal septum (A). There were no polyps or postnasal drips around the openings of the bilateral sphenoid sinus.Įndoscopic findings. Aspiration was performed at the bulging portion of the right nasal septum, and bloody pus was aspirated. Left-sided nasal septal deviation and bulging of the mucosa in the posterior portion of the right nasal septum were observed on endoscopic examination ( Fig. Because there were no abnormal findings other than the sphenoid sinus lesion, the patient was transferred to the department of otorhinolaryngology ( Fig. Paranasal sinus (PNS) CT and brain magnetic resonance imaging (MRI) were performed after admission to the neurology department. Brain computed tomography (CT) taken the previous week in the emergency department showed no abnormal findings except for soft tissue density of the bilateral sphenoid sinus. Past history and family history were unremarkable, and there were no symptoms except for bilateral temporo-occipital headache. He had been treated with oral antibiotics and analgesics for a week before admission, but the treatment was not effective. After returning home, his headache worsened, so he was admitted to the department of neurology. As the patient’s symptoms improved after symptomatic treatment, he was discharged without admission. The headache had been caused by scuba diving without a pressure control device 3 weeks previously, and immediately, after the scuba diving, mild epistaxis had occurred. Sinus barotrauma is thought to have increased significantly with the diversification of leisure activities and greater public involvement in marine sports.Ī previously healthy 18-year-old male patient visited our hospital emergency department because of a bilateral temporo-occipital area headache that had gradually worsened. Recently, we encountered a case of barotrauma of the sphenoid sinus after scuba diving, which progressed to a septal abscess and was treated by surgical management. Reports of sinus barotrauma related to marine sports such as scuba diving or diving are uncommon, and sinus barotrauma caused by diving generally involves the frontal sinus or maxillary sinus. Most cases of barotrauma are related to air travel and cause middle ear and inner ear injury, but sometimes, barotrauma of the paranasal sinus is reported after air travel. He therefore underwent surgery for sinus ventilation and abscess drainage.īarotrauma is tissue injury associated with rapid pressure change. After computed tomography and magnetic resonance imaging examination, he was diagnosed with sphenoid sinusitis that extended to the nasal septum.

The patient attended our emergency department because of intractable headache but did not improve with conservative treatment. We report the case of an 18-year-old male patient operated on for sphenoid sinus barotrauma after scuba diving.