Journal Article

Algorithm for Management of the Refractive Aerosinusitis Patient

Andrew G Boston, K Christopher McMains, Philip G Chen and Erik K Weitzel

in Military Medicine

Volume 183, issue 7-8, pages e246-e250
Published in print July 2018 | ISSN: 0026-4075
Published online June 2018 | e-ISSN: 1930-613X | DOI: https://dx.doi.org/10.1093/milmed/usx222
Algorithm for Management of the Refractive Aerosinusitis Patient

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  • Medicine and Health
  • Emergency Medicine
  • Trauma and Orthopaedic Surgery
  • Military Psychology
  • Warfare and Defence

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Abstract

Introduction

For some career military aviators, their ability to continue on flight status is limited by the pressure and pain of aerosinusitis, which is present only while in the flying environment. Failure to treat their disease process can mean the end of their flying careers and the loss of valuable assets trained with taxpayer dollars. Because some medications commonly used in treatment of sinus diseases are not allowed in aviation, this presents a unique problem for their medical management. Surgical treatment must be aimed at treating to symptom relief and not solely disease mitigation. One alternative is operating “beyond the scope of disease” present during a one-atmosphere clinic visit.

Materials and Methods

A case series of nine career aviators with aerosinusitis treated at one academic military Otolaryngology department in a tertiary care facility. Results from a treatment algorithm that balances symptomatology and staged surgical intervention are reviewed. The primary endpoint was return to flight duty.

Results

For patients treated according to this algorithm, the mean time to return to flight duty was 3.8 mo, requiring an average of 1.2 surgeries. To date, 100% of career aviators have returned to flight duty using this method.

Conclusion

Refractory aerosinusitis represents a potentially career-ending medical condition for the aviator and lost training costs to the taxpayers. Using the treatment algorithm presented, 100% of aviators were able to return to flight duty; a savings of millions of dollars for taxpayers. Future work will focus on modifications to the surgical techniques to reduce the extent of surgery while maintaining satisfactory results. Additional study should be undertaken to assess generalizability of these results in the broader aviation community.

Keywords: sinus barotrauma; aviation; sinusitis; endoscopic sinus surgery; aviator

Journal Article.  2288 words.  Illustrated.

Subjects: Medicine and Health ; Emergency Medicine ; Trauma and Orthopaedic Surgery ; Military Psychology ; Warfare and Defence

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