Malta Consensus Statements on Paranasal Sinus Disorders in SCUBA Diving: Results of a Delphi Study

To establish expert consensus on the diagnostic approach, treatment strategies, and fitness-to-dive assessment for divers with paranasal sinus disease, addressing the current lack of specific guidelines for this frequent diving-related disorder.

A rapid, conference-based modified Delphi process was conducted with a panel of 14 Dutch otorhinolaryngologists, including four certified diving medicine specialists. Consensus was defined as more than 80% agreement.

The panel achieved consensus on recommendations across four domains. For diagnosis, a comprehensive ENT evaluation including nasal endoscopy is recommended; low-dose CT-imaging is advised for persistent or recurrent cases to identify anatomical obstructions. Primary management is conservative, adhering to EPOS guidelines. Functional endoscopic sinus surgery (FESS) is reserved for cases refractory to medical therapy, particularly those with anatomical obstruction. Postoperatively, it is advised to refrain from diving for a minimum of 8 weeks. Return to diving requires confirmed mucosal healing via endoscopy and a test dive under controlled conditions.

This Delphi-based consensus provides practical, evidence-informed guidance for clinicians, bridging the gap in formal guidelines and promoting uniform evaluation and treatment strategies within diving medicine.