Excessive Paranasal Sinuses and Mastoid Aeration as a Possible Cause of Chronic Headache

The objective of this case report is to present a patient with chronic headache who was diagnosed with excessive aeration of all paranasal sinuses and mastoid air cells using computed tomography imaging. The volume and linear measurements of all of the cavities revealed values greater than the greatest values reported in the literature. To date, this is the second reported case of excessive enlargement of all paranasal sinuses and the first which includes the enlargement of the mastoid air cells. No surgical intervention was required for the patient, but in similar cases, with more severe symptoms, surgical treatment is a challenge for the surgeon and may mandate a multidisciplinary approach. 1. Introduction Excessive enlargement of the paranasal sinuses is a rare entity with an uncertain aetiology. In the medical literature, it has been described with many terms including hypersinus, pneumocele, pneumatocoele, sinus ectasia, hyperpneumatization, and pneumosinus dilatans. It usually affects the frontal sinus, although any sinus can be pathologically enlarged. We present a case of a patient with chronic headache, diagnosed with excessive aeration of all paranasal sinuses, together with atypical mastoid pneumatization. To the authors’ knowledge, this has not been previously reported in the literature. 2. Case Presentation A 38-year-old woman was referred for evaluation to the outpatient otorhinolaryngology clinic by the neurology department. The patient complained of intermittent episodes of moderate, nonthrobbing, and severe pressure-like headache since early adulthood. The headache was typically located at the anterior part of the cranium, mainly over the frontal, the anterior parietal, and temporal area. The symptoms usually lasted for hours and were sufficiently relieved by common analgesics such as paracetamol and nonsteroid anti-inflammatory drugs. The pain was not accompanied by facial swelling and was not related to head position (bending forward, lying down, or sitting up). Palpation of the face and anterior cranium did not reproduce the symptoms and no palpable or visually evident anatomic deformity was noted. Neurologic and ophthalmologic examinations were unremarkable. Routine laboratory parameters were within normal range. Nasal endoscopic examination did not reveal pathologic findings. The nasal septum was slightly deviated while the maxillary and sphenoid ostia appeared patent. Although the frontal sinus ostium could not be visualized endoscopically on either side, no mucosal abnormalities were apparent at the area of the frontal sinus