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

Abstract

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.

Computed Tomography Imaging Features of Chronic Headaches in Abuja, Nigeria

“…This condition was not commonly reported among the reviewed studies but appears to be a relatively significant etiology of headache in our environment. A solitary case of excessive pnuematization of all the paranasal sinuses was seen and has been reported in literature as a possible cause of chronic headache [31].…”

Pneumosinus dilatans: Our experience and literature review

“…An aerated sinus called a pneumocele has a noticeable weakening of the sinus wall. What distinguishes pneumocele from pneumosinus dilatans is thinning, which can affect specific or generalized sections of the sinus wall 13 . PSD can occur at any age, but more frequently among people between 20 and 40 years old.…”

Mucosal contact points and paranasal sinus pneumatization: Does radiology predict headache causality?

“…Three categories of sinus hyperpneumatization are recognized: hypersinus refers to an enlargement of a well‐aerated sinus that develops within the normal boundaries of the bone; pneumosinus dilatans differentiates from hypersinus by abnormal extent of aeration (e.g., anteriorly), causing frontal bossing or posteriorly displacing the adjacent anatomic structures such as the frontal lobe; and a pneumatoceles, the third type of hyperpneumatization, which is characterized by focal erosion or generalized thinning of the bony walls . There are reports of chronic headache that was attributed to frontal pneumosinus dilatans, with or without hyperpneumatization of maxillary and sphenoid sinuses . It is unknown whether variable aeration of the PNS can cause headache.…”

“…53 There are reports of chronic headache that was attributed to frontal pneumosinus dilatans, with or without hyperpneumatization of maxillary and sphenoid sinuses. 14,54 It is unknown whether variable aeration of the PNS can cause headache. To the best of our knowledge, this is the first publication to address this issue.…”

“…Another sinonasal variation suggested to contribute to the development of headache symptoms is the hyperaeration of the paranasal sinus (PNS) . However, it is unknown whether variable aeration of the PNSs can contribute to headache.…”