Hindawi Publishing Corporation Case Reports in Otolaryngology Volume 2013, Article ID 836064, 5 pages http://dx.doi.org/10.1155/2013/836064 Case Report Excessive Paranasal Sinuses and Mastoid Aeration as a Possible Cause of Chronic Headache Panagiotis Kousoulis, 1 Jiannis Hajiioannou, 1 Vassiliki Florou, 1 Dimitrios Kretzas, 1 and George Korres 2 1 Department of Otorhinolaryngology, General Hospital of Nikea-Piraeus, Greece 2 Department of Otorhinolaryngology, “Attikon” University Hospital of Athens, Greece Correspondence should be addressed to Panagiotis Kousoulis; pkousoulis@gmail.com Received 20 September 2013; Accepted 30 October 2013 Academic Editors: A. Rapoport, K. Takano, and A. Tas ¸ Copyright © 2013 Panagiotis Kousoulis et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. he 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. he 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 irst 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, hyperpneumati- zation, and pneumosinus dilatans. It usually afects 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 out- patient otorhinolaryngology clinic by the neurology depart- ment. he patient complained of intermittent episodes of moderate, nonthrobbing, and severe pressure-like headache since early adulthood. he headache was typically located at the anterior part of the cranium, mainly over the frontal, the anterior parietal, and temporal area. he symp- toms usually lasted for hours and were suiciently relieved by common analgesics such as paracetamol and nonsteroid anti-inlammatory drugs. he 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 unre- markable. Routine laboratory parameters were within nor- mal range. Nasal endoscopic examination did not reveal pathologic indings. he 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 outlow tract. A high resolution CT scan revealed that all the paranasal sinuses and especially the frontal sinuses were excessively enlarged. Similarly, the mastoid air cells showed bilaterally excessive pneumatization. No signs of bony erosion or thin- ning were evident in the CT scan. he frontal sinus extended posteriorly and laterally, encroaching the ophthalmic bulb. he frontal lobe appeared to be smaller in size, due to the posterior enlargement of the frontal sinus. No other