Middle Turbinate Osteoma Causing Migraine like Symptoms

Case Report

Austin J Otolaryngol. 2015;2(2): 1030.

Middle Turbinate Osteoma Causing Migraine like Symptoms

Ciftci Z1, Deniz M1, Celik O2*, Oznur M3 and Gultekin E1

1Department of Otorhinolaryngology, Namik Kemal University, Turkey

2Department of Otorhinolaryngology, Maltepe University, Turkey

3Department of Pathology, Namik Kemal University, Turkey

*Corresponding author: Çelik Oner, Department of Otorhinolaryngology, Maltepe University, Feyzullah cad. No 39 34843, Maltepe/Ýstanbul, Turkey

Received: November 19, 2015; Accepted: February 14, 2015; Published: February 17, 2015

Abstract

Objective: To report an extremely rare case of an osteoma localized in a pneumatized middle turbinate and to emphasize the importance of a detailed otorhinolaryngological examination and imaging in headache patients, even in the presence of a previously diagnosed headache etiology.

Features of the Case: A 50-year-old female patient presenting with symptoms of progressive headache on one side of the head, facial pain and nasal obstruction and attended to neurology department with a suspicion of migraine. Cranial MRI was performed with a report of normal cranial investigation and a mass in the middle turbinate. Therefore, patient was referred to otorhinolaryngology clinic.

Treatment and Prognosis: The patient underwent endoscopic excision of the tumor and histopathological diagnosis confirmed the diagnosis of ‘osteoma’. She reported that she quitted taking analgesic medications following the operation.

Conclusion: Sinonasal osteomas should be taken into consideration when dealing with a patient presenting with headache. Detailed otorhinolaryngological examination along with imaging in suspected cases may prevent misdiagnoses and unnecessary use of medications.

Keywords: Osteoma; Migraine; Misdiagnosis; Pneumatized middle turbinate

Introduction

Pneumatization of the middle turbinates is a common anatomical variation in paranasal region and an important etiology of headache. In symptomatic patients, they trigger pain response either by impeding the drainage and ventilation of other sinuses or creating contact points in the nasal cavity [1].

Presence of an osteoma in the nasal cavity is a rarely encountered situation. Its incidence was reported to be as low as 0.6% in the literature [2]. Infrequently, the osteomas may be confined to middle turbinates. They may either be incidentally found in asymptomatic patients or discovered when they become symptomatic. They may cause symptoms like headache, facial and orbital pain and nasal obstruction [3]. Diagnosing an osteoma localized within a cavity in the paranasal region is a real challenge for the physician because conventional physical examination methods may not be helpful in establishing a diagnosis. Furthermore, the pain caused by the space occupying lesion in the paranasal region – also referred to as ‘sinus headache’ – usually may overlap or trigger other primary headache syndromes such as migraine [4].

Co-existence of the abovementioned pathologies, in other words ‘presence of an osteoma in a pneumatized middle turbinate’, is an extremely rare condition. In this article, the symptoms and findings of a 50-year-old female patient with bilateral pneumatized middle turbinates and an osteoma in the left middle turbinate are presented. The diagnostic and therapeutic options of the paranasal sinus osteomas are also discussed under the scope of the literature with a special emphasis on the importance of a detailed endoscopic examination and imaging in approach to patients presenting with headache.

Case Presentation

A 50 year old woman admitted to neurology department with symptoms of progressive headache on one side of head, facial pain and nasal obstruction. At that time cranial magnetic resonance imaging (MRI) was performed with a report of normal cranial investigation and a mass in the middle turbinate. Therefore, patient was referred to otorhinolaryngology clinic. Her medical history was insignificant and she reported that she did not attend to any ear nose throat surgeon before. Physical examination of the patient was normal except a slightly deviated septum on the right side. Nasal endoscopy revealed bilateral hypertrophic middle turbinates. No further pathology was observed. Computed tomography (CT) scan of the paranasal sinuses was taken and bilateral pneumatized middle turbinates and a hyperdense enlargement in the left middle turbinate were observed (Figure 1). The lesion was reported to be a possible osteoma. Aeration patterns and structures of the other regions were reported to be normal.