|
|
|
| Case of the Month |
August 2007
Case of the Month
by Dr. Michael J. Sillers
|
26 yom presented with a prolonged h/o right frontal headaches and nasal congestion. His sense of smell was intact and he denied purulent nasal drainage. Diagnostic nasal endoscopy did not reveal significant inflammatory changes. He was initially treated with topical steroids with no improvement. Because of localized headaches and failure to improve with initial medical therapy, a 20-second screening CT was performed with near-complete right frontal sinus opacification noted. The patient was treated with 2-3 week courses of antibiotics, mucolytics and topical steroids with no change in symptoms. Subsequent 40-second, navigation protocol CT confirmed persistent disease, similar to the initial screening CT. Options were discussed with the patient and surgery was scheduled.
Careful inspection of the CT scan shows a partially opacified right frontal sinus with a well-aerated, moderate-sized agger nasi cell. The uncinate process is thickened and the maxillary infundibulum appears obstructed with associated maxillary mucosal thickening. The anterior ethmoid artery can be seen within the anterior ethmoid sinus and the posterior ethmoid cavity is non-diseased. The patient’s left side appears normal.
This case illustrates a common clinical problem: headache as a primary complaint with minimal associated nasal/sinus symptoms or endoscopic findings. CT scanning is generally not indicated as an initial test in all patients with headaches, particularly if diffuse, and prior to medical therapy. However, in patients with localized headaches, CT scanning can provide useful information and assist in guiding appropriate care. |
| |
|
|
|
|
|
| |
|
| |
Michael J. Sillers, M.D. graduated from the University of Alabama in 1984 and received his M.D. from the University of Alabama in 1988. He completed an internship in general surgery and a residency in otolaryngology-head and neck surgery at the University of Alabama-Birmingham in 1993. He completed his training as a fellow in rhinology and sinus surgery at the Medical College of Georgia and joined the faculty at UAB in 1994. He was promoted to Professor of Surgery in 2003 and held the endowed James J. Hicks Chair in Otolaryngology-Head and Neck Surgery. He is currently the founder and director of the Alabama Nasal and Sinus Center in Birmingham, AL.
Dr. Sillers has served on the American Rhinologic Society Board of Directors since 1999 and has served a one-year term as President. He has also served on the Rhinology and Paranasal Sinus Committee and received an Honor Award from the American Academy of Otolaryngology-Head and Neck Surgery in 2001. He has been listed as one of America’s top doctors (Castle and Connolly Medical LTD), is a member of Alpha Omega Alpha, and has been named faculty member of the year in Otolaryngology-Head and Neck Surgery on several occasions at UAB.
Dr. Sillers has published numerous peer review articles in the field of rhinology and sinus surgery and is an invited lecturer at educational courses around the country and abroad. He serves as a peer reviewer for the American Journal of Rhinology and the Archives of Otolaryngology. His clinical research interests include surgical navigation and extended applications of transnasal endoscopic surgery. |
|
|
