October 2007 Newsletter

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October 2007 Case of the Month

39 year-old male with history of nasal obstruction which has been intermittent for the past 10 years.  He has remote history of trimalar fracture, repaired via an open approach 20 years ago.  Medications include nasal steroid spray and intermittent nasal irrigation with saline.

 Most recently, he reports a worsening of the nasal obstruction, new onset of thick drainage and a general feeling of malaise.  Nasal endoscopy demonstrates bilateral edema of the middle meatus. He has been seen multiple times over the past 4 years with the same complaints.   Discussion was held with patient whether to continue with medical therapy or perform further investigation.  Due to the severity of symptoms, patient elected to have a point-of-service CT scan, as he had not had one at any other episode.   

MiniCAT™ CT was performed in the office, which demonstrated bilateral mucosal thickening of the maxillary sinus and the plate from the trimalar fracture.  No other pathology was identified.  Based on these findings and the history, patient was diagnosed with recurrent acute sinusitis, most likely viral in origin, and was treated with decongestants and nasal irrigations with saline.  Symptoms resolved over the subsequent week.

James N. Palmer, MD

Assistant Professor, Co-Director Division of Rhinology,

Department of Otorhinolaryngology-Head and Neck Surgery

Education

College:  University of Chicago, BA Chemistry, 1990

Medical School:  Ohio State University, MD, 1995

Residency Program:   Otolaryngology, Northwestern University School of Medicine

Fellowship:  Sinus Disease, Georgia Nasal and Sinus Institute

Board Certified

2001

Year Appointed to Penn Faculty

2001

Areas of Expertise

Diseases of the nose and sinuses

Areas of Special Interest

Frontal sinusitis

Fungal sinusitis

Allergic fungal sinusitis

Chronic sinusitis

Current research interests

Biofilm diseases of the sinuses

Allergic fungal sinusitis

Outcomes of chronic sinusitis

Positions Held in Major Societies (Past & Present)

American Academy of Otolaryngology-Head and Neck Surgery

Facial Plastic Surgery

American Rhinologic Society