Differential Diagnosis

The patient's symptoms of vertigo, tinnitus, and ear fullness, combined with the CT findings of polypoid mucosal thickening in various sinuses, suggest a range of possible diagnoses. Here is a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Chronic Rhinosinusitis with Nasal Polyposis: This condition is characterized by chronic inflammation of the sinuses and the formation of nasal polyps, which can cause the symptoms and CT findings described. The presence of polypoid mucosal thickening in multiple sinuses supports this diagnosis.

• Other Likely Diagnoses

  • Allergic Fungal Sinusitis: This condition involves an allergic reaction to fungi in the sinuses, leading to inflammation and polyp formation. It could explain the patient's symptoms and the CT findings.
  • Sinusitis with Eustachian Tube Dysfunction: The Eustachian tube connects the middle ear to the back of the nose and throat. Dysfunction of this tube can cause ear fullness and other symptoms described, and could be related to the sinusitis.
  • Vasomotor Rhinitis: This is a non-allergic condition that causes chronic nasal congestion, runny nose, and other symptoms, which might indirectly contribute to the patient's complaints, especially if it leads to Eustachian tube dysfunction.

• Do Not Miss Diagnoses

  • Sinus Cancer: Although less likely, cancer in the sinuses can cause similar symptoms and must be ruled out, especially if there are risk factors or if the patient does not respond to initial treatment.
  • Invasive Fungal Sinusitis: This is a serious and potentially life-threatening condition, especially in immunocompromised patients. It requires prompt diagnosis and treatment.
  • Cerebrospinal Fluid (CSF) Leak: If the sinuses are eroded, there could be a risk of CSF leak, which is a serious condition requiring immediate medical attention.

• Rare Diagnoses

  • Churg-Strauss Syndrome: A rare autoimmune condition that can cause asthma, high eosinophil counts, and vasculitis, including involvement of the sinuses.
  • Wegener's Granulomatosis (Granulomatosis with Polyangiitis): A rare autoimmune disorder that can affect various parts of the body, including the sinuses, and cause similar symptoms.
  • Sarcoidosis: A condition characterized by the growth of granulomas (inflammatory cells) in various parts of the body, including the sinuses, which could lead to the patient's symptoms.