Nasal speech associated with hyperaeration of the sphenoid sinus

The sinus sphenoidalis is the paranasal sinus most centrally located in the skull base and known to vary extremely in dimensions. A very large volume of the sinus visible on skull radiographs is called sinus 'hyperaeration'. This finding has been described many times in the literature, but is generally rare. The term 'pneumosinus dilatans' is synonymously used to address an unexpectedly large paranasal sinus. In the majority of cases, sphenoid sinus hyperaeration is not associated with any clinical symptoms. On the other hand, different complaints have been described in cases of extensive sphenoid sinus volume, such as headache, inflammation or neoplasia. This is a report of an adult patient with nasal speech who was thoroughly investigated for alterations of the upper airway in order to clarify the reason for the speech anomaly. After extensive diagnostics, the patient was found to have normal anatomy and no functional alteration of the velo-pharyngeal complex. However, an impressively large sphenoid sinus was shown on computed tomograms. This is likely the first report detailing a patient with nasal speech and hyperaeration of the sinus.