Isolated Dizziness as an Atypical Presentation of Ethmoid Sinus Mucocele: A Case Report

Paranasal sinus mucoceles are benign, expansile lesions that most commonly affect the frontal sinus with less frequent ethmoid sinus involvement. The most common presentation of these lesions is nasal or orbital symptoms due to their anatomical proximity to critical structures. Vestibular symptoms such as dizziness are exceedingly rare and unreported in the literature as a primary presentation of ethmoid mucoceles. We describe the case of a 77-year-old male patient with a history of well-controlled hypertension and hyperlipidemia who experienced a fall at home due to a sudden onset of dizziness, without losing consciousness. He reported persistent dizziness after the fall for three consecutive days, which prompted him to seek medical attention. Physical examination was unremarkable. Imaging performed revealed a chronic subdural hematoma and a left anterior ethmoid mucocele, which was compressing the medial orbit. He underwent endoscopic sinus surgery, which uncapped and drained the left ethmoid mucocele, after which the patient's clinical condition was noted to have improved. This anterior ethmoid mucocele presenting as isolated dizziness is indeed rare and unusual. This case illustrates the need to consider paranasal sinus disease in the differential diagnosis of peripheral vestibular disorders in the elderly. Prompt imaging combined with timely surgery may enhance outcomes and further avert complications.