Question

A 36-year-old man presents with nasal congestion, headache, fatigue, facial pain, and chronic post-nasal drip. He has had similar episodes in the past, occurring 2-3 times a year for the last several years. He has been diagnosed with acute sinusitis and antibiotics have been prescribed, providing him with relief for a brief period. This time, however, his symptoms have bothered him on and off for the last 3 months. He was given a 14-day course of antibiotics, but he experienced only partial relief. He is tired of the recurrent episodes and wants a cure. On exam, he is afebrile, nasal mucosa is inflamed, and there is mucopurulent secretion in the nasal cavity. The right maxillary sinus is tender on palpation. Lungs are clear.

What is the next step in managing this patient?

Answer 1

The next step in managing this patient is to refer him to an otolaryngologist for further evaluation and management. Sinus CT scan and sinus surgery may be considered. Medical management strategies such as nasal saline rinses, intranasal corticosteroid sprays, and long-term antibiotic therapy may be recommended.

Step-by-step explanation:

The next step in managing this patient is to refer him to an otolaryngologist (ear, nose, and throat specialist) for further evaluation and management. Given the patient's chronic symptoms and previous partial response to antibiotics, it is important to explore other possible causes and consider more aggressive treatment options.

The otolaryngologist may recommend a sinus computed tomography (CT) scan to assess the severity of sinus disease and to identify any structural abnormalities. In cases of chronic sinusitis, sinus surgery may be considered to improve sinus drainage and alleviate symptoms.

Additionally, the otolaryngologist may suggest medical management strategies such as nasal saline rinses, intranasal corticosteroid sprays, and possibly long-term antibiotic therapy to reduce inflammation and prevent infection recurrence.