The Many Faces of Rhinosinusitis: Case Challenges

Gordon H. Sun, MD, MS

September 22, 2015

Clinical Presentation: First Case—What Type of Sinusitis?

A 51-year-old teacher presented to an urgent care center with an 8-day history of bilateral yellowish nasal discharge; a clogged sensation in the nostrils; mild tenderness over both cheeks; and a slight, nonproductive cough. Her symptoms had remained stable since onset, though she "felt warm" during the first few days. She denies current fever, visual deficits, otalgia, or otorrhea.

She had similar symptoms approximately 2 months previously, which resolved without treatment, though she "doesn't think they lasted this long." She reported that one of her grade-school students had recently been ill. The patient had no significant medical history, had not been taking any medications, and quit smoking 12 years ago.

The patient appeared comfortable but sounded congested when speaking. She was afebrile, and all other vital signs were within normal limits. Eye exam was normal. Otoscopy demonstrated patent external auditory canals without otorrhea and clear tympanic membranes with normal mobility on pneumatic insufflation.

Anterior rhinoscopy demonstrated boggy, pale nasal mucosa, a septal deviation to the right, and yellowish mucus. Oral cavity and oropharyngeal examination demonstrated small tonsils without exudate and no postnasal drainage. The remainder of the head and neck examination was unremarkable.

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