Now offering gift cards up to $3,000
Critical Thinking Clinical Cases

Critical Thinking Clinical Case: Sinusitis

John Bielinski, MS PA-C By November 30, 2022No Comments

Sinusitis Case

43 yo M presents with a two-week history of sinusitis as confirmed by XRAY on day 10. He was started in decongestants on day 4 of symptoms without relief, then at day 8 was started on Amoxicillin 500mg TID. He’s been on the antibiotics for 6 days without relief. He still complains of frontal face pain, at times purulent nasal discharge and congestion.

What would you do next?


Per Sanford’s Guide:

1.) With acute sinusitis, clinical failure is considered after 3 days of treatment.

2.) Persistent sinus pain, nasal congestion, purulent nasal discharge and, perhaps, fever

despite recommended therapy.

3.) Could result from:

  • Infection due to an antibiotic resistant organism
  • Obstruction of the ostium of one or more sinuses
  • Sinusitis due to a non-infectious disease. e.g., granulomatosis with polyangiitis

Time for an ENT consult folks!

  • Optional diagnostic methods: collection of sinus exudate for culture by either sinus puncture or direct sinus endoscopy.
  • We must remember, common things happen commonly. Sinusitis for two weeks isn’t normal. Dig deeper. Horses are horses. Zebras initially look like horses.

If you still have questions please email us at

For account log in issues, email