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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?

Solution

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.

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