Case study ( 4253 views as of February 22, 2018 )
Janice, a 39-year-old mother of two young children, presents with a 10-day history of a worsening cold and nasal congestion that is not getting better. She states that it all started with a cold that got somewhat better after the first five days but has now become worse again. She is getting coloured nasal discharge, pain and pressure in both her cheek sinuses. She finds that her nasal passages are congested and her sense of smell is compromised. She feels tired and does not have the energy to get out of bed and drop her kids off at school in the morning. She denies fevers.
As her symptoms have worsened and continue past seven days, Janice now has moderate to severe acute rhinosinusitis. She meets the Canadian Guidelines criteria for acute sinusitis as she complains of the PODS (pain and pressure, obstruction, discharge and smell loss) symptoms lasting more than five days.
Recommended acute sinusitis treatment is starting Janice on a nasal steroid spray, two sprays to each nostril twice daily, nasal irrigations with saline once to twice daily and encouraged hydration. If her symptoms do not start to turn around within 48 hours, Janice should be started on an antibiotic regimen with the first line of treatment being amoxicillin 500mg po tid.Author: Dr. Amin Javer