1a. A patient with fever and unilateral facial pain / headache
Case history– A 20 year’s lady suffered from fever, running nose and headache 5days ago and improved with paracetamol. Now she presents with reappearance of fever, pain and tenderness on the right side of face particularly over maxillary prominence.
What diagnosis strikes in your mind?
Acute bacterial rhinosinusitis (complication of common cold).
What key questions would you ask?
Unilateral facial fullness, pressure and tenderness over the cheek
Pain may refer to the upper incisor and canine teeth.
The “double-sickening” history.
What will you examine?
Fever
Tenderness over maxillary or other sinus
Nasal inspection- Purulent nasal discharge
Initial investigations-
Blood for TC, DC, Hb% and ESR. May be normal.
X-ray PNS OM view-will show haziness of maxillary or frontal sinus (in comparison to orbital shadow or contra lateral sinus)
Treatment-
- Steam inhalation
- Nasal decongestant-(spray/drop) nasal oxymetazoline, 0.05%, or xylometazoline, 0.05–0.1%, one or two sprays in each nostril every 6–8 hours for up to 3 days.
- With or without oral decongestants —e.g. oral pseudoephedrine, 30–120 mg per dose, up to 240 mg/d;
- Antibiotics- Amoxicillin-clavulanate 1gm (875 mg–125 mg) twice daily 10 days;
Alternatives,
- Doxycycline 200 mg once daily x 1 day, 100 mg twice daily thereafter for 7–10 days
- Levofloxacin- 500 mg once daily 10 days
- Common bacteria (e.g. Strep. pneumoniae, H. influenzae)