This week was busy at the clinical site. We have a lot of sinus infections, ear infections, and general colds. I am feeling more confident in my ability to do assess patients and discern the appropriate diagnosis and treatment. I have never been very comfortable treating children, but it is getting easier to interact with pediatric patients as well. Pediatric patients have always been somewhat intimidating to me because I got my start in the fire department. When we would run a pediatric call, there was either nothing wrong, or something was horribly wrong. Most of our pediatric calls had to do with a breathing problem or some type of trauma. It is nice to be able to see pediatric patients in an office when it’s not an emergency.
This week a mother brings in her daughter because she was complaining of a sore throat and was worried that she had strep again. The patient is scheduled for a tonsillectomy next week but the mother did not want the surgeon to know that her daughter was sick because she was afraid he would cancel the surgery. I completed a physical examination, the tonsils were swollen and pitted, but did not have exudate and the throat did not have petechiae. I could visualize postnasal drainage down the back of the throat and the tissue looked irritated. Both ears were clear. The nasal passages were inflamed and had clear rhinorrhea. Her strep test was negative, and she was diagnosed with sinusitis.
Sinus infections happen when fluid builds up in the air-filled pockets in the face (sinuses), which allows germs to grow. Viruses cause most sinus infections, but bacteria can cause some sinus infections. A lot of times sinus infections can stem from allergies or structural abnormalities in the anatomy that keeps the nasal passages from draining appropriately. In this case, the patient had enlarged adenoids as well as tonsils. Common symptoms of sinus infections include a runny or stuffy nose, headache, sore throat, cough, ear pain, or facial pain (Hoffman et al., 2018).
Antibiotics are not needed for many sinus infections. Most sinus infections usually get better on their own without antibiotics (The Center for Disease Control and Prevention, 2019). In this case, since the patient has chronic infections and is having surgery next week, the practitioner wanted to consult the ENT surgeon to ask for his input. We had to explain to the patient that he needed to know and help advise what would be the best course of treatment. If the surgery were to be delayed it would be for the health and safety of her daughter. She agreed. The surgeon was consulted and agreed that a round of antibiotics would be warranted. The antibiotic of choice was Augmentin. She was a larger teen and received the adult dose.
References
Centers for Disease Control and Prevention. (2019, August 27). Sinus infection (sinusitis). Centers for Disease Control and Prevention. Retrieved November 9, 2021, from gov/antibiotic-use/sinus-infection.html” class=”external” target=”_blank” rel=”noreferrer noopener”>https://www.cdc.gov/antibiotic-use/sinus-infection.html (Links to an external site.).
Hoffmans, R., Wagemakers, A., van Drunen, C., Hellings, P., & Fokkens, W. (2018). Acute and chronic rhinosinusitis and allergic rhinitis in relation to comorbidity, ethnicity and environment. PloS one, 13(2), e0192330. https://doi.org/10.1371/journal.pone.0192330
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