SOAP(Acute Bacterial Sinusitis)
AcuteBacterial Sinusitis SOAP
Thepatient notes that he had an intermittent and very sharp pain on theforehead and the right cheek, which had lasted for a week. This is inline with literature which points out that pain over the cheek thatradiates to the teeth and frontal part of the head is one of thesymptoms. One of the alleviating factors of such pain is bending overor strenuous activities (Piccirillo,2004),which is also what the patient explained as the pain increasing withbending over. Postnasal discharge is also characteristic of acutebacterial sinusitis, which is pointed out in the patient’s history.The patient also has nasal blockage (Piccirillo,2004),and therefore, has been taking nasal decongestants to relieve theblockage. This is in comparison with one of the signs and symptoms ofacute bacterial sinusitis. The patient also has malaise, headache,headaches and a sore throat, which constitutes some of the symptomsone presents when they have bacterial infections. The patient hasbeen smoking ever since he was sixteen, which is significantconcerning acute bacterial sinusitis since according to literature,it is one of the causes of the disease.
Onexamination, the patient has a yellowish purulent discharge, which isa feature of bacterial sinusitis, and most bacterial infections. Theslight erythema is also consistent with findings of acute bacterialsinusitis findings, caused by inflammation of the olfactory mucosa(Piccirillo,2004).Swelling and tenderness of the frontal and maxillary sinuses is alsoconsistent with literature, as this occurs due to the edema and painthat accompanies the inflammation. As literature points out, acutebacterial sinusitis can extend to the throat and affect theoropharyngeal area (Piccirillo,2004).This is seen in this patient as the inflammatory process in thepharynx and amygdale. There is erythema in on the pharyngeal mucosa,which suggests inflammation, accompanied by a sore throat.
Acutebacterial sinusitis is the main diagnoses denuded from the patient’shistory as most of the presentations are concurrent with theclassicality of the condition. The patient presents with fever,malaise, a general feeling of weakness and headaches, which ischaracteristic of bacterial infections. However, the patient alsopresents with pain on the right cheek, which radiates to the teeth.The pain is also experienced on the forehead, which is characteristicof acute bacterial sinusitis according to established literature.Headaches and a dull or pressurized feeling are common with acutebacterial sinusitis. This pain increases when a patient bends forwardor gets involved in strenuous exercise. This is exactly what thepatient presented in the history. Additionally, inflammation in theaffected area causes erythema, swelling and tenderness, which formthe hallmark of inflammation in any area of the body rubor, tumor,dolor and function laesa (Piccirillo,2004).This is seen in the patient, especially on the olfactory mucosa andthe mucosa on the oropharynx and amygdala. The erythema isaccompanied by swelling and tenderness in the area. As noted invarious literature sources, maxillary sinus infections present witherythema, which extends to the upper, lateral aspect of the cheek.This is also seen in the patient in the physical examination.
Ifwe were to think in other lines apart from acute bacterial sinusitis,other differential diagnoses that present with facial pain includedental abscesses, whose presentation varies from a light discomfortin the affected area to severe pain. The pain is sharp and throbbing,same as the pain the patient is experiencing. Trigeminal neuralgia isanother differential diagnosis, which involves intense facial painthat is triggered by activities such as bending forward, as thepatient presents, among other things like eating, talking, andshaving and brushing teeth. Atopic or allergic rhinitis is anotherdifferential, which presents with some symptoms seen in the patientsuch as nasal congestion, rhinitis and obstruction. The patientexperiences fever and the temperature range between 99.5 to 100.9 °F,which are seen in the patient. Other differentials include opticneuritis, migraine or cluster headaches, a space-occupying lesionlike a tumor, nasal polyps among others.
Amoxicillinis the most reasonable antibiotic as first line therapy. Amoxicillinor clavulanate is usually indicated if the patient’s symptoms donot improve after one week on amoxicillin alone (Chow et al, 2012).However, antibiotics are not recommended for patients who presentwith mild / moderate disease during the first week of infection. Thisis because of an increased risk of adverse drug effects andantibiotic resistance. In this case, the patient was put on Augmentin(Amoxicillin & Clavulanate) 875mg/125mg orally. This was one tab.This is in line with literature since the patient had experiencedthese symptoms for more than seven days, and warranted combinedtherapy.
Forconfirmed acute bacterial sinusitis, intranasal corticosteroids areuseful, as indicated in literature (Chow et al, 2012). This is thereason the patient was put on Fluticasone propionate 50 mcg 2 spraysto each nostril daily for 5 days.
Inpatients suspected to have allergic rhinitis, Leukotriene inhibitorsare useful as they reduce bronchoconstriction, especially when thepatient had nasal blockage. In this light, the patient was givenSingulair (Montelukast) 10 mg 1 tab, which is an LTD4 blocker (Chowet al, 2012).
Torelive the pain, NSAIDS are useful. Therefore, it was important forthe patient to be given Ibuprofen, which also helps to controlallergic symptoms as it is anti-inflammatory, according toliterature.
Ifthe symptoms worsened in 72 hours, it is important for the patient toseek medical advice from an ENT specialist, as it might be a seriouscase. Scheduling follow-up visits for acute bacterial sinusitis isnecessary. Increasing fluid intake also helps to reduce the symptoms.Since smoking plays a central role in the condition, smokingcessation will also be important for the patient’s positiveresponse to therapy. It is usually important to give educate thepatients on flu prevention. Influenza and pneumococcal vaccines arealso helpful, especially when dealing with a smoker, to preventchances of recurrent infection (Chow et al, 2012).
Chow,A. W., Benninger, M. S., Brook, I., Brozek, J. L., Goldstein, E. J.,Hicks, L. A., … & File, T. M. (2012). IDSA clinical practiceguideline for acute bacterial rhinosinusitis in children and adults.ClinicalInfectious Diseases,cir1043.
Piccirillo,J. F. (2004). Acute bacterial sinusitis. NewEngland Journal of Medicine,351(9),902-910.