any recommendations for this pt?

[indytravl]

60 yof has chronic sinusitis + allergies. Also says that as result of chornic problems, has lost alot of nasal septum so "nose is dropped". Due to these issues, has problems with headaches, rhinorrhea, & sleep (breathing). Is doing sinus lavage with the prepared package mix. Any further recommendations? What nonsedating antihistamine could you suggest? Any definitive procedure or surgery? Any other symptomatic management? Thank you!

 

[lipofuscin232]

So I'm doing some studying for step 2 and read your post. Is the loss of nasal septum due to chronic intranasal steroids? One of my books says that in patients with chronic rhinitis unresponsive to usual treatments think of Wegener's. Due to her constitutional findings (headaches) and pulmonary (breathing problems) maybe it's worthwhile to consider even though it's so rare! Although if she hasn't tried any other nonsedating antihistamines other than claritin, i would recommend allegra.

 

[indytravl]

hey lipofuscin,

thanks for your help (though was needing for some practicing ent input)!

the pt says that she had problems with a deviated septum & had surgery & some more surgery with the result that there's not much there now. I don't think she has pulmonary problems; it's more the mechanical obstruction at nose/sinus.

....will take a look at the allegra re. and if there's ents out there, would really like to hear any of their ideas too

 

[resxn]

60 yof has chronic sinusitis + allergies. Also says that as result of chornic problems, has lost alot of nasal septum so "nose is dropped". Due to these issues, has problems with headaches, rhinorrhea, & sleep (breathing). Is doing sinus lavage with the prepared package mix. Any further recommendations? What nonsedating antihistamine could you suggest? Any definitive procedure or surgery? Any other symptomatic management? Thank you!

There are so many questions here I don't know where to begin. If you're a med student please present the patient in a normal format: Hx, PE, Studies, etc. I can't begin to answer a question like that with such random limited information.