### 21 years old boy presents with nasal blockade associated with headache on and off since 5 years. He has consulted many doctors before but he hasn't got any permanent cure. His recent X-Ray PNS is shown below which shows maxillary and ethmoidal sinusitis. His X-Ray Nose Lateral view is within normal limits and his Chest X-Ray PA view is also within normal limits. What treatment should be prescribed for this case?



First find out the cause sir (Allergic or Infective ) Whether any nasal polyps are present? Investigation :CT PNS Diagnostic nasal endoscopy Rx:Allergic -T.Montecop 1 HS Infective-A course of antibiotics and follow up. If symptoms are persistent, Go for Functional endoscopic sinus surgery

Thank you so much

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Chronic Sinusitis. Probably Allergic in origin. Check the factor responsible. Get CBC and Vitamin D3 level..

Sir, why vitamin D3 level needs to be checked?

To cure sinusitis, firstly karvol plus steam inhalation should be advised for atleast 1 week minimum on TID basis... Put pt on Amox 500mg TID, Metrogyl 400mg TID, Hifenac BD, CHX mouthwash 1:1 dilution TID for atleast 1 week cz patient must b having postnasal drip... Also add nasal otrivin for 5 days TID basis... Take proper history to rule out if patient has undrgon any extraction of upper posteriors and check for any oroantral communication / fistula.. Which could lead to sinusitis in maxillry sinus followed by its spread to ethmoid sinus also... Or if there is any history of trauma which may hav lead to fracture of nasal bones or maxillary sinus wall fractures... Get a CBCT skull done and kindly update us with the proper histry and CBCT images...

Thank you sir

Medical and surgical treatment sos

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