From the Guidelines
For a patient with 2 days of cough and sinus pressure with injected tympanic membranes (TMs) but no ear pain, I recommend starting with symptomatic treatment to improve quality of life and reduce morbidity. The patient's symptoms are consistent with viral rhinosinusitis (VRS), a self-limited disease characterized by cough, sneezing, rhinorrhea, sore throat, and nasal congestion 1.
Symptomatic Treatment
- Take acetaminophen (Tylenol) 650mg every 6 hours or ibuprofen (Advil, Motrin) 400-600mg every 6-8 hours as needed for pain and inflammation, as these medications can help alleviate symptoms 1.
- Use an intranasal steroid like fluticasone (Flonase) 1-2 sprays in each nostril daily to reduce nasal inflammation, which may provide symptomatic relief 1.
- Saline nasal irrigation with a neti pot or saline spray can help clear congestion and is a low-risk intervention 1.
- Stay well-hydrated and consider using a humidifier to help relieve symptoms.
Monitoring and Follow-up
The injected TMs without ear pain suggest early inflammation that may resolve with these measures. This presentation is most consistent with a viral upper respiratory infection, so antibiotics are not recommended initially unless symptoms persist beyond 7-10 days, worsen after initial improvement, or are severe from the outset 1. If symptoms worsen or don't improve within a week, follow up with your healthcare provider for reassessment.
From the FDA Drug Label
Patients should use Fluticasone Propionate Nasal Spray, USP, at regular intervals for optimal effect Adult patients may be started on a 200-mcg once-daily regimen (two 50-mcg sprays in each nostril once daily). Maximum effect may take several days Regular-use patients who have responded may be able to be maintained (after 4 to 7 days) on 100 mcg/day (1 spray in each nostril once daily).
The patient has cough and sinus pressure with injected TMs but no ear pain. The symptoms are not explicitly described as allergic rhinitis in the question, and the drug label does not directly address the treatment of cough and sinus pressure with injected TMs. Treatment with fluticasone propionate nasal spray may be considered for allergic rhinitis, but the question does not provide enough information to determine if this is the correct diagnosis. The FDA drug label does not answer the question.
From the Research
Treatment Options
- For a patient with 2 days of cough and sinus pressure, no ear pain but injected tympanic membranes (TMs), the treatment options are limited by the available evidence.
- According to 2, first-line treatment for acute sinusitis is amoxicillin, and antibiotics should only be used when there is reasonable clinical certainty about the presence of acute sinusitis.
- However, there is no clear indication for antibiotic use in this case, as the patient does not have ear pain and the diagnosis of sinusitis is not certain.
Symptom Management
- For symptom management, pseudoephedrine may be helpful in relieving symptoms of the common cold and sinusitis, as stated in 3.
- Additionally, paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) may be used to relieve pain, as suggested by 4, although the evidence is limited and of low quality.
Comprehensive Management
- A comprehensive management approach, as outlined in 5, may be necessary to address the patient's symptoms, including sinus pressure, pain, or headache.
- This approach may involve interdisciplinary care, including otolaryngology and neurology, to diagnose and treat underlying conditions that may be contributing to the patient's symptoms.
Further Evaluation
- Further evaluation, including sinus computed tomography (CT) scans and endoscopic sinus surgery (ESS), may be necessary to diagnose and treat underlying conditions, as discussed in 5.
- However, these interventions should be used judiciously and only when necessary, as they may not always be effective in relieving symptoms.