Differential Diagnosis

• Single most likely diagnosis
  • Acute Sinusitis: The patient's symptoms of nasal congestion, productive cough with brown sputum, and facial pain (referred to as ear pain due to the sinusitis affecting the trigeminal nerve) are classic for acute sinusitis. The addition of low-grade fevers and relief with Advil (ibuprofen) further supports this diagnosis.
• Other Likely diagnoses
  • Acute Bronchitis: The productive cough with brown sputum could also suggest acute bronchitis, especially if the patient has a history of smoking or exposure to irritants. However, the presence of significant nasal congestion and ear pain leans more towards sinusitis.
  • Allergic Rhinitis: The itchy, stinging eyes and bilateral wheeping could indicate allergic rhinitis, which often coexists with or predisposes to sinusitis. The patient's symptoms of nasal congestion and productive cough could be exacerbated by allergies.
  • Viral Upper Respiratory Infection (URI): Given the duration of symptoms and the presence of low-grade fevers, a viral URI is possible, but the specific combination of symptoms, especially the localized pain and productive cough, makes sinusitis more likely.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Orbital Cellulitis: Although less likely, the presence of eye symptoms (itchy, stinging eyes) and facial pain could, in rare cases, indicate orbital cellulitis, a serious infection requiring prompt antibiotic treatment.
  • Mastoiditis: The ear pain could potentially be related to mastoiditis, an infection of the mastoid bone, which is a complication of otitis media. This condition requires urgent medical attention.
  • Invasive Fungal Sinusitis: In immunocompromised patients, invasive fungal sinusitis is a life-threatening condition that must be considered, although the patient's current presentation does not strongly suggest this.
• Rare diagnoses
  • Wegener's Granulomatosis (Granulomatosis with Polyangiitis): A rare autoimmune disorder that can cause sinusitis, cough, and eye symptoms, but it would typically be associated with more systemic symptoms and a longer duration of illness.
  • Sarcoidosis: Another rare condition that can cause sinusitis and eye symptoms, but it is usually associated with other systemic manifestations and would be an unlikely first consideration without additional findings.