Differential Diagnosis

The patient presents with persistent nasal blockage, blocked ears, and sleep disturbance following a upper respiratory tract infection (URTI). The differential diagnosis can be categorized as follows:

• Single most likely diagnosis
  • Chronic rhinosinusitis: The patient's symptoms of persistent nasal blockage, mouth breathing at night, and minimal phlegm are consistent with chronic rhinosinusitis. The markedly swollen turbinates bilaterally and the initial response to nasal spray also support this diagnosis.
• Other Likely diagnoses
  • Allergic rhinitis: The patient's symptoms of nasal blockage, sleep disturbance, and initial response to antihistamine and nasal spray suggest allergic rhinitis as a possible diagnosis.
  • Eustachian tube dysfunction: The patient's blocked ears, hearing impairment, and fluid levels/bubbles behind the eardrum are consistent with Eustachian tube dysfunction, which can be caused by chronic rhinosinusitis or allergic rhinitis.
  • Nasal polyps: The patient's persistent nasal blockage and swollen turbinates could be caused by nasal polyps, which can be associated with chronic rhinosinusitis or allergic rhinitis.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Nasopharyngeal carcinoma: Although rare, nasopharyngeal carcinoma can present with nasal blockage, hearing impairment, and Eustachian tube dysfunction. It is essential to consider this diagnosis to avoid delayed diagnosis and treatment.
  • Granulomatosis with polyangiitis (GPA): GPA is a rare autoimmune disorder that can cause chronic rhinosinusitis, nasal blockage, and Eustachian tube dysfunction. It is essential to consider this diagnosis due to its potential for severe complications if left untreated.
• Rare diagnoses
  • Sarcoidosis: Sarcoidosis is a rare autoimmune disorder that can cause chronic rhinosinusitis, nasal blockage, and Eustachian tube dysfunction. Although rare, it should be considered in the differential diagnosis.
  • Cystic fibrosis: Cystic fibrosis is a rare genetic disorder that can cause chronic rhinosinusitis, nasal blockage, and Eustachian tube dysfunction. Although rare, it should be considered in the differential diagnosis, especially if the patient has a family history of the disease.