Hoarseness for chronic pharyngitis

Patient is 78-year-old male who states that for the last seven months he has had significant sore throat and has constant postnasal drip and runny nose as well as coughing due to this. He does have a history of allergies and saw an allergist in area and did allergy shots for multiple years. He then moved to Idaho about three years ago and is concerned that he is having recurrence of his allergy symptoms. He also has been concerned about trouble swallowing. He has been seeing Dr. who did an endoscopy a few years ago and did not see any abnormal signs here, but that was prior to having his trouble swallowing. He then saw Dr. and they did a rhinoscopy and did see some inflammation in the throat and the vocal cord that could be due to a postnasal drip or allergies.

He does currently complain of sneezing, clear nasal discharge, postnasal drip, frequent nose blowing, frequent throat clearing, sore throat, hoarseness, and frequent nosebleeds. This occurs everyday. They may have some seasonal variation, but he is not sure. He has had some sinus infections. He denies nasal polys, TMJ, frequent headaches, aspirin-induced nasal symptoms, nasal surgery, frequent bad colds, or frequent tonsillitis. He states that his nasal symptoms are very severe. He does use loratadine and Flonase. Flonase does seem to provide good relief, but not completely resolves his constant sore throat and hoarseness.

He denies any frequent ear infections, dizziness, or lightheadedness. He does admit to have hearing impairment.

He does have some eye itching, dryness, and burning. He denies redness, tearing, light hurting his eyes, yellow-green discharge, eyelid swelling or eyelid irritation.

He denies any history of lung troubles or wheezing. He has not had any history of allergic skin problems. The last time he was evaluated for allergies was when he was approximately 30 years old. He was on allergy shots from 1968 to 2013.

ASSESSMENT:
1. Mixed rhinitis.
2. Chronic postnasal drip.
3. Hoarseness for chronic pharyngitis.

PLAN:
1. At this time, I don’t believe that all of patient’s symptoms are caused by his allergies. He does have some animal dander and dust mite allergies but does not seem to be chronically exposed to these items. I do want to see if his troubles are definitely because of chronic postnasal drip. So, I would like him to try a Dymista combination using Flonase and azelastine one spray each nostril twice daily to see if this improves some of his symptoms, reduces coughing and his sore throat.
2. If that does not help, I would also recommend him to go and see Dr. again and do another endoscopy to ensure that he is not having any esophageal strictures due to his trouble swallowing or other problems. He has been trialed on omeprazole for his symptoms as well. He did get off of it about two weeks ago because of concern of long-term side effects and has not noticed difference in his troubles. We will follow up in two weeks to see how he is doing. If he has no improvement, then I may recommend him going to see Dr. again.

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