Vasomotor rhinitis

I had the pleasure of seeing patient again today for a followup visit of her last visit occurring on 00/00/0000. She came at that time with a chief complaint of congestion of the nose, ears, runny nose, hives, sinusitis, and headaches. patient has a history of chronic sinus pressure and congestion. She has used multiple sprays in the past and medications and has had intermittent relief with all of these treatments. She currently is using Flonase one spray each nostril twice daily as well as the azelastine one spray each nostril twice daily as opposed to Dymista that we would want to try her on due to medication cost. She just started this treatment approximately one week ago and feels like she has had some relief of her congestion in her sinuses. It is, however, still there. Last time we saw her. We prescribed prednisone for three days to see if we can reduce any severe inflammation occurring in her sinuses. At that time, she was using Flonase and did not see much change. She continues to have that feeling of sinus congestion, but since the prednisone did not seem to help or the Flonase reduce inflammation, I suspect that it is more of a hypertrophy of the nasal turbinates causing her problems. She also complains of having eustachian tube dysfunction with ear plugging sensation. She does, however, note that the recent addition of azelastine seems to be helping her some. I would like to continue with this medication for a longer time to get an adequate trial of this medication. Otherwise, she denies any nasal bleeding or yellow or green discharge out of her nose or any sinus infection since last time saw her.

ASSESSMENT:
1. Vasomotor rhinitis.
2. GERD.
3. Eustachian tube dysfunction.
4. History of chronic sinusitis.

PLAN:
1. At this time, we will continue using azelastine nasal spray one spray each nostril twice daily and discontinue use of Flonase as it does not seem to be helping. I would like to trial her on this medication for just two more weeks consistently to see if this nasal spray works better for her.
2. She can continue using Benadryl at night to help with congestion going to bed as this seems to help her very well.
3. We also encouraged her to use omeprazole 40 mg daily to reduce any associated GERD symptoms that may be contributing to her overall congestion.
4. We will follow up in two weeks’ time to see how this azelastine is working. If she continues to have nasal congestion on top of this, we may reevaluate her condition and try another treatment and plan.

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