Taking a Side


Question:  A 70 year old woman is referred to your clinic for management of chronic rhinosinusitis.  She describes unilateral facial pain for 3 months, purulent rhinorrhea, and nasal obstruction only on the right side.  She was treated with 3 courses of oral antibiotics with only temporary resolution each time.  She denies any ophthalmologic symptoms and has no history of immune deficiency.  On examination you find no evidence of nasal polyposis but significant mucosal edema and purulence from the maxillary os.  What is the most likely source of recalcitrant infection?  [Answer will be posted with next week's new question]

Answer to last week's question, What's in a Name (June 15, 2015): 

Posterior glottic stenosis: interarytenoid adhesion.  This is distinct from complete posterior glottic stenosis which is located in the interarytenoid space and in the posterior commissure.