ENT New Patient Clinic Letter

Specialty: Otorhinolaryngologist (ENT Specialist) **Current Issues** Patient presents with chronic bilateral nasal congestion and recurrent epistaxis for the past 6 months, significantly impacting quality of life. **Background** Key diagnoses include allergic rhinitis and mild hypertension. No other significant co-morbidities. Previous ENT surgical procedures: Nil. ENT investigations to date: CT Paranasal Sinuses (1 May 2024) - "Mild mucosal thickening in maxillary sinuses, no polyps." Past medical history: Allergic Rhinitis, Essential Hypertension. **Audiometry** Audiometry (1 October 2024): Normal hearing thresholds bilaterally. No significant change from previous audiometry (1 November 2023). **Impression** - Chronic rhinosinusitis without polyps, likely allergic aetiology. **2WW Status:** Clock continues pending further investigation **Plan** - Prescribe a course of intranasal corticosteroids (Fluticasone Propionate spray) for 6 weeks. - Arrange allergy skin prick testing to identify specific allergens. - Follow-up appointment in 8 weeks to assess response to treatment and review allergy test results. **Requested GP Actions** - Initiate Fluticasone Propionate nasal spray on repeat prescription. - Refer for allergy skin prick testing. **Assessment** During your visit today, you presented with chronic bilateral nasal congestion and recurrent nosebleeds that have been troubling you for the past six months. You explained how these symptoms have significantly impacted your daily life, causing discomfort and affecting your sleep. We discussed the history of your presenting complaints, including their onset and progression, and noted the absence of any other concerning symptoms such as facial pain, headache, or visual changes, which is a positive finding. **Medications:** - You are currently taking Ramipril 5mg daily for hypertension. - You also mentioned using a daily over-the-counter antihistamine, Cetirizine, which you find provides some temporary relief. **Allergies:** - You have reported no known drug allergies. - You have a known allergy to dust mites, which can trigger your nasal symptoms. **Social History:** - You work as a primary school teacher. - You are a non-smoker. - You consume alcohol socially, approximately 2-3 units per week. **Examination Findings:** - Anterior rhinoscopy revealed bilateral mucosal oedema and mild septal deviation to the left. - No evidence of active bleeding or polyps was observed. - Oropharynx was clear. - Otoscopy revealed clear external auditory canals and healthy tympanic membranes bilaterally. **Investigations:** - We have ordered allergy skin prick testing for you to identify specific environmental allergens. **Information for patient:** We have discussed that your symptoms are likely related to chronic rhinosinusitis with an allergic component. We have started you on a nasal spray, and further investigations will help us tailor your treatment more precisely. You should use the nasal spray as prescribed, and we will review your progress in your follow-up appointment. We have explained that we will be performing allergy skin prick testing to determine what specific allergens might be contributing to your nasal congestion. This test involves placing small amounts of different allergens on your skin and observing for a reaction, which can help us understand your triggers. Your next steps involve using the prescribed nasal spray and attending your allergy testing appointment, followed by a review in 8 weeks to discuss the results and adjust your management plan as needed. **Copy to:** Dr. Sarah Jenkins (GP)