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petermaguire-2649-78985- 280216-3446.WAV <BODY> Re-eval. Sinus headache, bouts of vertigo associated with sinus pressure, decreased sense of smell. Recall went through allergy shots some time ago before pregnancy. Elm. Also saw her for possible insect reaction. Feels that the symptoms of sinus blockage and headache, but she is also pointing towards temporal areas as well as frontal ethmoid, and also points to the TMJ areas also is causing her discomfort and pain. On Flonase, but sense of smell seems to be decreasing while she is using that. Would like to switch back to Nasacort. Singulair in the past. 2 young kids. Interference with quality of life in terms of functioning. Has been treated with ABX for possible rhinosinusitis 4 times in the past. Sinus issues more common in the current ROS 14 point. Pleasant, VSS, NAD. SKIN: Nonfocal. HEENT: NC, AT. PERRLA. EOMI. TMs clear. Very gentle palpation to HEENT. No masses. Could have some TMJ component, however. Nasal exam very edematous, swollen inferior turbinate. Could not see past inferior turbinate. Significant turbinate hypertrophy. OP slight PNDLP. EXT, NEURO: Stable. Significant inferior turbinate hypertrophy. Could have chronic sinusitis, allergic rhinitis mixed picture. She would like to avoid IT. Immunotherapy if possible. Gave Nasacort 2 sp bilat lateral spray technique. Monitor for side effects such as decreased sense of smell or improvement of smell, which would be an improvement. After sinus CT scan ENT consultation to evaluate inferior turbinate hypertrophy, whether it is chronic sinusitis or whether a TMJ component. We discussed anti-vertigo OTC medications if needed, may cause some sedation. Also may follow up in my clinic. Will inform of results. 15 min, counseling greater than 50 percent. </BODY>
