A 36-Year-Old Woman With a Worsening Cough and Hearing Loss

Nicole Davey-Ranasinghe, MD; Constantine K. Saadeh, MD

Disclosures

September 05, 2019

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

Background

A 36-year-old woman with long-standing allergic rhinitis, recurrent sinusitis, atopic dermatitis, and asthma was referred for allergy and asthma evaluation by her primary care physician because of her respiratory symptoms. She developed a cough that has worsened over the past 3 months. She reports that the cough is generally productive and denies hemoptysis. She also reports that her chronic rhinorrhea has been more bothersome. She has also had a decrease in hearing that has been subtle over the past 6 months.

She has required antibiotics for sinusitis four times over the past 12 months. She requires use of her rescue inhaler approximately four times per week and has noted an increase in her asthma exacerbations. She received a course of oral prednisone three times over the past 12 months. She also notes new-onset chest pain over the past month that is worse upon moderate exertion.

She has no current rash but reports that she has struggled with eczema intermittently since childhood. She is currently taking a daily antihistamine, intranasal fluticasone, and an inhaled combination long-acting beta-agonist and glucocorticoid with mometasone-formoterol (200 µg/5 µg).

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