Doctor: Hello, ma'am. What is the reason for your visit today? 
Patient: I was referred by a doctor to come see you so that you could check up on my nasal problems. Here is my report from my previous doctor who referred me to you. 
Doctor: Thank you. Let me take a look.  I see here it says you had severe sinusitis two to three months ago, correct? 
Patient:  Is that what they're calling my nasal problems? 
Doctor: Yeah, it is. Sinusitis is the inflammation of your nasal airways. 
Patient: I see. Thank you for describing it to me. 
Doctor: No problem. Would you be able to describe to me what you had been feeling two to three months ago? 
Patient: Yeah, I can. My face would feel uncomfortable, my nose was stuffy, my eyes hurt, and I felt something dropping in the back of my throat.
Doctor: Have you ever been prescribed any medication? 
Patient: Here's the list of medicine I was taking. 
Doctor: I see you were given antibiotics, correct? 
Patient: I was, but I don't know what those are. Could you explain them to me? 
Doctor: Antibiotics are usually used to fight infections. 
Patient: I had an infection? I thought I just had some nasal problems. 
Doctor: Your report states you had a severe infection. Do you remember if the antibiotics helped? 
Patient: Not really. I felt like my symptoms were the same. 
Doctor: I see. Did your doctor order any advanced imaging's? 
Patient: Yeah. They did a C T scan of my nose. Here is the report from my C T scan. 
Doctor: Let me take a look. It looks like you had some thickening of the mucosal layer in your right paranasal sinus. You also had some obstruction in your right ostiomeatal complex and excess growing of some of the bones in your nose. Uhm. Oh, one more thing. I see your nasal septum was shifted to the left. 
Patient: Oh, wow. Thank you for explaining everything to me. 
Doctor: No problem. Going back to your list of medications, I know you took antibiotics for your infection, but did you take any medication for your sinuses? 
Patient: No, I haven't. I did try this cream for my nose, but that didn't work either. Nothing worked! 
Doctor: I see. Looks like the cream you used was a topical nasal corticosteroid. Are there any other symptoms that you have been experiencing? 
Patient: I've had some trouble with my balance, and I feel like I've lost some of my hearing. I thought this was odd since I'm only fifty years old. I think my ears felt plugged or full of air, so they just needed to pop. 
Doctor: I see. Let's perform an audiogram test to check your ears. 
Patient: Sounds good. 
Doctor: I'm seeing that you have some mild high frequency sensorineural hearing loss. Your tympanometry seems to be normal. Your speech discrimination was also normal. 
Patient: That's reassuring. 
Doctor: I want to ask a few more questions about your ears. Do you feel any fullness or pressure?  
Patient: No, I don't feel anything like that right now. 
Doctor: Do you hear any humming, buzzing, or roaring sounds?
Patient: Nope. I don't hear anything like that. 
Doctor: We checked your ears and now understand more about the problem, but I wonder why your balance is affected. When did you start noticing your balance was affected? 
Patient: I think it could have been to this one medicine that starts with an A. I forgot the name, but it didn't really help my nasal problems. It just made my balance worse. 
Doctor: Was the medicine called Allegra? 
Patient: Oh, yeah. That's what it was called. I thought I had some sort of allergy, so I thought it would help. 
Doctor: I see. Did you ever feel any dizziness too? 
Patient: Yeah, I did. 
Doctor: I will have you do some movements to see if your dizziness occurs. 
Patient: Sounds good. 
Doctor: Could you look to the left and then look to the right. 
Patient: Oh, wow. That made me very dizzy. 
Doctor: Looks like sudden movements and head turning make your dizziness worse.

Clinical note:
Symptoms: facial discomfort, nasal congestion, eye pain, postnasal drip, balance issues, hearing loss, dizziness
Diagnosis: chronic sinusitis, mild high frequency sensorineural hearing loss
History of Patient: severe sinusitis two to three months ago, minimal improvement with antibiotics, tried topical nasal corticosteroid therapy and Allegra without much improvement, worsened balance with Allegra
Plan of Action: perform audiogram test (results: mild high frequency sensorineural hearing loss, normal tympanometry, normal speech discrimination), further evaluation and treatment for chronic sinusitis, avoid Allegra due to worsening balance, assess dizziness with positional changes