A middle-aged man presented with purulent nasal discharge for 3 months, associated with occasional left-sided facial pain. He had no history of fever or cough, and the only co-morbidity was that of chronic asthma, for which he had been on fluticasone and ventolin inhalers for years.

He had seen a number of doctors with no real subsequent improvement, even after short courses of oral antibiotics.

Clinical examination was unremarkable – there was no overlying maxillary tenderness. A CT of the sinuses was ultimately performed.

Questions:

  1. What is the likely underlying diagnosis?
  2. How can this diagnosis be proven, and how is it managed?
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