Patient with nasal congestion, purulent discharge, facial pain and hyposmia

A 46-year-old female presented at the outpatient clinic with nasal congestion, purulent discharge, facial pain with pressure sensation, headache, hyposmia, and fever (38.2 Cº) that had persisted for four months. This symptomatology was worse at night or upon awakening in the morning. Three months before, she was initially treated with antibiotics (amoxicillin/clavulanate) for a period of 10 days but did not improve. An anterior rhinoscopy examination demonstrated bilateral nasal mucosal oedema, dense purulent rhinorrhoea, a deviated nasal septum, and nasal polyps. Posterior pharyngeal drainage was also noticed. Her clinical history highlights the existence of hypertension, obesity (body mass index = 33), hypercholesterolaemia, and poorly controlled insulin-diabetes.