The patient’s blood pressure was 103/79, her heart rate was 81bpm and her temperature was 36.1C. Her right tympanic membrane was dull but otherwise unremarkable, while her right was dull with a mild sucked in appearance. She did not have any photophobia. I felt that the most likely diagnosis was sinusitis causing systemic symptoms. In view of her systemic symptoms and unusual presentation, I gave her a course of amoxicillin and some stemetil for symptomatic relief. Due to the unusual symptoms, I safety-netted very carefully. Safety netting is even more important in remote consultations as it is easier to miss cues.
Initially, I was concerned about sepsis or an intracranial pathology. The ability to examine the patient was very reassuring, as I was able to see that her observations were normal and she was afebrile. Being able to examine her ears was also vital in reassuring me of a diagnosis of sinusitis, as the findings supported this.