A 45-Year-Old Man Is Evaluated for Recurrent Sinusitis and Otitis

A 45-year-old man is evaluated for recurrent sinusitis and otitis.  He has been treated with antibiotics and intranasal corticosteroids on and off for the past 6 months, but he still has scant yellow nasal discharge occasionally mixed with blood.  On review of systems, he has fatigue but no fevers, chills, cough, or abdominal symptoms.  The patient is an ex-smoker with a 15-pack-year history.  He takes over-the-counter ibuprofen and aspirin for joint and back pains.  He is afebrile.  Chest and abdominal examinations are unremarkable.  Otoscopy shows erythema and a small ulceration in the right auditory canal.  Laboratory results are as follows: His HIV testing is negative.  Which of the following is the best next step in management of this patient?

A) Aspirin challenge and desensitization
B) Nasal mucosal biopsy
C) Qualitative serum autoantibodies
D) Quantitative immune globulin levels
E) Sweat chloride testing

Correct Answer:

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