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Arcus Clinic

  4.4  (16 ratings)

ENT Specialist Clinic

205, Vikas Surya Galaxy, Sector-4, Dwarka Delhi
1 Doctor · ₹600
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Arcus Clinic   4.4  (16 ratings) ENT Specialist Clinic 205, Vikas Surya Galaxy, Sector-4, Dwarka Delhi
1 Doctor · ₹600
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About

We are dedicated to providing you with the personalized, quality health care that you deserve....more
We are dedicated to providing you with the personalized, quality health care that you deserve.
More about Arcus Clinic
Arcus Clinic is known for housing experienced ENT Specialists. Dr. Manish Munjal, a well-reputed ENT Specialist, practices in Delhi. Visit this medical health centre for ENT Specialists recommended by 53 patients.

Timings

TUE, THU, SAT
07:00 PM - 08:00 PM

Location

205, Vikas Surya Galaxy, Sector-4, Dwarka
Dwarka Delhi, Delhi - 110075
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Doctor

Dr. Manish Munjal

MD, DNB, MBBS
ENT Specialist
88%  (16 ratings)
20 Years experience
600 at clinic
₹400 online
Unavailable today
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Sinusitis: Management and Prevention

MBBS
Endocrinologist, Tumkur
Sinusitis: Management and Prevention

Sinusitis: Management and Prevention

Sinusitis is infl ammation of the mucous membranes lining one or more of the paranasal sinuses. The various presentations are as folllows:
● acute sinusitis: infection lasting less than 30 days, with complete resolution of symptoms
● subacute infection: lasts from 30 to 90 days, with complete resolution of symptoms
● recurrent acute infection: episodes of acute infection lasting less than 30 days, with resolution of symptoms, which

Recur at intervals of at least 10 days apart
● chronic sinusitis: infl ammation lasting more than 90 days, with persistent upper respiratory symptoms
● acute bacterial sinusitis superimposed on chronic sinusitis:

New symptoms that occur in patients with residual symptoms from prior infection (s). With treatment, the new symptoms resolve but the residual ones do not.
Physical findings and clinical presentation
● patients often give a history of a recent upper respiratory illness with some improvement, then a relapse.
● mucopurulent secretions in the nasal passage
● purulent nasal and postnasal discharge lasting more than 7 to 10 days
● facial tightness, pressure, or pain
● nasal obstruction
● headache
● decreased sense of smell
● purulent pharyngeal secretions, brought up with cough, often worse at night
● erythema, swelling, and tenderness over the infected sinus in a small proportion of patients
● diagnosis cannot be excluded by the absence of such findings.
● these fi ndings are not common, and do not correlate with number of positive sinus aspirates.
● intermittent low-grade fever in about one half of adults with acute bacterial sinusitis
● toothache is a common complaint when the maxillary sinus is involved.
● periorbital cellulitis and excessive tearing with ethmoid sinusitis
● orbital extension of infection: chemosis, proptosis, impaired extraocular movements.

Characteristics of acute sinusitis in children with upper respiratory tract infections:
● persistence of symptoms
● cough
● bad breath
● symptoms of chronic sinusitis (may or may not be present)
● nasal or postnasal discharge
● fever
● facial pain or pressure
● headache
● nosocomial sinusitis is typically seen in patients with nasogastric tubes or nasotracheal intubation.

Cause
● each of the four paranasal sinuses is connected to the nasal cavity by narrow tubes (ostia), 1 to 3 mm in diameter; these drain directly into the nose through the turbinates. The sinuses are lined with a ciliated mucous membrane (mucoperiosteum).
● acute viral infection
● infection with the common cold or infl uenza
● mucosal edema and sinus infl ammation
● decreased drainage of thick secretions, obstruction of the sinus ostia
● subsequent entrapment of bacteria

A. Multiplication of bacteria
B. Secondary bacterial infection

Other predisposing factors
● tumors
● polyps
● foreign bodies
● congenital choanal atresia
● other entities that cause obstruction of sinus drainage
● allergies
● asthma
● dental infections lead to maxillary sinusitis.
● viruses recovered alone or in combination with bacteria (in 16% of cases):
● rhinovirus
● coronavirus
● adenovirus
● parainfluenza virus
● respiratory syncytial virus
● the principal bacterial pathogens in sinusitis are streptococcus pneumoniae, nontypeable haemophilus influenzae, and moraxella catarrhalis.
● in the remainder of cases, fi ndings include streptococcus pyogenes, staphylococcus aureus, alpha-hemolytic streptococci, and mixed anaerobic infections (peptostreptococcus, fusobacterium, bacteroides, prevotella).

Infection is polymicrobial in about one third of cases.
● anaerobic infections seen more often in cases of chronic sinusitis and in cases associated with dental infection; anaerobes are unlikely pathogens in sinusitis in children.
● fungal pathogens are isolated with increasing frequency in immunocompromised patients but remain uncommon
Pathogens in the paranasal sinuses. Fungal pathogens include aspergillus, pseudallescheria, sporothrix, phaeohyphomycoses, zygomycetes.
● nosocomial infections occur in patients with nasogastric tubes, nasotracheal intubation, cystic fi brosis, or those who are immunocompromised.
● s. Aureus
● pseudomonas aeruginosa
● klebsiella pneumoniae
● enterobacter spp.
● proteus mirabilis

Organisms typically isolated in chronic sinusitis:
● s. Aureus
● s. Pneumoniae
● h. Infl uenzae
● p. Aeruginosa
● anaerobes

Differential diagnosis
● migraine headache
● cluster headache
● dental infection
● trigeminal neuralgia

Workup
● water’s projection: sinus radiograph
● ct scan
● much more sensitive than plain radiographs in detecting acute changes and disease in the sinuses
● recommended for patients requiring surgical intervention, including sinus aspiration; it is a useful adjunct to
 

Guide therapy:
● transillumination
● used for diagnosis of frontal and maxillary sinusitis
● place transilluminator in the mouth or against cheek to assess maxillary sinuses, and under the medial aspect of the supraorbital ridge to assess frontal sinuses.
● absence of light transmission indicates that sinus is filled with fluid.
● dullness (decreased light transmission) is less helpful in diagnosing infection.
● endoscopy
● used to visualize secretions coming from the ostia of infected sinuses
● culture collection via endoscopy often contaminated by nasal flora; not nearly as good as sinus puncture
● sinus puncture
● gold standard for collecting sinus cultures
● generally reserved for treatment failures, suspected intracranial extension, nosocomial sinusitis.

Treatment Nonpharmacologic therapy
● sinus drainage
● nasal vasoconstrictors, such as phenylephrine nose drops, 0.25% or 0.5%

● topical decongestants should not be used for more than a few days because of the risk of rebound congestion.
● systemic decongestants
● nasal or systemic corticosteroids, such as nasal beclomethasone, short-course oral prednisone
● nasal irrigation, with hypertonic or normal saline (saline may act as a mild vasoconstrictor of nasal blood fl ow)
● use of antihistamines has no proved benefi t, and the drying effect on the mucous membranes may cause crusting,

Which blocks the ostia, thus interfering with sinus drainage.
● analgesics, antipyretics.

Antimicrobial therapy
● most cases of acute sinusitis have a viral cause and will resolve within 2 weeks without antibiotics.
● current treatment recommendations favor symptomatic treatment for those with mild symptoms.
● antibiotics should be reserved for those with moderate to severe symptoms who meet the criteria for diagnosis of

Bacterial sinusitis.

● antibiotic therapy is usually empirical, targeting the common pathogens.
● first-line antibiotics include amoxicillin, tmp-smz.
● second-line antibiotics include clarithromycin, azithromycin, amoxicillin-clavulanate, cefuroxime axetil, loracarbef, ciprofloxacin, levofloxacin.
● for patients with uncomplicated acute sinusitis, the less expensive first-line agents appear to be as effective as the

Costlier second-line agents.

Surgery
● surgical drainage indicated
● if intracranial or orbital complications suspected
● for many cases of frontal and sphenoid sinusitis
● for chronic sinusitis recalcitrant to medical therapy
● surgical débridement imperative for treatment of fungal sinusitis

Chocking or suffocating felling in throat all the time: this can occurs previously, then a ENT advised a liver infection. After that I am fine but this feeling starts again, so tell me, what can I do.

MBBS
General Physician,
Chocking or suffocating felling in throat all the time: this can occurs previously, then a ENT advised a liver infect...
Hi, Thanks for your question on Lybrate I do understand your concern As per your clinical history please check your breathing rate per minutes and if it is less than 20 breaths per minutes then it may not be due to respiratory tract rather check GI tract ,so do an endoscopy examination first to see the passage between mouth and stomach to ruled out Esophageal Stricture. Hope that helps
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Bacterial sinus problems of viridians strep with s.epidermidis .which homeo medicines should I take for a long time (immunity enhancement at the same time. Please give me advice.

Diploma in Otorhinolaryngology (DLO), DNB (ENT)
ENT Specialist, Nagpur
Hi when you know about the organism in sinusitis I think you should take organism specific antibiotics and decongestant to add to it .it will help decrease the bacterial load. Yes about homeopathy not sure if you get antibiotics in it. Regards.
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Azee and augmentin antibiotic taken together for throat infection bimistake. Any sideffect.

MBBS, MS - ENT
ENT Specialist, Gurgaon
Azee and augmentin antibiotic taken together for throat infection bimistake. Any sideffect.
You can have loose stools so take a pro biotic More than that taken these 2 antibiotics together is useless stop. 1 of them.
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I am having this itchy, runny nose with lot of sneezing accompanied by red watery eyes? Am I having a allergy or what is it? What to do?

MD - Internal Medicine
General Physician,
I am having this itchy, runny nose with lot of sneezing accompanied by red watery eyes? Am I having a allergy or what...
Yes it is allergy to some substance. Maybe dust or cold air or pollens if happens only in a particular season. Best is to avoid allergen and when acute episode arises get medicines prescribed by your physician. U can get your allergen test also.
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I am able to hear tap sound in ear which occurs tapping doing from past 3 days I don't know what to do so please suggest me I'm really getting fear please Help me.

DHMS (Diploma in Homeopathic Medicine and Surgery)
Homeopath, Calicut
I am able to hear tap sound in ear which occurs tapping doing from past 3 days I don't know what to do so please sugg...
It must be tinnitus. Can be related to stress. So reduce your stress by being happy, carefree, take a break etc. Exercise plays a major role. Do ground exercises. If possible do yoga.
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Ate watermelon and avocado since 40 days on regular basis due to summer but now sick and facing throat problem Now how to cure and rescue.

Bachelor of Ayurveda, Medicine and Surgery (BAMS), MD - Ayurveda
Ayurveda, Sri Ganganagar
Ate watermelon and avocado since 40 days on regular basis due to summer but now sick and facing throat problem
Now ho...
You should take septiline syrup 2tsf bd and septiline tablets 1 tab TDs for chewing. Madhuyashthi and Kali maricha for chewing.
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My father is suffering from cerebral sinus thrombosis. They have blood clots in superior superior sagittal sinus & right transverse sinus. 15 days ago, they came across stroke, after stroke we had hospitalized them. Doctor gave him treatment of LMWH & now he is on xarelto for min. 2 years. Doctor said he have deficiency of protein C & S. And told us to check clotting status after 3 months. Now he is able to walk ,speak, and do all other activity as earlier. But still I need second opinion. Is possible to get reed of this clotting through operation or current treatment of Anti coagulation is right for them. Please suggest some specialist.

Homeopath, Anand
According to. Me,anti coagulation therapy is going ok. You should start homepathic anti coagulants along with main treatment. It would support the treatment as well as increase immunity and would bring fast recovery. Also homeopathic nerve tonics are quite effective in such type of chronic cases. Include omega 3 rich food good for brain like walnuts, dates, avocados also give protein rich food like nuts, legumes,lentils (dals) etc.
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Hello doctor, I have tonsil problem in my neck my voice is also down what can I do ,today is 7 day to face this problem.

BHMS
Homeopath, Secunderabad
If it does not get better then get it examined by a doctor. Keep gargling with salt water daily 3-4 times. Avoid chilled water or oily food. Have more fruits and soups. Revert back after the that. You can take Homeopathy if it does not get better.
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Suffering from running nose. What is the solution to relief from that. Pls advice.

B.A.M.S
Ayurveda, Banaskantha
Suffering from running nose. What is the solution to relief from that. Pls advice.
Dear Lybare user, Skip late night sleeping and wake late in morning. Do Yoga Pranayam regularly 30-40 mins. Skip spicy and junk food in regular diet. Apply Desi cow ghee in both nostriles 3-4 times a day regularly and drink water shoul be boiled which can be reduced upto 1/4th part added 1tspSunth Powder in it during boiling.
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Actually my friend is suffering from excess sore throat & cold. She is having problem in speaking. It had started 2 days ago .In the beginning she had normal cough & cold .Then next day she also got fever. She is having a lot of discomfort today due to all this.

MBBS
General Physician, Cuttack
Actually my friend is suffering from excess sore throat & cold. She is having problem in speaking. It had started 2 d...
1.Do betadine gargle 2-3 times daily 2.Avoid drinking cold water, have luke warm water, tea, coffee, hot soup 3.Take throat lozenges, 4.Give voice rest 5..Avoid smoking 6.If no relief you have to take antibiotic 7.Consult doctor for further advice
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I am diagnosed for tinnitus and ear meunière disease. It is causing vet Vertigo nausea. Vomiting etc. Please prescribe best medicine for it and oblige.

MBBS
General Physician,
Hi, Thanks for your question on Lybrate I do understand your concern As per your clinical history is concerned you have meniere'sdisease so you may follow like this -: 1)you can take meclizine for vertigo sensation 2)if regurgitating present then [promethazine] can be integrated 3)if you have history of fluid retention then diuretic amalgamation like trimterene+hydrochlorothiazide] should be integrated 4)take potassium -affluent foods like bananas,oranges,spinach,and sweat potatoes 5)Boil four basil leaves in one cup of milk.Inhale the smell and drink this salubrious tonic daily afore going to bed.Do this for at least a few weeks. 6)If conservative method fails then last option is surgical Hope that helps
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I am suffering from vertigo since last 20+ days. It improved a little gradually over 15 days but with a lot of sleep requirement. As it improved, I tried to get back to my daily routine of exercise (light exercise only) with 7-8 hrs sleep. Within 3 days, vertigo has again increased. I have consulted an ENT and Neuro already and both said nothing to worry. But recurrence is making me worried. What should I do?

MD - Internal Medicine, MBBS
General Physician, Delhi
I am suffering from vertigo since last 20+ days. It improved a little gradually over 15 days but with a lot of sleep ...
Since you have been examined by specialists and nothing serious is there, relax and don't worry. Vertigo may take many weeks and sudden movements can worsen it so continue medication and restricted activity.
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I'm suffering from ear ache and ear blockage since 3 days, it feels like my ear is fall What would be the cause? And what is the remedy?

Diploma in Otorhinolaryngology (DLO), DNB (ENT)
ENT Specialist, Nagpur
I'm suffering from ear ache and ear blockage since 3 days, it feels like my ear is fall What would be the cause? And ...
Hi, ear block and feeling of something in ear most likely there is accumulation of wax in your ear causing the blocked sensation. Still to rule out other causes visit an ent specialist and get your ears examined. Regards.
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I am having bubble like sensation in my throat. I consulted doctors. And they have medicines like antacids. It gives me relief. But the problem is not entirely solved. When I am busy or doing some work I don't have this problem. But when I think about it or during stressful time it's starting to feel. It's been more than one month. I am a fatty boy. And I am addicted to fast foods. Etc. When I searched on the net and people are saying that it could be acid reflux problem. Can you help me please. And they are also saying that this could be solved by change in life style. Please answer me fast.

MSc Applied Biology, Diploma in Naturopathy
Ayurveda, Delhi
I am having bubble like sensation in my throat. I consulted doctors. And they have medicines like antacids. It gives ...
Acid reflex the stomach acid instead of going down comes back .........not a big issue start taking light raw veges fruits ....stop fried items....... add healthy soups less carbohydrates 50 %fibers 35% Proteins and only 15% CHO ...2-3 ltrs of water and 15 mts exercise daily .......think all done without medicines
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I have nose bleeding in summer please how can I stop this and what should I do to stop it.

Doctor of Homeopathic Medicine (H.M.D.)
Homeopath, Ahmednagar
I have nose bleeding in summer please how can I stop this and what should I do to stop it.
Nose bleeding in summer is very common it is due to increase in the body heat. We in homoeopathy try to reduce body heat so that your epistaxis bleeding nose.
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I am having vertigo issue I think. I feel dizziness for most of the time and vomits. Not able to stand or walk it remains till I sleep for some hours. Earlier I got middle ear infection but I took homeopathy ear drop for some time but no improvement. I also had sudden hearing loss before but it is cured as per medical prescription from hamdard medical institute delhi. Pls advice some medicine to get rid of vertigo. Thanks.

C.S.C, D.C.H, M.B.B.S
General Physician,
I am having vertigo issue I think. I feel dizziness for most of the time and vomits. Not able to stand or walk it rem...
If your vertigo comes from your left ear and side: Sit on the edge of your bed. ... Quickly lie down on your back, with your head on the bed (still at the 45-degree angle). ... Turn your head halfway (90 degrees) to the right without raising it. ... Turn your head and body on its side to the right, so you're looking at the floor
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Yesterday I was bathing in a swimming pool and after the bath I felt like water got sticked in my right ear and its not coming out. I feel like it sticked badly and now m also feeling some pain when I am try to take that water out. It also caused blockage to my ear. please help me how to cure that.

B.H.M.S, M.D.(HOM) in Practice of Medicine
Homeopath, Kolkata
Yesterday I was bathing in a swimming pool and after the bath I felt like water got sticked in my right ear and its n...
Use cotton bud for absorb water, MULLIEN OIL ear drop- 2 drops on ear and hold it KALI MUR-200 - one drop twice daily for 3 days.
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