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Cysts Removal Procedure
Treatment of Tonsils (Tonsillitis)
Hearing Aid Fitting
Treatment of Throat and Voice Problems
Earlobe Repair Procedure
Treatment of Sleep Disturbance
Nose Reshaping Procedure
Hearing Testing Techniques
Nasal And Sinus Allergy Care
Cochlear Implant Procedure
Ear Micro Surgery
Treatment Of Hearing Deficiency
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Hello doctor. I am 20 years old I have type 1 diabetes and last month I had unprotected vaginal sex with a prostitute and then after 2 weeks I got scabies and they were cured in 2 weeks now I am having fungal infections and oral thrush, a sore throat and a painless swollen lymph node under my right jaw does it mean I have hiv?
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
● 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
● bad breath
● symptoms of chronic sinusitis (may or may not be present)
● nasal or postnasal discharge
● facial pain or pressure
● nosocomial sinusitis is typically seen in patients with nasogastric tubes or nasotracheal intubation.
● 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
● foreign bodies
● congenital choanal atresia
● other entities that cause obstruction of sinus drainage
● dental infections lead to maxillary sinusitis.
● viruses recovered alone or in combination with bacteria (in 16% of cases):
● 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
● 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
● 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.
● 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.
● 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
● 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.
● 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
She have suffering by tonsils from last few year's, what is the future diagnosis of the tonsil, if not treated from a long distance?
It is that that time of the year when insect are all around. Suddenly one feels a buzzing sound or an itchy feel in the ear. To your horror, one feels a live insect in the ear which can be extremely annoying and a nightmare. Insects get stuck in the ear when enter our ears as they cannot fly or crawl out. They try their way out and their movements inside our ears can be very uncomfortable, painful, and itchy. Moreover, they can easily produce infection.
In this scenario, do not try to remove an insect with cotton swabs, tweezers or hair clips as it will make situation worse and can lodge the insect deeper into ear canal damaging the eardrum, leading to permanent hearing loss. If an individual is not certain of the potential for harm in regard to insect in the ear, one should seek medical care immediately. Insects in the ear are common reasons for visits to doctor's clinic, especially in children.
If one suspects an insect in ear, one may experience pain, swelling, blood or crackling. One may even feel biting, stinging, hearing loss or dizziness. It is best to stay calm in this situation as being active may lodge the bug further in ear or cause it to move further back, or cause serious damage to the sensitive eardrum
One way to try to remove a bug in ear is by tilting the ear toward the ground and attempt to wiggle the ear. Grasp the earlobe and give it a wiggle. If the bug is not too far into ear canal, it may fall out on its own. If the bug is still alive and is not too far inside of the ear canal, it may simply come out on its own. If one stays calm and keep objects including fingers away from ears, it is likely that the bug will find its way back out of ear.
One can also try to flush the ear with warm water with a dropper or a bulb syringe. This can be done by holding head upright and stretching the ear canal by pulling the outer ear and then putting a steady stream of warm water into ear. Tilt head to the side to drain out the ear. Do not try this if one suspects that ear drum has been ruptured to prevent additional damage.
To avoid stinging or eardrum rupture from scratching or biting , one may use a drop or two of mineral, baby, or olive oil inside your ear canal to kill the insect. Finally, visit an ENT specialist doctor as they can remove the insect by special suction devices. Post insect removal, one must look out for signs of infection as swelling, dizziness, hearing loss, fever, and pain. Finally follow up with ENT specialist or Otolaryngologist for the final opinion. In case you have a concern or query you can always consult an expert & get answers to your questions!