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Dr. Rupali Gulavni

ENT Specialist, Pune

500 at clinic
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Dr. Rupali Gulavni ENT Specialist, Pune
500 at clinic
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Hello and thank you for visiting my Lybrate profile! I want to let you know that here at my office my staff and I will do our best to make you comfortable. I strongly believe in ethics; a......more
Hello and thank you for visiting my Lybrate profile! I want to let you know that here at my office my staff and I will do our best to make you comfortable. I strongly believe in ethics; as a health provider being ethical is not just a remembered value, but a strongly observed one.
More about Dr. Rupali Gulavni
Dr. Rupali Gulavni is an experienced ENT Specialist in Aundh, Pune. You can meet Dr. Rupali Gulavni personally at AIMS Hospital - Aundh in Aundh, Pune. Book an appointment online with Dr. Rupali Gulavni and consult privately on Lybrate.com.

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AIMS Hospital - Aundh

Survey No.154, Aundh. Landmark: Near Parihar Chowk, PunePune Get Directions
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Sinusitis: Management and Prevention

MBBS, Fellowship In Endocrinology
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

5 people found this helpful

My throat gets sore most of the times and mainly area and glands under the ears are painful. Some doctors say allergy, snoring, GERD etc could be the cause.

BHMS
Homeopath, Faridabad
My throat gets sore most of the times and mainly area and glands under the ears are painful. Some doctors say allergy...
Hello, kindly tell me - since how long you have been suffering? any fever with it? is there any other symptom/ complaint with it? have you got any investigations done, if yes, kindly share the reports with me or else at least get your blood tested for cbc (with esr). Meantime, start taking homoeopathic medicines - kali mur. 6 x and ferrum phos. 6x - thrice daily for 1 week. Revert back.
1 person found this helpful
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I have a pain at corner of one eye and nose. Eyeball and above are also paining. Can it be sinus? Pl suggest suitable remedies. Awaiting your prompt reply. Thanks.

MD Hom., Certificate in Food and Nutrition, BHMS, Diploma In Yoga, PGDM
Homeopath, Indore
Yes it is sinus problem. But you need to go for x-ray PNS to confirm the diagnosis. Treatment will be given after taking your whole case taking including the site of pain, type of pain, aggravating and ameliorating factors, etc General management- 1 keep yourself warm 2 be hydrated 3 take steam inhalation 4 be stress free 5 massage your scalp to relieve pain for homeopathic medicines, contact us.
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I not able to sleep well for more than 4 to 5 days and my ears gone red so please help me.

MBBS
General Physician, Cuttack
I not able to sleep well for more than 4 to 5 days and my ears gone red so please help me.
1. You may be having anxiety or stress. Avoid stress. 2. You need 7-8 hours of sound sleep to remain healthy. 3. Go for regular exercise, Take part in games and sports, 4. Do yoga, meditation and deep breathing exercise like pranayama to calm your mind, control your emotion, relieve anxiety and improve concentration. 5. Adhere to a specific sleep time and regular schedule 6. Take light dinner. 7. Avoid taking tea/coffee at bed time. Have a glass of warm milk at bed time. 8. Don’t go to sleep immediately after dinner. Take a small walk after dinner and if possible take hot water bath before sleep. Read a light magazine or interesting book before going to bed 9. Avoid late night. 10. Don’t sleep in day time 11. Don’t take sleeping pill 12. If no relief consult doctor.
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I have migraine and its like severe headache and it causes vomiting too after complete vomit I feel better and headache get disappear also I am suffering from cough since my childhood and chronic sinusitis patient too. Kindly help me. Thank you.

MS - ENT, DNB (ENT)
ENT Specialist, Delhi
Please avoid migraine triggers like hot sun, bright lights, cheese, lack of sleep etc. For sinus problem kindly refer once to an ent specialist. Regards.
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I am 62 yrs old young man suffering of 1) instant anger 2) Drowsy/sleeping whol eday even after having full-night sleep 3) snoring with loud sound 4) sexual dissatisfaction due to early ejaculation Body weight 84kg and Height 1.72m BP 140mm / 95-100mm No diabetic once suffered/operated for Heart rhythm disorder.

MBBS
General Physician, Mumbai
I am 62 yrs old young man suffering of
1) instant anger
2) Drowsy/sleeping whol eday even after having full-night sle...
For all your problems I will suggest you to take Tablet folvite 5mg once a day for six months and tablet vitamin D3 60000iu once a week for six months and we will get the results if you don't skip the tablet
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Sir I am in depressed from April 2017. Due to taking extra stress and fear from illness. Actually I have a vertigo on 1st March and after searching reasons on vertigo on internet I become so scared and I tested ECG tmt and city scan of mind and endoscopy of small intestine all reports are normal I loss weight of 6 kg due to stress .Now I am so stressed and hate my self in front of mirror and a phobia to see in mirror many times .Please suggest best treatment and how long it take place. I already taken mirtaz7. 5 for 10 days and nexito plus for 10 days already.

CCEBDM, PG Diploma In Clinical cardiology, MBBS
General Physician, Ghaziabad
Sir I am in depressed from April 2017. Due to taking extra stress and fear from illness. Actually I have a vertigo on...
Firstly relax and take life as it comes. Do not over stress your self I will help you to come out of the problem do 1.no alcohol 2. Maitain body wt 3. No smoking/ tobacco 4. Diet - no ghee/ butter, have mix of vegetable oils - mustard, til, ground nut, olive oil, have more green vegetables and fruits, have whole grain atta, no fried. Fast. Spicy / processed/ junk food. Less sugar, potato, rice 5. 30 mts brisk walk daily. Start your day with walking 6. Deep breathing exercise for 10 mts daily 7. Meditation daily for 10 mts. 6-8 hrs of sleep at night 8. Expose your body to sun for 15-20 mts daily after some oil massage to get vit d. 9. Take more water- proper hydration. For medicine and further contact on private chat .along with your daily routine be positive and interact with friends and relatives .whom you trust write your BP follow above and do not see internet too much good luck.
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Have runny nose and dust allergy and using esiflo and flutarol rotor caps since 4 years but now those medicines are not working pls let us know any other medicines.

MBBS
General Physician, Mumbai
Take tablet Histafree M twice a day for five days and improve your immunity by taking Tablet folvite 5mg once a day for six months and tablet vitamin D3 60000iu once a week for six months
1 person found this helpful
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Natural Remedies for Ear Infections in Children

DNB (Pediatrics), MBBS
Pediatrician, Ghaziabad
Natural Remedies for Ear Infections in Children

Ear aches are a common complaint for many children. An ear infection can be explained as an inflammation of the middle ear. Unlike other aches, this one cannot be soothed by scratching or applying pressure and hence makes children cranky. Ear infections are usually triggered by bacteria or viruses. This causes inflammation that narrows the tube in the ear and allows fluid to build up. This fluid buildup is responsible for the pain. 

However, not all ear infections need to be treated with medication. When it comes to treating ear aches in children, picking a natural remedy is a much better option ,since it has no side effects and can address the root cause of the infection. Here are a few natural remedies for earaches:

  1. Compress: Hot and cold compresses are very effective ways of treating pain and can be used for earaches as well. Place an ice pack or a warm, moist compress over the ear to soothe the ache. Heat relaxes the muscles and stimulates blood flow while ice controls inflammation and swelling. Hot and cold compresses should not be applied for over 20 minutes at a time. 
  2. Water: Some actions can help open up the eustachian tube to the middle ear. Swallowing is one such action. To encourage your child to swallow, offer him lots of fluids. 
  3. Oil: Before using oil to treat an earache ensure that your child is not suffering from a ruptured eardrum and there is no fluid leaking from the ear. Pouring a few drops of warm olive oil or sesame oil can help soothe the pain by opening up the eustachian tube. It can also prevent the buildup of excessive ear wax and form a protective layer on the outer ear against bacteria and other infections. 
  4. Elevate the head: Elevating a child's head can help improve sinus drainage. When it comes to children, instead of using a pillow below their head, place the pillow below the mattress to create a gradual slope. 
  5. Onion: Onions can be used in many different ways to treat earaches. You could either juice an onion and put a few drops of the same in the ear or slice an onion in half and heat it before placing it over the ear like an ear muff. Onion contains anti inflammatory and antibacterial properties that help soothe earaches effectively and quickly. 

If the earache does not reduce or if there is a discharge from the ear, do not continue to self treat it and consult a doctor immediately.

Related Tip: "Common Ear Infections: What You Should Know About Them"

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