Category Archives: Nose and Sinuses

Home Care Tips for Cold & Sore Throat

Re blogged from my old post

Usually with winter respiratory and throat infection cases increases, but this year physicians and ENT clinics are witnessing increased number of Patients as Mumbai is experiencing unusual low levels of temperature.

With High level of pollutants and particulate matter allergic cold (rhinitis) and sore throat cases are on rise.

3157516906_2df91217faphoto by quirkyrocket at flickr creative commons

Here are few home care tips to fight with stuffy nose/sore throat:–

Though it does not replace proper diagnosis and medical management but it helps as supportive treatment in faster recovery and reduces sleepless nights. Personally I have advised these tips to patients and it works in lessening patient’s discomfort.

  •  Proper rest
  •  Take balanced diet with plenty of vitamin and minerals to boost defense mechanism.
  •  Vitamin c and zinc supplements.
  •  Keep hydration adequate as cold air has drying effect
  • Hot soups like tomato soup, chicken soup works wonder in thinning of secretions.
  •  Black pepper, basil leaves, cloves and ginger boil with water and drink at night time; it’s soothing and helps in mucus coming out.
  • Honey is age old miraculous natural cure from cough.
  • One pinch of turmeric with 1 cup warm milk helps in easy expulsion of mucus.
  • Researches show ginger, garlic and onion has medicinal properties and helps in cold and cough.

_-______________ 

  • Gargles with warm saline (salt in warm water)
  •  Saline irrigation or nasal wash (1/4 teaspoonful of salt in lukewarm water)
  •  Humidification. Use of vaporizer (Steam inhalation) or humidifier can be done to increase the humidity in the air.
  •  Avoid smoking; active and passive.
  •  Avoid alcohol as it increases swelling of mucus membrane.
  •  Avoid dust, pollen, pets, deodorants, chemical irritants.
  • Do deep breathing exercises.

Get flu vaccine before season starts, it works.

  • Dress in layers wear woolen cloths
  • Protect hands and feet (30% of heat escapes through hands and feet
  • Cover head with hat or scarf (40% of heat lost through head)

Enjoy Winter With Home Care for Stuffy Nose/Sore Throat

photo by quirkyrocket at flickr creative commons

Usually with winter respiratory and throat infection cases increases, but this year physicians and ENT clinics are witnessing increased number of Patients as Mumbai is experiencing unusual low levels of temperature for prolonged period.

With High level of pollutants and particulate matter trapped in the morning fog allergic cold (rhinitis)  and sore throat cases are on rise.

You can read more about air pollution in Mumbai at agreeneryoutoo.blogspot.com by Sunita purushottam

Usually you can wait for 7-10 days for symptoms to go away with some home measures if it is improving or not worsening.

Here are few home care tips to fight with stuffy nose/sore throat:–

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cc Flickr Photo by assbach

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  • Dress in layers wear woolen cloths
  • Protect hands and feet (30% of heat escapes through hands and feet
  • Cover head with hat or scarf (40% of heat lost through head)
  • In excessive old cover your face with scarf

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  • Decongestants shrink the blood vessels in the lining of the nose and relieve stuffiness. Decongestant nasal sprays and drops should not be used for more than 3 days, because they have rebound effect and can make the congestion worse.

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  • Antihistamines may reduce the amount of mucus but most antihistamines make people drowsy.

  • Gentle saline nasal sprays are quite helpful.

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  • For a baby an infant nasal aspirator can help remove the mucus. Putting two or three saline nose drops into each nostril helps in loosening of thick mucus. Discharge can be cached outside the nostril on a tissue rather than inserting cotton swab inside the nose.

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  • Warm saline gargles (lukewarm water with common salt) soothes throat.
  • Use of vaporizer (Steam inhalation) or humidifier can be done to increase the humidity in the air.
  • Maintain hydration as cold air has drying effect.
  • Keep the head elevated while sleeping.

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  • Adhesive strips can be placed on the nose. These strips help widen the nostrils, making breathing easier.

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  • Hot tea, broth, or chicken soup may be especially helpful.
  • Keep balanced diet with vitamins and minerals to boost immunity.
  • Avoid outside food
  • Take adequate rest
  • Wash hands regularly
  • Avoid smoking and alcohol as it increases nasal irritation

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The FLU Ends with U. Learn more: www.flu.gov

    • Get flu vaccine

______________________________________________________________________________________

It is important to understand the symptoms of common cold, flu and sinusitis for appropriate treatment.

______________________________________________________________________________________

Last but not the least  to share with all health care professionals

The FLU Ends with U. Healthcare providers make a difference. Learn more: www.flu.gov

Evaluation of Child with Nose Block, Snoring and Restless Sleep

With increasing awareness about sleep apnea child is increasingly being refereed to otorhilnolaryngologist (E N T specialists) by pediatricians to evaluate the cause of nose block, snoring and restless sleep.

Nasal blockage is the sensation of reduced air flow either through one nostril (unilateral) or both nostrils (bilateral).

It is common thinking amongst people that blocked nose (congested or stuffy nose) is because of thick mucus and they try to blow it out. But it is wrong thinking.

Image attributesflickr photos/flatiron32 creative commons

Nasal block is a common complaint in children and it usually resolves without treatment. However it may cause a significant problem with abnormalities in teeth and face as well as heart and lung of child. Nasal block can interfere with the ears, hearing, and speech development. In first few months of life it can interfere with feeding and cause life threatening problems.

Thus every nasal block and mouth breathing in children should be evaluated carefully and potential serious causes must be considered in the differential diagnosis.

Causes of Nose Block

There are many different causes of nasal obstruction. Some causes are present at birth (congenital), oOther causes are acquired later in life.

Infectious/inflammatory mucosal swelling

  • Allergic rhinitis
  • Chronic rhino-sinusitis

Structural problems

  • Enlarged Adenoids
  • Deviated nasal septum (DNS)
  • Enlarged turbinate
  • Nasal polyps

Foreign Body nose

Congenital

  • Posterior choanal stenosis/atresia
  • Encephalocele/meningoencephalocele
  • Craniofacial deformities
  • Dermoids/Craniopharyngiomas/Teratomas/Chordomas
  • Nasoalveolar and Nasopharyngeal (Tornwaldt’s) cysts

Evaluation of a child with nose block

The goals of the evaluation are to determine specific causes of problems, the severity of the obstruction, and the presence of associated medical complications.

This is achieved by thorough history of symptoms and clinical examination of nose along with endoscopic examination of nose and nasopharynx.

Examination of nose of a young child can be done by simply tilting the tip of the nose upwards or using an otoscope.  An extensive examination of nose is often difficult and not possible.

Following diagnostic tests based on clinical findings may be advised:-

  • Allergy skin tests
  • Blood tests (such as CBC)
  • Sputum culture and throat culture
  • X-rays of the sinuses, Nasopharynx and chest
  • Serum total IgE

Differential diagnosis

Rhintis –

Nasal mucosa is thin pinkish lining that covers inside of the nose.  Swelling or inflammation of this mucosa can be caused by allergies, irritants (smoke and pollution), infection, hormonal (vasomotor rhinitis) and abuse of nasal drops (rhinitis medicamentosa).

Careful history and evaluation of the nose (nasal endoscopy for detailed examination) is all that is required to find out the likely diagnosis. Sometimes, additional tests may be advised to confirm the cause.

Usually medical treatment along with antibiotics and steroid nasal spray are required along with preventive measures to avoid allergen/irritants.

Allergy shots are successful treatment method. SLIT skin tests and sometimes blood tests are used to make allergy-inducing substances specific to an individual patient.

Chronic sinusitis is evaluated by CT scan during the quiet periods. A very conservative approach is followed as far as children are concerned. If patient fails to respond to medical treatment endoscopic sinus surgery may be necessary.

Deviated Nasal Septum (DNS)

Nasal septum is mid line partition which divides the nose into two halves. Child may be born with a deviated septum, or may develop after injury to nose.

Clinical examination by headlight and mirror is enough to conform the diagnosis, nasal endoscopy may be done for detailed examination of nose to rule out other anatomical abnormalities inside the nose and nasopharynx.

Sometimes DNS does not cause any symptoms but if it is severe enough to block the nasal passage it is to be corrected with surgery of septum (septoplasty)

Adenoid Enlargement

Second most common cause of nose blockage is enlarged or hypertrophied adenoids. Adenoids are lymphoid tissue similar to tonsils situated at back space of nose.

Adenoids are not directly visible and mirror examination or nasal endoscopy is required to see it. X-ray of nasopharynx may be done to see the enlarged adenoids.

If adenoids are blocking nasal airway leading to sleep apnea it has to be removed surgically.

You can read more about tonsils and adenoids in previous post

Foreign Body Nose–

A common cause of nasal obstruction in the younger child is an object (foreign body) placed in the nose (such as peanut, seeds, beads, button cell).

Characteristic history usually raises strong suspicion. Child usually comes with a foul smelling drainage from the nose on the side of the foreign object.

Removal can be done in the office without anesthesia but occasionally, if the foreign body has been present a long time, a short general anesthesia is necessary to remove it.

Congenital  Malformations

Choanal atresia (back opening of the nose is blocked with either tissue or bone), if bilateral (both sides are involved) surgical repair is needed immediately to allow the child to breath normally. If only unilateral (one sided) the diagnosis may be made much later in life.

Tumors such as nasal dermoids, chordoma and craniopharyngiomas most often present during infancy and early childhood however, they may be missed early in life.

Summary:

In summary, chronic nasal obstruction in children is a common symptom that requires careful evaluation, a correct diagnosis and treatment plan. Both the diagnostic evaluation and the treatment must take into account not only the nature and severity of the primary disease, but also the possible adverse effects on hearing, facial growth as well as cardiac and pulmonary systems.

Balloon sinuplasty; A non-surgical treatment of sinusitis

Sinusitis is inflammation of sinuses. Mucus collects and blocks the sinus openings.

Symptoms are headache, facial pain,nasal discharge, nasal blockage and post nasal drip.

Aim of treatment is to open up blocked sinus passageways.

balloon-sinuplasty

Balloon sinuplasty is true advance in the field of sinus care. It works on same concept as balloon angioplasty for the treatment of clogged coronary arteries.

A wire catheter (approved by FDA) is introduced through the nostril and moved towards blocked passageways. Catheter has a balloon in the front.Then balloon gradually inflated to open up blocked passageways, then it is deflated and removed. Sinus drainage is restored.

Balloon sinuplasty alone may eliminate the need for surgery in some patients and others may require concurrent endoscopic sinus surgery.

Balloon sinuplasty is safe, effective , minimally invasive, cost effective, takes less recovery time, has less patient discomfort, and has no side effects.

Studies confirm it’s safety and efficacy and high patient satisfaction. But still it is under evaluation for long term success and further studies are needed to see it’s effectiveness in presence of nasal polyp or when ethmoid sinus is involved.

How to diagnose acute sinusitis? Clinical criteria and investigations

Mostly patients of sinusitis can be benefitted without much investigation as diagnosis is mainly based on clinical criteria in patient who presents with persistent or severe upper respiratory symptoms.

 

Although sinus aspiration is the gold standard for the diagnosis of acute bacterial sinusitis, it is an invasive, time consuming, and potentially painful procedure that should only be performed by a specialist (Oto-rhino-laryngologist).  It is not recommended for the routine diagnosis of bacterial sinusitis.

 

Nasal endoscopy for proper visualization of nose and sinuses is important for appropriate management.

 

Sometimes if symptoms persist for longer duration further investigation may be required like examination of mucocilliary mechanism, allergic and immune status of patient and computerized tomography (CT scan) of sinuses.

  How sinusitis develops?–

 Acute sinusitis usually follows an upper respiratory tract infection.

Upper respiratory infection causes– over production of mucus and– impaires mucocilliary clearance (small hair like structure, cilia helps propel mucus out).

 This compounded with blockage of opening of sinuses (osteomeatal area or key area) by mucosal edema and associated structural deformity of nose (like DNS, spur) leads to stagnation of secretion.

 Blockage of sinus opening also impedes with ventilation of sinus cavity.

 Stagnation and poor ventilation causes growth of bacteria.

  Certain factors predisposes for sinusitis-allergy, structural defects like deviated nasal septum, spur, low immunity like in HIV, defects of ciliary mechanism like cystic fibrosis, kartagenar’s  syndrome, and immotile cilia syndrome.

 Diagnosis of sinusitis:–

 Diagnosis is usually based on proper history and thorough physical examination.

 Nasal endoscopy for proper visualization of nose and sinuses is important for appropriate management.

 Symptoms:-

 Purulent discharge from nose

Pain/pressure sensation over face more on leaning forward.

Headache

Nasal blockage

Changes in taste/smell

Poor response to decongestant

Toothache

Pressure sensation in the ear. 

Be prepared with bombarding with questions, you may feel useless or you may not want to answer especially if you are having sinus headache. But it helps your clinician to reach to the diagnosis.

 Examination of nose:

 Nose is inspected thoroughly with nasal speculum (a small metal instrument), with a good source of light focused inside your nose. Any discharge coming from sinuses opening or any structural deformity is looked for. 

120px-thudichum27s_nasal_speculum_ent_instrument_medical

Previously head mirror and Bulls lamp was used to focus light in to nasal cavity.

head mirrorhead mirror

 

Bulls lamp

Bulls lamp

Some use direct source of light attached to headlight by a cable.

Head light with light source
Head light with light source

 With advancement in technology many E.N.T. Specialist are using nasal endoscope attached to camera and monitor to see the nose and nasopharynx. Endoscopic assessment of nose guide therapy and at the same time accurate pus-swab can be obtained for bacteriological examination.

Clinically tenderness over specific point of sinuses is assessed.

 Laboratory test: 

Not of much value in acute sinusitis.

In cases not responding to treatment it may be done.

 Immune status of patient-HIV/chemotherapy

Allergy testing

Nasal cytology

Sweat chloride test for cystic fibrosis

Cilliary function test

 In refractory cases one should always think possibility of fungal sinusitis.

 Radiology:-– 

X-Rays of sinuses are not helpful in making diagnosis.

 CT scan- CT scan are generally not advised routinely. It is advised by otolaryngologist if surgery is anticipated (to evaluate the extent of sinusitis and guiding during surgery), infection is severe or there is risk of complication.

 MRI– MRI is not as effective as CT scan in evaluating sinusitis and is more costly. But when your ENT specialist is suspecting fungal sinusitis (a topic I will cover in my next blogs), want to differentiate sinusitis from tumor or there is intracranial complications.  

 Determination of causative organism: –

 It requires puncture, aspiration of mucopus and culture, but usually it is not done initially as it is invasive procedure. It is reserved for cases refractory to primary line of management.

  Further studies are required in the field and acute bacterial sinusitis is to be differentiated from viral rhinosinusitis and severe common cold. Further researches are required to develop noninvasive strategies to accurately diagnose acute bacterial sinusitis.

 

 

 

 

 

Home Care for chronic cough

Though general home remedies do not replace proper diagnosis and medical management but it helps as supportive treatment in faster recovery and reduces sleepless nights. It works in lessening patient’s discomfort.

  

Proper rest

 

Take balanced diet with plenty of vitamin and minerals to boost defense mechanism.

 

Vitamin c and zinc supplements.

 

Keep hydration adequate.

 

Hot soups like tomato soup, chicken soup works wonder in thinning of secretions.

 

Black pepper, basil leaves, cloves and ginger boil with water and drink at night time; it’s soothing and helps in mucus coming out.

 

Honey is age old miraculous natural cure from cough.

 

One pinch of turmeric with 1 cup warm milk helps in easy expulsion of mucus.

 

Researches show ginger, garlic and onion has medicinal properties and helps in cold and cough.

 

Gargles with warm saline (salt in warm water)

 

Saline irrigation or nasal wash (1/4 teaspoonful of salt in lukewarm water)

 

Humidification.

 

Steam inhalation.

 

Avoid smoking; active and passive.

 

Avoid alcohol as it increases swelling of mucus membrane.

 

Avoid dust, pollen, pets, deodorants, chemical irritants.

 

Do deep breathing exercises.

 

Get flu vaccine before season starts, it works.

Home care for sinus problem

Infection of sinuses is called sinusitis. Sinusitis may be caused by anything that interfere with airflow into the sinuses and mucus drainage out of the sinuses, usually follow a viral infection, allergy, or irritants. Thus treatment is aimed at thinning of secretions for easy drainage or reducing inflammation to open up blocked sinus passageways.

Home remedies effectively reduce symptoms of sinusitis and reduce visits to doctor’s clinic.

Proper rest and nutrition.

Vitamin c, vitamin A and zinc

Sleep with head elevated.

Maintain adequate hydration.

Drink hot drinks like hot soups and tea.

Steam inhalation– Plain water or medicated steam with menthol has soothing effect and helps in improving sinus drainage. hot shower also helps.

Hot fomentation-application of warm cloth, hot water bottle or gel pack to face for 5-10 minutes relieves pain and inflammation to some extent.

Saline irrigation nose and sinuses should be washed by 1/4 tsf salt in 1 cup water using bulb syringe, alternatively commercially available saline nasal sprays can be used.

Avoidance of allergen if any.

Avoidance of irritants/smoke.

Use of humidifier.

If symptoms persist visit your clinician or otolaryngologist.

Nasal douching or “jala-neti” for sinusitis

Originally a yogic tradition nasal wash, nasal douching, nasal irrigation or “jala-neti” is very effective in  sinusitis-allergic or infective, post nasal drip and even post-sinus surgery to clean nasal passages and easy breathing.

 

As an E.N.T. specialist I have witnessed improved quality of life and reduced visits of patients to my clinic. 

Randomized controlled trials (General of family practice by Dr Rabago) shows that it improves smptoms of sinusitis and quality of life, with decreased use of medications.

Alternatively saline nasal sprays can also be used to clean the nose and sinuses.

 

 

  • How it works? 

**Hyper tonic saline used in nasal irrigation improves drainage of secretion by:-

  • Improving mucocilliary clearance ( Sinuses are lined by respiratory epithelium with Goblet cells to secretes mucus (forming mucus blanket) and cilia (fine hair like structure) to help trap and propel pollutant and bacteria outward to nose through osteum (opening) of sinuses.
  • Helps in thinning of mucus.
  • Possibly reduce inflammation.

     

 

 

  •  **Procedure for nasal douching- 

You will find so many articles written on procedure and some are very cumbersome but believe me it is very simple, there is no need of sophisticated equipments-  “It is saline that works not equipment”.

1: Take slightly warm water in a bowl or “jala-neti pot” .

 

 

2: Add 1/2 teaspoonful of salt and a pinch of sodium bicarbonate and mix well.

 

 

3: Pour some into the palm of your hand and sniff into your nose, alternatively you can use “chip syringe or bulb syringe” or “simple 10 cc syringe” to gently push solution into your nose.

 

 

4: Let your nose drain by its own first, you can very gently blow one nostril at a time keeping other nostril closed. Do not blow forcefully.

5: Repeat procedure at least 3 times on each side. 

Sinus, Acute sinusitis and treatment

Management of sinusitis has witnessed fundamental change in the last two decades. Nasal endoscopy and CT scan has revolutionized visualization of nose and sinuses.

 

 

 

Basic understanding- (What is Sinus?)

Human skull contains four pairs of hollow air filled cavities connected to the space between nostril and nasal passage; these are called Sinuses (or Para Nasal Sinuses). Sinuses help insulate the skull, reduce its weight and add resonance to voice.

There is 4 major pair of sinuses–
1.Frontal (in the forehead), 2. Maxillary (behind the cheek bones) 3.Ethmoid (between the eyes), 4. Sphenoid (behind the eyes).

sinusitis

 

 

 

Sinuses are lined by respiratory epithelium with Goblet cells to secretes mucus (forming mucus blanket) and cilia (fine hair like structure) to help trap and propel pollutant and bacteria outward to nose through osteum (opening) of sinuses.

 

Most of the sinuses drain into a key area (Osteo-Meatal complex). Thus treatment of sinusitis is focused on this area.

Acute sinusitis


Infection of sinuses is called sinusitis–acute or chronic based on the time span.
Sinusitis may be caused by anything that interfere with airflow into the sinuses and mucous drainage out of the sinuses, usually follow a viral infection, allergy, or irritants.

Most common bacteria involved are streptococcus pneumonae, Haemophilus influenzae, and moraxella catarhalis.

 

 

 

Signs and symptoms of sinusitis depend on which sinus is involved–usually present with:
-nasal congestion and discharge or post nasal drip
-headache, or facial pain, or pain under or around the eyes
-fever

 

 

 

Treatment of acute sinusitis:-

Maxillary sinus is most commonly involved followed by ethmoid, frontal and sphenoid.

 

 

Aims of management are:-

1. To achieve normal healthy sinuses

2. To decrease duration of the symptom

3. To prevent complications

4. To prevent development of acute sinusitis.

 

 

 

 

Most patients of acute sinusitis can be benefitted without many investigations as diagnosis is mainly clinical. Nasal endoscopy for proper visualization of nose and sinuses is important for appropriate management. Endoscopic assessment of nose guide therapy and at the same time accurate pus-swab can be obtained for bacteriological examination.

Sometimes if symptoms persist for longer duration further investigation may be required like examination of mucocilliary mechanism, allergic and immune status of patient and computerized tomography (CT scan) of sinuses.

 

 

 

Medical management:-

Analgesics, antibiotics and decongestants are given to reduce swelling and thus increase clearance and drainage from the sinuses.

Antibiotics–studies have confirmed that acute bacterial sinusitis treated with antibiotics have more rapid resolution of symptoms.

Antibiotics should be effective and should cover wide range of organisms.

In general antibiotics are required for 10 days but in some cases especially recurrent cases up to 2 weeks course may be given.

Usually amoxicillin, ampicillin, co-amoxyclav and cephalosporins are primary drugs of choice. If first line drugs fail then second line treatment is based on culture and sensitivity report of pus aspirated from sinuses by antral lavage.

 

 

 

Nasal decongestant drops–Nasal decongestant or steroid drops or sprays are used to decongest sinus osteum and thus encourage drainage.

Clinicians prefer long acting preparation because of less rebound phenomena. Topical decongestant drops should not be used for long duration as it back fires and person develops “rhinitis medicamentosa.”

 

 

 

Oral decongestant or mucolytics–may be used to reduce mucosal inflammation. In general antihistamines are to be avoided in acute bacterial sinusitis because it will thicken and dry the secretion.

 

 

 

Analgesics–any suitable and safe pain killer medicine acetaminophen or ibugesic are prescribed to relieve pain.

 

 

 

Home care–

Steam inhalation— plain water or medicated steam with menthol provides relief from symptoms and helps in improving sinus drainage.

 

Hot fomentation–application of warm cloth, hot water bottle or gel pack to face for 5-10 minutes relieves pain and inflammation to some extent.

 

Saline irrigation, Nasal wash or “jala neti” –-nose and sinuses should be washed by ¼ tsf salt in 1 cup water using bulb syringe or alternatively commercially available saline nasal sprays can be used.

 

Avoidance of allergy if any

Use of humidifier
Avoidance of irritants

 

Baloon Sinuplasty it’s new nonsurgical technique which is cost effective.

A balon is placed in the affected nasal cavity, inflated for short duratin to open up sinus passageways.  

Surgical management-

 

Usually acute sinusitis is treated by medicines. Most cases of acute maxillary sinusitis resolve with effective and proper medical management. Very rarely when medical treatment fails surgical approach is required.

 

Surgical treatment is reserved for-

Failure of medical management

Severe pain

Impending complications.

 

Antral lavage-

This is opd procedure under local anaesthesia where medial wall of maxillary sinus is punctured in the region of inferior meatus, sinus is drained and irrigated. Now this technique is rarely employed and endoscopic enlargement of middle meatus is preferred.

Frontal sinuses wash outs-

This is done in general anaesthesia. Small incision is given below eyebrow medially.

 

 

 

Functional Endoscopic sinus surgery-

Recurrent acute bacterial sinusitis or sinusitis of long duration unresponsive to medicine is major indication for endoscopic sinus surgery.

Endoscopic surgery is minimally invasive surgery. It does not require skin incisions and done by endoscope inserted through nose.

CT scanning is must before surgery.

One thing to be remembered-meticulous postoperative cleaning is equally important for success as is the expertise of surgeon.

 

 

 

 

Treatment plan for acute sinusitis may vary according to experience of treating physician, but it is crucial to understand the importance of “osteomeatal region”.

 

Effective medical management requires good doctor-patient understanding. Medical professional should take time for patient to educate them on importance of taking antibiotics regularly and in proper doses as advised. Often it is irregular time interval and missed doses which create resistant bacteria leading to failure of medical treatment.

 

From my article at helium.com- http://www.helium.com/items/1269826-treatment-of-acute-sinusitis