30 yr old female c/o occasional expulsion of calcified,foul smelling small balls on cough. H/0 post nasal drip with chronic sinusitis present. No other co morbidity. I think its tonisilolith advised to improve oral hygiene, saline and betadine gargle.Pls suggest your opinion and management.Thanks



Advise:- esnophilya,polymorphonuclear Symptom:- Headache due to pressure in partially or completely blocked sinuses. The pain may increase when the person bends down. Facial tenderness and/or swelling when facial areas over sinus areas are touched Pressure or pain due to mucus pressing on sinus tissue or inflammation of sinuses.Fever due to inflammation of sinus tissues and infection. A cloudy, discolored nasal drainage is often seen in bacterial sinus infections. Congestion is a feeling of nasal stuffiness and occurs with both infectious and non-infectious sinusitis. Postnasal drip is mucus overproduction from sinusitis that flows to the throat and irritates throat tissue. Sore throat is inflammation of throat tissue by postnasal drip. Cough is a response to post nasal drip and the body's attempt to clear out throat tissue irritants. Tooth pain caused by pressure on surrounding nerves and tissues Ear pain caused by pressure on surrounding nerves and tissues Eye pain caused by pressure on surrounding nerves and tissues Fatigue due to fever, immune response, and/or coughing Bad breath usually is due to bacterial infections Itching/sneezing - In noninfectious sinusitis, other associated allergy symptoms of itching eyes and sneezing may be common but may include some of the symptoms listed above for infectious sinusitis. Nasal drainage usually is clear or whitish-colored in people with noninfectious sinusitis. Ulceration can occur with rare fulminant fungal infections with sharply defined edges and a black, necrotic center in the nasal area. Some fungal infections cause dark, black-appearing exudates. This requires immediate medical evaluation. Multiple chronic (over one to three months) symptoms usually are a sign of subacute or chronic sinusitis Treatment:-Viral sinusitis Antibiotics are not necessary for sinusitis caused by a virus. Frequently recommended treatments include pain and fever medications, for example: acetaminophen [Tylenol]) Decongestants and mucolytics dissolves are medications that dissolve or breakdown mucous, for example, guaifenesin. Bacterial sinusitis Bacterial infection of the sinuses is suspected when facial pain, nasal discharge resembling pus, and other symptoms last longer than a week and are not responding to over-the-counter (OTC) nasal medications. Acute sinus bacterial infection usually is treated with antibiotics aimed at treating the most common bacteria known to cause a sinus infection. It is unusual to get a reliable culture without aspirating the sinuses. The five most common bacteria causing sinus infections are: Streptococcus pneumoniae Haemophilus influenzae Moraxella catarrhalis Staphylococcus aureus Streptococcus pyogenes Antibiotic treatment for sinus infections must be able to kill these five types of bacteria. Amoxicillin (Amoxil) is acceptable for uncomplicated acute sinus infections; however, many doctors prescribe amoxicillin-clavulanate (Augmentin) as the first-line antibiotic to treat a possible bacterial infection of the sinuses. Amoxicillin usually is effective against most strains of bacteria. Other antibiotics may be used as a  first choice if you are allergic to penicillin, for example, cefaclor (Ceclor) loracarbef (Lorabid) clarithromycin (Biaxin) azithromycin (Zithromax) sulfamethoxazole (Gantanol) trimethoprim (Bactrim, Septra) ciprofloxacin (Cipro)  (Note:- some casce antibiotics is not necessary) Anti-inflammatory,anti paratic:-acitometephene Anti histamine:- levocetirizine, montilucast etc. Nasal spray:-Corticosteroid sprays,Saline spray,Nasal rinses,Decongestant sprays Gargle:-Gargling is another way to drain your sinuses. Gargling vibrates your throat and sinus passages and helps them open to let the mucus out. Gargling also helps with bad breath. Plus it sounds and looks pretty cool. Gargling is when you put a little bit of salt water or mouthwash in your mouth, tip your head back and blow air out through your throat, making the liquid gurgle. If you’ve never done it, don’t try it until an adult is there to help.

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