just for ur info .....Neuro-ophthalmology

National Hospital for Neurology and Neurosurgery

Neuro-ophthalmology 

Typically, patient care is multidisciplinary. Specialist diagnostic and follow-up clinics are provided within the Eye Clinic, these are most often used for patients who develop visual problems in association with neurological disease, for example idiopathic intracranial hypertension, pituitary tumours, epilepsy, multiple sclerosis and cerebrovascular disease. There are additional facilites for EMG-guided orbital botulinum therapies and pupillometry, and there are close links with the UCL Institutes of Neurology and Ophthalmology, and with Moorfields Eye Hospital.

Mr Fion Bremner Consultant Mr James Acheson Consultant Dr Gordon Plant Consultant

Mr Fion Bremner Neuro-ophthalmology, Ophthalmology Mr James Acheson Neuro-ophthalmology, Neurology and neurosurgery Dr Gordon Plant Neuro-ophthalmology, Neurology and neurosurgery

​Elsewhere ​there r specialised neurology and nuero surgery hospitals like we have heart institutes. So focus and facilities are much highre level then in a general hospitals. Neuroopthalmolgy is a french and latin in most part of India except Sankar netralaya , Chennai . 

Glaucoma is the eye disease that goes unnoticed

Daily Checkup: Glaucoma is the eye disease that goes unnoticed

Half of Americans over 40 with the disease don't know they have it, which makes eye exams vital

BY KATIE CHARLES / NEW YORK DAILY NEWS

Read more: http://www.nydailynews.com/life-style/health/daily-checkup-glaucoma-unnoticed-article-1.1580972#ixzz2qsffldK7

Dr. Janet Serle of Mount Sinai says, "For the majority of patients this disease can be held in check."

THE SPECIALIST: Dr. Janet Serle

A professor of ophthalmology at Mount Sinai, Dr. Janet Serle exclusively treats patients with glaucoma. January is Glaucoma Awareness Month.

WHO’S AT RISK

While doctors estimate that 2.7 million Americans over the age of 40 have glaucoma, it’s believed that half of those patients don’t even know they have it.

“Glaucoma is a chronic disease that causes damage to the optic nerve that connects the back part of the eye to the brain,” says Serle. “If inadequately treated, glaucoma can lead to blindness, which is why it’s so important to see an eye doctor regularly and get diagnosed quickly if glaucoma does develop.”

The optic nerve is located at the back of the eye, surrounded by the retina. “The optic nerve is like a telephone wire that contains 1 million fibers. If they get damaged, the visual information can’t travel from eye to brain,” says Serle. “Typically, patients lose central nerve fibers last, so they can see well straight ahead after the peripheral vision goes, though some patients don’t fit this pattern and may lose central vision early in the course of the disease.”

Doctors have yet to identify the underlying cause of glaucoma. “We assume there are genetic and environmental factors, and we have defined several genes that are more common in many patients with glaucoma,” says Serle.

“You’re more likely to develop the disease if you’re African-American or Latino, or if you have a family history of the disease, diabetes, thin corneas, optic nerve cupping, or are a chronic user of steroid pills or steroid eye drops,” says Serle. “A general rule of thumb is that the higher your eye pressure, the higher your risk, but 50% of patients don’t actually have high eye pressure, so the diagnosis of glaucoma can never be solely based on high eye pressure.”

While it is possible for patients to develop glaucoma at any stage of life — some babies are even born with glaucoma — the risk does increase with age. “In whites and Latinos, your risk of glaucoma starts going up after age 50, but for African-Americans risk goes up starting at 40,” says Serle. “If you have any risk factors, you need to be monitored as early as your teens and 20s.”

SIGNS AND SYMPTOMS

One of the problems with treating glaucoma is that it can slide under the radar for years. “Most patients’ glaucoma is completely asymptomatic, which means that it is usually detected during a routine eye exam,” says Serle. “The doctor either finds high eye pressure and explores further, or looks in and visually sees the damage in the optic nerve.” The doctor then performs a series of tests to confirm the diagnosis.

TRADITIONAL TREATMENT

Upon being diagnosed with glaucoma, the first step is to assess the intraocular pressure. “One test isn’t enough — we usually need to do several readings over a few days,” says Serle. “Then, our initial treatment is medications like topical drops to lower eye pressure by 30%, which may or may not be enough.” How and when you apply the drops is vital to maximize their effect.

Although several states have legalized medical marijuana for glaucoma patients, it is not a good treatment option. “When it does reduce eye pressure, the duration of effect is very short, typically 3 to 4 hours, whereas the eye drops we use lower pressure from 6 to 24 hours,” says Serle. “In order for marijuana to effectively reduce eye pressure, it would need to be smoked round the clock, interfering with a patient’s daily activities, due to the common side effects.”

If eye drops don’t work, the next option is laser surgery. “The goal is to enhance the flow of fluid out of the eye and thus decrease the eye pressure. We apply 50-100 shots of the laser to the angle of the eye,” says Serle. “Laser surgery basically buys us time before a more invasive surgery. It’s a temporary measure that usually works for anywhere from a few weeks to a few years.”

Laser surgery can only be performed three times, and the efficacy usually decreases each time.

Surgery is the final option. “There are two traditional surgical approaches: one puts a hole in the eye and one puts a tube in the eye, in both cases to drain fluid out,” says Serle. “There are also newer procedures, like MIGS [minimally invasive glaucoma surgery], in which we put little devices in the angle of the eye.” The traditional surgeries are the most effective, but even they sometimes need to be repeated years down the road.

While glaucoma can have dire consequences if left untreated, the current treatment options are highly effective. “For the majority of patients this disease can be held in check,” says Serle. “The key is to take your meds religiously and come back for your eye exams.”

RESEARCH BREAKTHROUGHS

Promising new medications are currently under clinical investigation. “It’s exciting to have three potential new meds to lower eye pressure, all of them working with different mechanisms,” says Serle. “We haven’t had a new drug to treat glaucoma since 1995, so it’s time.”

QUESTIONS FOR YOUR DOCTOR

A good leadoff question for everyone is, “What is my eye pressure?” If it turns out to be over 21, then ask, “Am I at risk of glaucoma?” Follow up by asking, “Do I have any suspicious findings on my eye exam?” and “Should I see a specialist?”

“Sometimes you have to push your doctor a little bit,” says Serle. “But it’s worth doing, because early detection and intervention is so essential for treating glaucoma.”

WHAT YOU CAN DO

Get informed. There are many glaucoma-focused websites; Serle recommends starting with the American Academy of Ophthalmology (aao.org) and Mount Sinai (mountsinai.org/eyecare).

Don’t skip eye checkups. The checkup schedule depends on your age. Newborns with any risk factor should be checked on the first day of life; schoolchildren should be checked once; teens to thirtysomethings should be checked every 2-4 years; patients in their 40s and 50s should be checked every one to three years; and patients over 60 should be checked annually.

Comply with your prescription. If you have glaucoma, one of the most important things you can do is to be vigilant about taking your meds are prescribed. “Enlist a spouse or caregiver to help with the eye drops, which can be hard to instill,” says Serle.

Read more: http://www.nydailynews.com/life-style/health/daily-checkup-glaucoma-unnoticed-article-1.1580972#ixzz2qsfRlJ4e

copy of Brain MRI Repot Ambani sep 2013 Dr Nita Shah

But when will Mumbai Eye hosps and large clinics will have neuro-ophthalmologists ....Alok

worst is in Mumbai most do not know if neuro ophthalmologists super super specialty exists. In USA they are everywhere and in India Sankar Netralaya has 5 of them ......Alok

North Shore Eye Care Adds Ophthalmologists Lawrence Buono, MD Christine Speer-Buono, MD To Medical Staff

In their continuing effort to expand their comprehensive eye care services, the doctors and staff of North Shore Eye Care proudly welcome Lawrence M. Buono, M.D., a Fellowship-Trained Neuro Ophthalmologist who trained at the world-renowned Wills Eye Institute in Philadelphia, PA and his wife, Christine Speer-Buono, MD a general ophthalmologist.

“It is rare to have a physician of Dr. Buono’s training and expertise join our medical staff,” said Jeffrey Martin, MD.

Southold, Long Island (PRWEB) September 12, 2013

In their continuing effort to expand their comprehensive eye care services, the doctors and staff of North Shore Eye Care proudly welcome Lawrence M. Buono, M.D., a Fellowship-Trained Neuro Ophthalmologist who trained at the world-renowned Wills Eye Institute in Philadelphia, PA and his wife, Christine Speer-Buono, MD a general ophthalmologist.

Dr. Buono is a New York native who grew up in the area and enjoys the opportunity to continue practicing on the east end of Long Island. “I am honored by the opportunity to join the medical staff of such a progressive and established eye center as North Shore Eye Care,” said Dr. Buono, who along with his wife have been practicing on the east end of Long Island for nearly nine years. “North Shore Eye Care has a rich tradition of excellence on Long Island and our philosophies on patient care are a perfect fit.”

In addition to Dr. Buono’s extensive experience in treating complex ocular and neuro-ophthalmic conditions, he also has considerable experience with implanting presbyopia-correcting intraocular lenses and treating complicated cataract cases. He currently serves on staff at Southampton Hospital, Eastern Long Island Hospital and Peconic Bay Medical Center.

“I love the challenge of treating complex cataract and neuro-ophthalmic conditions,” said Dr. Buono, “but also thoroughly enjoy utilizing all of the breakthroughs in lens implant technology, diagnostics and surgical techniques to help improve our results in standard cataract surgery.”

Dr. Buono completed his medical degree at Thomas Jefferson Medical College. After completion of a medical/surgical internship at the Presbyterian Hospital/ University of Pennsylvania, he returned to New York for his ophthalmology residency at New York Medical College in Valhalla. Upon completion of his residency, he completed a neuro-ophthalmology fellowship at the Wills Eye Hospital in Philadelphia. Dr. Buono then served as an Assistant Professor of Ophthalmology at Duke University in the neuro-ophthalmology and comprehensive ophthalmology divisions and has authored numerous papers in the ophthalmic literature, and has educated medical students, residents, and fellows.

“It is rare to have a physician of Dr. Buono’s training and expertise join our medical staff,” said Jeffrey Martin, MD. “With Dr. Buono’s training and expertise, we feel confident that our level of comprehensive eye care that we now offer out of our six Long Island locations meets or surpasses the services found in the leading eye centers in the world.” Dr. Buono and Dr. Speer-Buono will be practicing in the Southold, Riverhead and Southampton offices of North Shore Eye Care.

Also joining North Shore Eye Care’s medical staff is Dr. Buono’s wife, Christine Speer Buono, MD, FACS. Dr. Speer Buono graduated from Vanderbilt University with a degree in Chemistry and Spanish, then returned to her home state of Arkansas to receive her medical degree and graduate first in her class from the University of Arkansas for Medical Sciences. She completed an internship at Georgetown Hospital/ INOVA Fairfax Hospital and then residency at the Wills Eye Hospital in Philadelphia, PA. After her residency completion, Dr. Buono became an Assistant Clinical Professor of Ophthalmology at the Duke Eye Center where she practiced comprehensive ophthalmology including cataract surgery.

She also educated medical students and residents through lectures, clinics, and surgical staffing. Since that time, Dr. Buono has enjoyed being a part of this outstanding practice on the East End. Her interests include cataract surgery, laser surgery for glaucoma and after cataract surgery, dry eye, glaucoma, herpetic eye disease, and other anterior segment disorders. She enjoys caring for and being a part of our community. She is on staff at Southampton Hospital and the Suffolk Surgery Center.

“Ophthalmology provides me ample opportunities to enrich the lives of my patients,” said Dr. Buono, “and I consider it an honor to help make a measurable difference in their lives every day.”
The entire medical staff at North Shore Eye Care is proud to have the husband and wife ophthalmic team on staff. “Dr. Buono and his wife have brought a wealth of knowledge in several areas of ophthalmic care to our practice and have been excellent additions to our growing team of surgeons,” said Dr. Martin.

North Shore Eye Care is Long Island’s most established full-service comprehensive eye care provider. This year they are celebrating 50 years of eye care excellence since Dr. Sidney Martin founded the practice in 1962. North Shore Eye Care is also the official Eye Care Provider for the New York Islanders and the official LASIK Providers of the New York Mets. Many of their doctors have been voted ‘TOP DOCTORS’ in the New York Metro Area by Castle Connolly and North Shore Eye Care has earned ‘Best Of Long Island’ honors for the past few years.

North Shore Eye Care maintains offices in Smithtown, Riverhead, Holbrook, Deer Park, Southampton and Southold. They specialize in cataract care, LASIK laser vision correction, glaucoma management, diabetic eye disease, oculoplastics, neuro-ophthalmology, and retinal care. For more information about North Shore Eye Care, please contact Jacqueline Hernandez at 631-265-8780.

Contact Jacqueline Hernandez
Office: 631-265-8780
Email: Jacqueline(at)nsEYE(dot)com

From: Google Alerts <googlealerts-noreply@google.com>
Date: Fri, Sep 13, 2013 at 4:26 PM
Subject: Google Alert - neuro-ophthalmologists
To: atholiya@gmail.com

http://www.prweb.com/releases/2013/9/prweb11114115.htm

News	1 new result for neuro-ophthalmologists

North Shore Eye Care Adds Ophthalmologists Lawrence Buono, MD ...PR Web (press release) Upon completion of his residency, he completed a neuro-ophthalmology fellowship at the Wills Eye Hospital in Philadelphia. Dr. Buono then served as an ... See all stories on this topic »

I am diagonised with Right Mastoiditis and Chronic Right Maxillary sinus.....Shows MRI @ Ambani : on 4ht Sep 2013

Do not know whether to go to ENT or  Neurologist or Onco or Interventionist or ???? Pl. talk to ur friend doctor if any and advise......Alok  

Why I went for MRI: I hv a Right optic nerve and chiasm atrophy means right eye optic nuritis. Besides I hv constant headache on right side.

Mastoiditis

From Wikipedia, the free encyclopedia

Jump to: navigation, search

Mastoiditis
Classification and external resources
Side view of head, showing surface relations of bones. (Mastoid process labeled near center.)
ICD-10	H70
ICD-9	383.0-383.1
DiseasesDB	22479
MedlinePlus	001034
eMedicine	emerg/306 ped/1379
MeSH	D008417

Mastoiditis is the result of an infection that extends to the air cells of the skull behind the ear. Specifically, it is an inflammation of the mucosal lining of the mastoid antrum and mastoid air cell system inside^[1] the mastoid process. The mastoid process is the portion of the temporal bone of the skull that is behind the ear which contains open, air-containing spaces.^[2][3] Mastoiditis is usually caused by untreated acute otitis media (middle ear infection) and used to be a leading cause of child mortality. With the development of antibiotics, however, mastoiditis has become quite rare in developed countries where surgical treatment is now much less frequent and more conservative, unlike former times.^[2] Untreated, the infection can spread to surrounding structures, including the brain, causing serious complications.^[4]

Contents

• 1 Features
• 2 Diagnosis
• 3 Pathophysiology
• 4 Prevention and treatment
• 5 Prognosis
• 6 Epidemiology
• 7 References
• 8 Further reading
• 9 External links

Features

Some common symptoms and signs of mastoiditis include pain, tenderness, and swelling in the mastoid region. There may be ear pain (otalgia), and the ear or mastoid region may be red (erythematous). Fever or headaches may also be present. Infants usually show nonspecific symptoms, including anorexia, diarrhea, or irritability. Drainage from the ear occurs in more serious cases, often manifest as brown discharge on the pillowcase upon waking.^[4][5]

Diagnosis

Mastoiditis with subperiostal abscess

The diagnosis of mastoiditis is clinical—based on the medical history and physical examination. Imaging studies provide additional information; The standard method of diagnosis is via MRI scan although a CT scan is a common alternative as it gives a clearer and more useful image to see how close the damage may have gotten to the brain and facial nerves. Planar (2-D) X-rays are not as useful. If there is drainage, it is often sent for culture, although this will often be negative if the patient has begun taking antibiotics. Exploratory surgery is often used as a last resort method of diagnosis to see the mastoid and surrounding areas.^[2][6]

Pathophysiology

The pathophysiology of mastoiditis is straightforward: bacteria spread from the middle ear to the mastoid air cells, where the inflammation causes damage to the bony structures. Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus, Haemophilus influenzae, and Moraxella catarrhalis are the most common organisms recovered in acute mastoiditis. Organisms that are rarely found are Pseudomonas aeruginosa and other Gram-negative aerobic bacilli, and anaerobic bacteria.^[7] P. aeruginosa, Enterobacteriaceae, S. aureus and anaerobic bacteria (Prevotella, Bacteroides, Fusobacterium, and Peptostreptococcus spp. ) are the most common isolates in chronic mastoiditis.^[8] Rarely, Mycobacterium species can also cause the infection. Some mastoiditis is caused by cholesteatoma, which is a sac of keratinizing squamous epithelium in the middle ear that usually results from repeated middle-ear infections. If left untreated, the cholesteatoma can erode into the mastoid process, producing mastoiditis, as well as other complications.^[4]

Mastoid cells of Lenoir

Prevention and treatment

In general, mastoiditis is rather simple to prevent. If the patient with an ear infection seeks treatment promptly and receives complete treatment, the antibiotics will usually cure the infection and prevent its spread. For this reason, mastoiditis is rare in developed countries. However, the rise of "superbugs" that are resistant to conventional antibiotics increases the risk that ear infections will worsen into mastoiditis. Most ear infections occur in infants as the eustachian tubes are not fully developed and don't drain readily.
In the United States the primary treatment for mastoiditis is administration of intravenous antibiotics. Initially, broad-spectrum antibiotics are given, such as ceftriaxone. As culture results become available, treatment can be switched to more specific antibiotics directed at the eradication of the recovered aerobic and anaerobic bacteria.^[8] Long-term antibiotics may be necessary to completely eradicate the infection.^[4] If the condition does not quickly improve with antibiotics, surgical procedures may be performed (while continuing the medication). The most common procedure is a myringotomy, a small incision in the tympanic membrane (eardrum), or the insertion of a tympanostomy tube into the eardrum.^[6] These serve to drain the pus from the middle ear, helping to treat the infection. The tube is extruded spontaneously after a few weeks to months, and the incision heals naturally. If there are complications, or the mastoiditis does not respond to the above treatments, it may be necessary to perform a mastoidectomy: a procedure in which a portion of the bone is removed and the infection drained.^[4]

Attack triangle in mastoidectomies

Prognosis

With prompt treatment, it is possible to cure mastoiditis. Seeking medical care early is important. However, it is difficult for antibiotics to penetrate to the interior of the mastoid process and so it may not be easy to cure the infection; it also may recur. Mastoiditis has many possible complications, all connected to the infection spreading to surrounding structures. Hearing loss is likely, or inflammation of the labyrinth of the inner ear (labyrinthitis) may occur, producing vertigo and an ear ringing may develop along with the hearing loss, making it more difficult to communicate. The infection may also spread to the facial nerve (cranial nerve VII), causing facial-nerve palsy, producing weakness or paralysis of some muscles of facial expression, on the same side of the face. Other complications include Bezold's abscess, an abscess (a collection of pus surrounded by inflamed tissue) behind the sternocleidomastoid muscle in the neck, or a subperiosteal abscess, between the periosteum and mastoid bone ( resulting in the typical appearance of a protruding ear). Serious complications result if the infection spreads to the brain. These include meningitis (inflammation of the protective membranes surrounding the brain), epidural abscess (abscess between the skull and outer membrane of the brain), dural venous thrombophlebitis (inflammation of the venous structures of the brain), or brain abscess.^[2][4]

Epidemiology

In the United States and other developed countries, the incidence of mastoiditis is quite low, around 0.004%, although it is higher in developing countries. The condition most commonly affects children aged from two to thirteen months, when ear infections most commonly occur. Males and females are equally affected.^[3]

References

1. ^ Diseases of ear nose & throat by PL dhingra & shruti dhingra. published by elsevier
2. ^ ^{a b c d} "Mastoiditis". MedlinePlus Medical Encyclopedia. Retrieved July 30, 2003.
3. ^ ^{a b} "Ear Infections – Treatment". webmd.com. Retrieved 24 November 2008.
4. ^ ^{a b c d e f} Young, Tesfa. "Mastoiditis". eMedicine. Retrieved June 10, 2005.
5. ^ "What to Do About Ear infections". webmd.com. Retrieved 24 November 2008.
6. ^ ^{a b} Bakhos D, Trijolet JP, Morinière S, Pondaven S, Al Zahrani M, Lescanne E (2011 Apr). "Conservative management of acute mastoiditis in children". Arch Otolaryngol Head Neck Surg. 137(4): 346–50.
7. ^ Nussinovitch M, Yoeli R, Elishkevitz K, Varsano I (2004). "Acute mastoiditis in children: epidemiologic, clinical, microbiologic, and therapeutic aspects over past years". Clin Pediatr (Phila) 43: 261–7.
8. ^ ^{a b} Brook I (2005). "The role of anaerobic bacteria in acute and chronic mastoiditis". Anaerobe 11: 252–7.

Further reading

• Durand, Marlene & Joseph, Michael. (2001). Infections of the Upper Respiratory Tract. In Eugene Braunwald, Anthony S. Fauci, Dennis L. Kasper, Stephen L. Hauser, Dan L. Longo, & J. Larry Jameson (Eds.), Harrison's Principles of Internal Medicine (15th Edition), p. 191. New York: McGraw-Hill
• Cummings CW, Flint PW, Haughey BH, et al. Otolaryngology: Head & Neck Surgery. 4th ed. St Louis, Mo; Mosby; 2005:3019–3020.
• Mastoiditis E Medicine

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Maxillary sinus

From Wikipedia, the free encyclopedia

Jump to: navigation, search

Maxillary sinus
Outline of bones of face, showing position of air sinuses.
Latin	sinus maxilliaris
Gray's	subject #223 999
Artery	infraorbital artery, posterior superior alveolar artery
Nerve	posterior superior alveolar nerve, middle superior alveolar nerve, anterior superior alveolar nerve, and infraorbital nerve
MeSH	Maxillary+Sinus

The pyramid-shaped maxillary sinus (or antrum of Highmore) is the largest of the paranasal sinuses, and drains into the middle meatus of the nose.^[1]

Contents

• 1 Development
• 2 Discovery
• 3 Structure
  • 3.1 Nasal wall/base
  • 3.2 Posterior wall
  • 3.3 Floor
• 4 Pathology
  • 4.1 Maxillary sinusitis
    • 4.1.1 Sinusitis treatment
• 5 Cancer
  • 5.1 Age
• 6 Additional Images
• 7 See also
• 8 References
• 9 External links

Development

It is present at birth as rudimentary air cells, and develops throughout childhood.

Discovery

The maxillary sinus was first discovered and illustrated by Leonardo da Vinci, but the earliest attribution of significance was given to Nathaniel Highmore, the British surgeon and anatomist who described it in detail in his 1651 treatise.^[2]

Structure

Found in the body of the maxilla, this sinus has three recesses: an alveolar recess pointed inferiorly, bounded by the alveolar process of the maxilla; a zygomatic recess pointed laterally, bounded by the zygomatic bone; and an infraorbital recess pointed superiorly, bounded by the inferior orbital surface of the maxilla. The medial wall is composed primarily of cartilage. The ostia for drainage are located high on the medial wall and open into the semilunar hiatus of the lateral nasal cavity; because of the position of the ostia, gravity cannot drain the maxillary sinus contents when the head is erect (see pathology). The ostium of the maxillary sinus is high up on the medial wall and on average is 2.4 mm in diameter; with a mean volume of about 10 ml.^[3][1] Stand near the person during an extraoral examination to visually inspect and bilaterally palpate the maxillary sinuses.^[4]
The sinus is lined with mucoperiosteum, with cilia that beat toward the ostia. This membrane is also referred to as the "Schneiderian Membrane", which is histologically a bilaminar membrane with ciliated columnar epithelial cells on the internal (or cavernous) side and periosteum on the osseous side. The size of the sinuses varies in different skulls, and even on the two sides of the same skull.^[3]
The infraorbital canal usually projects into the cavity as a well-marked ridge extending from the roof to the anterior wall; additional ridges are sometimes seen in the posterior wall of the cavity and are caused by the alveolar canals.
The mucous membranes receive their postganglionic parasympathetic nerve innervation for mucous secretion originating from the greater petrosal nerve (a branch of the facial nerve). The superior alveolar (anterior, middle, and posterior) nerves, branches of the maxillary nerve provide sensory innervation.

Nasal wall/base

Its nasal wall, or base, presents, in the disarticulated bone, a large, irregular aperture, communicating with the nasal cavity.
In the articulated skull this aperture is much reduced in size by the following bones:

• the uncinate process of the ethmoid above,
• the ethmoidal process of the inferior nasal concha below,
• the vertical part of the palatine behind,
• and a small part of the lacrimal above and in front.

The sinus communicates through an opening into the semilunar hiatus on the lateral nasal wall.

Posterior wall

On the posterior wall are the alveolar canals, transmitting the posterior superior alveolar vessels and nerves to the molar teeth.

Floor

The maxillary sinus can normally be seen above the level of the premolar and molar teeth in the upper jaw. This dental x-ray film shows how, in the absence of the second premolar and first molar, the sinus became pneumatized and expanded towards the crest of the alveolar process (location at which the bone meets the gum tissue).

The floor is formed by the alveolar process of the maxilla, and, if the sinus is of an average size, is on a level with the floor of the nose; if the sinus is large it reaches below this level.
Projecting into the floor of the antrum are several conical processes, corresponding to the roots of the first and second maxillary molar teeth; in some cases the floor can be perforated by the apices of the teeth.

Pathology

Maxillary sinusitis

Maxillary sinusitis is inflammation of the maxillary sinuses. The symptoms of sinusitis are headache, usually near the involved sinus, and foul-smelling nasal or pharyngeal discharge, possibly with some systemic signs of infection such as fever and weakness. The skin over the involved sinus can be tender, hot, and even reddened due to the inflammatory process in the area. On radiographs, there is opacification (or cloudiness) of the usually translucent sinus due to retained mucus.^[4]
Maxillary sinusitis is common due to the close anatomic relation of the frontal sinus, anterior ethmoidal sinus and the maxillary teeth, allowing for easy spread of infection. Differential diagnosis of dental problems needs to be done due to the close proximity to the teeth since the pain from sinusitis can seem to be dentally related.^[1] Furthermore, the drainage orifice lies near the roof of the sinus, and so the maxillary sinus does not drain well, and infection develops more easily. The maxillary sinus may drain into the mouth via an abnormal opening, an oroantral fistula, a particular risk after tooth extraction.

Sinusitis treatment

Traditionally the treatment of acute maxillary sinusitis is usually prescription of a broad-spectrum cephalosporin antibiotic resistant to beta-lactamase, administered for 10 days. Recent studies have found that the cause of chronic sinus infections lies in the nasal mucus, not in the nasal and sinus tissue targeted by standard treatment. This suggests a beneficial effect in treatments that target primarily the underlying and presumably damage-inflicting nasal and sinus membrane inflammation, instead of the secondary bacterial infection that has been the primary target of past treatments for the disease. Also, surgical procedures with chronic sinus infections are now changing with the direct removal of the mucus, which is loaded with toxins from the inflammatory cells, rather than the inflamed tissue during surgery. Leaving the mucus behind might predispose early recurrence of the chronic sinus infection. If any surgery is performed, it is to enlarge the ostia in the lateral walls of the nasal cavity, creating adequate drainage.^[4]

Cancer

Carcinoma of the maxillary sinus may invade the palate and cause dental pain. It may also block the nasolacrimal duct. Spread of the tumor into the orbit causes proptosis.^[1]

Age

With age, the enlarging maxillary sinus may even begin to surround the roots of the maxillary posterior teeth and extend its margins into the body of the zygomatic bone. If the maxillary posterior teeth are lost, the maxillary sinus may expand even more, thinning the bony floor of the alveolar process so that only a thin shell of bone is present.^[4]

Additional Images

• 

  Maxillary sinus
• 

  Maxillary sinus

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• 
  

Mastoiditis

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Mastoiditis is an infection of the mastoid bone of the skull. The mastoid is located just behind the ear.

Causes

Mastoiditis is usually caused by a middle ear infection (acute otitis media). The infection may spread from the ear to the mastoid bone of the skull. The mastoid bone fills with infected materials and its honeycomb-like structure may deteriorate.
Mastoiditis usually affects children. Before antibiotics, mastoiditis was one of the leading causes of death in children. Now it is a relatively uncommon and much less dangerous condition.

Symptoms

• Drainage from the ear
• Ear pain or discomfort
• Fever, may be high or suddenly increase
• Headache
• Hearing loss
• Redness of the ear or behind the ear
• Swelling behind ear, may cause ear to stick out

Exams and Tests

An examination of the head may reveal signs of mastoiditis. The following tests may show an abnormality of the mastoid bone:

• CTscan of the ear
• Head CT scan

A culture of drainage from the ear may show bacteria.

Treatment

Mastoiditis may be difficult to treat because medications may not reach deep enough into the mastoid bone. It may require repeated or long-term treatment. The infection is treated with antibiotics by injection, then antibiotics by mouth.
Surgery to remove part of the bone and drain the mastoid (mastoidectomy) may be needed if antibiotic therapy is not successful. Surgery to drain the middle ear through the eardrum (myringotomy) may be needed to treat the middle ear infection.

Outlook (Prognosis)

Mastoiditis is curable with treatment. However, it may be hard to treat and may come back.

Possible Complications

• Destruction of the mastoid bone
• Dizziness or vertigo
• Epidural abscess
• Facial paralysis
• Meningitis
• Partial or complete hearing loss
• Spread of infection to the brain or throughout the body

When to Contact a Medical Professional

Call your health care provider if you have symptoms of mastoiditis.
Call for an appointment with your health care provider if:

• You have an ear infection that does not respond to treatment or is followed by new symptoms
• Your symptoms do not respond to treatment

Prevention

Promptly and completely treating ear infections reduces the risk of mastoiditis.

References

Chole RA, Sudhoff HH. Chronic otitis media, mastoiditis, and petrositis. In: Flint PW, Haughey BH, Lund LJ, et al, eds. Cummings Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2010:chap 139.
Klein JO. Otitis externa, otitis media, and mastoiditis. In:Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap57.
O’Handley JG, Tobin EJ, Shah AR. Otorhinolaryngology. In: Rakel RE, ed. Textbook of Family Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 19.

Update Date: 8/30/2012

Updated by: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington. Seth Schwartz, MD, MPH, Otolaryngologist, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc

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Dr Vaibhav 's advise to trat thru Ayurved

Dr. Vaibhav <sangamhealthcentre@gmail.com>	Jan 23
to me

take ayurved netrabasti and also triphala-daruhaldi eyewash under vaidya guidance,you will benefit as I have from personal experience-dr vaibhav lunkad

Personal corresspondence on right eye

Vipresh Gangwal <vipreshg@gmail.com>	Feb 25
to me

Mamaji Pranam,

Bottom Line on Top: Please keep a copy of all your medical records and doctors opinions ready for me.

I am very excited to see you all soon next week and meet you.

In this short trip with one of the big events in my life, I know time is going to fly by. I realize in the rush and hurry might not be able to even greet everyone with as much time as I would personally want. But in the midst of all this, I do not want to miss the opportunity to get a copy (digital or photocopy) of all your records regarding the Glaucoma.

I want to talk to some specialists here and get a second opinion. I don't see any harm in trying.

I do not have names of any particular doctors in mind, but I will surely do my research and consult a few of them. So if you know about some hospital or doctor that are good, you can include those details too in the records copy.

I am waiting to see you and get your blessings before the big day in my life.

Love you 

Your mastikhor bhanja

Pampoo

On Mon, Jan 28, 2013 at 6:56 AM, Alok Tholiya <atholiya@gmail.com> wrote:

 

As  usual my self own my own found that there is some development in my right eye. No one believed me initially. Even eye specialist did not diagonise nor first believed what I was saying as I am just 58. Then he must have realized I may have Glaucoma.Doc then sent me for tests .

 

Great news. 75% vision in my right is permanently lost. These are messages from almighty that has started liking me and considering my name for his invite list and Yamdut is busy so unless it is urgent it may take few years for him to send me invite.

 

In the meanwhile he has given me time to :

1. Stretegise my plans for retirement

2. enjoy more time with meditation and keep in touch with him

3. spend some time on health so I am less burden to active members in family ( but I hv to develop will power as knowing that is not enough)

4. Given me alert to Beautifully design my will and last testament.

5. Increase pace of good work for humanity ( next item on agenda is Ambulance for society).( my novel idea  Day creche / Palna Ghar for Dada Dadi ( Sr. citizens ) so earning members can attend to office/ emergency seems little distant)

6. Tour some  destinations longed for whole life that one day I will be free and will be able to find time. Finally I thought post my dear daughters marriage I will be free when  I hand over her to a loving , caring , honest , character worthy husband and his family but .....but if wishes were horses  fools would ride. As bad-luck was chasing me we tied know to Nishant Paras Jain, who had connived with Vidhi and Shilpa to fool and cheat us so I further became busy and tormented. Police, Courts, fraud stree Chetana and its advocate Helen and others are further delaying the matter and siding with wife cheater and beater Nishant Jain by delaying the justice. Insha Allah things will be alright as I have not learnt to bow down to wrongdoers and will ultimately come out victorious as it is rightly said that there is delay but not injustice in the darbar of Almighty.

7. I will now be able to raise more vehemently issues dear to me , fight for right, RTI, activism, fight police and courts who have different procedures and standards for different set of people and so on.

 

Hope you will enjoy , celebrate and become enlightened with this news of my loss of 75% vision and take it as a step reaching near and dear GOD and will not waste time on asking several questions on this development.

Why I am making this open as I am not the one who tries to keep everything secret and hidden. Read me like a open book. ...........