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What Causes Vertigo When Suffering From Tonsillitis And Sinusitis?
Question: My daughter is 10 year old. She in the past has had various ENT problems including tonsillitis and sinusitis. From time to time she also complains about vertigo, during the current episode of flu her vertigo was more prominent. We therefore decided to consult a neuro-physician.
The neuro-physician initially diagnosed it as a dietary problem and recommended regular intake of fluids etc. But he also recommended an MRV. The results of the MRV are as follows:
Normal MRI brain without contrast.
Right transverse and sigmoid venous sinuses attenuated in thickness - hypoplastic - developmental variant.
Rest of MRV brain without contrast unremarkable.
Significant pansinusitis
Upon seeing these results he recommended the following treatment regimen:
Zinc Sulfate 5ml 3 times a day
Vi-Daylin Syrup (Vitamin Supplement) 2 times a day
Panadol Half Tablet three times a day
Warfarin 5mg Tablets – Half and Quarter tablet on each successive day.
He also ordered Blood coagulation profile test, the results of which are as follows
PT (Patient): 11.5 Sec
PT (Control): 11.3 Sec
INR: 1.02
Based on the above, I would like your assessment (second opinion) on the following specific questions.
• Do we need to put the patient on Warfarin at this time or should we first focus on pansinusitis.
• Your assessment of the results on the MRV test. What do these results mean in layman language? What should we do in the short as well as long term if you think the results pose significant issues for the patient?
• The patient has been treated earlier (3 months back) for sinusitis and tonsillitis through heavy dose antibiotic (Cefim) for 10 days. But we are still seeing pansinusitis in the patient. What should be the treatment regimen for pansinusitis.
• What long/short term vitamin/supplement do you recommend for my daughter?
The neuro-physician initially diagnosed it as a dietary problem and recommended regular intake of fluids etc. But he also recommended an MRV. The results of the MRV are as follows:
Normal MRI brain without contrast.
Right transverse and sigmoid venous sinuses attenuated in thickness - hypoplastic - developmental variant.
Rest of MRV brain without contrast unremarkable.
Significant pansinusitis
Upon seeing these results he recommended the following treatment regimen:
Zinc Sulfate 5ml 3 times a day
Vi-Daylin Syrup (Vitamin Supplement) 2 times a day
Panadol Half Tablet three times a day
Warfarin 5mg Tablets – Half and Quarter tablet on each successive day.
He also ordered Blood coagulation profile test, the results of which are as follows
PT (Patient): 11.5 Sec
PT (Control): 11.3 Sec
INR: 1.02
Based on the above, I would like your assessment (second opinion) on the following specific questions.
• Do we need to put the patient on Warfarin at this time or should we first focus on pansinusitis.
• Your assessment of the results on the MRV test. What do these results mean in layman language? What should we do in the short as well as long term if you think the results pose significant issues for the patient?
• The patient has been treated earlier (3 months back) for sinusitis and tonsillitis through heavy dose antibiotic (Cefim) for 10 days. But we are still seeing pansinusitis in the patient. What should be the treatment regimen for pansinusitis.
• What long/short term vitamin/supplement do you recommend for my daughter?
Brief Answer:
Avoid using warfarin...
Detailed Answer:
Hi
Thanks for posting the query
I have gone through the history and understood the problem; I'll try my best to help you with this.
According to the history given by you, I do feel the dizziness could be related to blockage of the sinuses and migraine. According to the MRI findings, the brain is perfectly normal, which is a great relief.
I do completely agree with you that the sinusitis has to be treated first before giving any other medicines.
Unresolved sinusitis is because the antibiotic which was given before to the child was not effective. In other words, cefixime is not the drug of choice to treat tonsillitis or flu. The drug of choice is the penicillin group of drugs, which will take care of both sinusitis as well as tonsillitis.
I would prefer to encourage your daughter to eat plenty of fresh fruits and vegetables which are natural source of vitamins. I personally don’t administer vitamin supplements unless the patient is unable to consume food or in severe vitamin deficiencies.
My sincere suggestion for you is:
1. Get your child examined by an apt ENT specialist.
2. Encourage the child to drink plenty of warm water and do steam inhalation.
3. A mucolytic such as bromhexine or ambroxol (available under various brand names) will help in lysing the secretions and clearing the sinuses.
4. Use saline nasal spray, saline nasal spray is beneficial in cleaning the nose and clearing the sinus secretions.
5. I would not recommend the use of warfarin, as I see no indications to advocate the same.
6. Try using steroid nasal spray. Steroid nasal spray (such as momentasone), aids in opening the blocked sinuses.
7. Paracetamol can be used if the child complains of headache.
Hope with the above measures, your child will be alright. Revert back to me if you any follow-up queries.
Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Avoid using warfarin...
Detailed Answer:
Hi
Thanks for posting the query
I have gone through the history and understood the problem; I'll try my best to help you with this.
According to the history given by you, I do feel the dizziness could be related to blockage of the sinuses and migraine. According to the MRI findings, the brain is perfectly normal, which is a great relief.
I do completely agree with you that the sinusitis has to be treated first before giving any other medicines.
Unresolved sinusitis is because the antibiotic which was given before to the child was not effective. In other words, cefixime is not the drug of choice to treat tonsillitis or flu. The drug of choice is the penicillin group of drugs, which will take care of both sinusitis as well as tonsillitis.
I would prefer to encourage your daughter to eat plenty of fresh fruits and vegetables which are natural source of vitamins. I personally don’t administer vitamin supplements unless the patient is unable to consume food or in severe vitamin deficiencies.
My sincere suggestion for you is:
1. Get your child examined by an apt ENT specialist.
2. Encourage the child to drink plenty of warm water and do steam inhalation.
3. A mucolytic such as bromhexine or ambroxol (available under various brand names) will help in lysing the secretions and clearing the sinuses.
4. Use saline nasal spray, saline nasal spray is beneficial in cleaning the nose and clearing the sinus secretions.
5. I would not recommend the use of warfarin, as I see no indications to advocate the same.
6. Try using steroid nasal spray. Steroid nasal spray (such as momentasone), aids in opening the blocked sinuses.
7. Paracetamol can be used if the child complains of headache.
Hope with the above measures, your child will be alright. Revert back to me if you any follow-up queries.
Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
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Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
Answered by
Dr. Naveen Kumar Nanjasetty
Otolaryngologist / ENT Specialist
Practicing since :2001
Answered : 2540 Questions
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