- Warts
- Fibromyalgia
- SinusitisDiagnosis and treatment of pediatric sinusitis is very similar to that in adults, but it is important to remember that there are differences. Symptoms which occur more prominently in children include irritability, earache, nasal odors, cough and halitosis.
- Medical Weight LossThese drugs have been found to rarely cause abnormalities in liver functions, and Zyflo must be monitored with blood tests on a monthly basis for the first several months. Accolate may cause a rare disease called the Churg-Strauss syndrome. It typically may present with symptoms such as fever, weight loss and generalized aches and pains. It is caused by inflammation of the blood vessels. More information can be found on the FDA's website listed in bookmarks.
- Pediatric Care
- Bronchitis
- Diarrhea
- Pneumonia
- ImmunizationsTo determine specific antibody levels, we challenge patients with the Pneumovax vaccine as well as diphtheria and tetanus and then do matched-pair antibody levels before and four weeks after the injections. This will determine if they are able to respond to a bacterial challenge and form antibodies. It is important to have facilities to store the bloods in your office for at least one month so that a matched pair can be sent to the laboratory. It is also critically important to save a specimen of the blood taken before the immunizations so that if the laboratory loses the blood you will still have some of the pre-immunization specimen. You must assume that the lab will lose the specimen, since they will about 25% of the time.
- Pregnancy
- Internal MedicineDr. Tichenor is Board Certified in internal medicine and is a fellow of the American College of Physicians and a Fellow of the Academy of Allergy, Asthma and Immunology. He also teaches courses at the annual meeting of the Academy on endoscopic evaluation of sinusitis. He is an Associate Professor of Medicine at New York Medical College. He has published articles on sinusitis including a Task Force Report on endoscopic evaluation of sinusitis.
- EndoscopyThis section is based in part on practice parameters which were developed by the Sinusitis Committee of the American Academy of Allergy, Asthma and Immunology, of which I am a part. I mention this only for the purpose of properly crediting the source of much of this material. It is NOT in any way meant to imply any endorsement of any kind by the Academy. The practice parameters have been published and are now available. There is a link on the bookmark page at the end of this site. It is also based on a recently completed a paper on endoscopic evaluation of patients with sinusitis (both before and after surgery. It is available at http://www.aaaai.org/media/resources/academy_statements/practice_papers/endoscopy.pdf.
- Interstitial Cystitis
- Multiple SclerosisCastro et. al. suggested that Honey Bee Venom may be safely used to treat Multiple Sclerosis, larger studies need to be done to determine efficacy.
- Attention Deficit Hyperactivity Disorder (ADHD)Brawley et al reported that a high percentage of patients with ADHD had allergic rhinitis which they speculated there could be an interrelationship which might contribute to cognitive defects and sleep disturbance.
- Depression
- Insomnia
- Anxiety
- Thyroid
- UltrasoundTransillumination of the sinuses and ultrasound have a minimal degree of usefulness except under rare circumstances. Plain films are now rarely done, although occasionally in patients with acute sinusitis they may be helpful. Because of the fact that in many institutions CT scans may be obtained for approximately 50% more in cost than plain films, for the most part limited CT scans with coronal views are commonly done. Typically views may be primarily focused on the area of the ostiomeatal complex. Caution must be observed as viral URI's have been demonstrated to cause thickening of the mucosal lining on CT scan analogous to findings with sinusitis. MRI scans are generally less useful except in fungal disease. Several representative CT scans are located in another section of this website.
- MRIJust found your page. My bride has suffered with headaches diagnosed as Migraine; some of them were. Some of the head pain was due to meds. Currently taking DEPAKOTE, avoiding cola, caffeine, and other triggers. The pain is on the bridge of the nose, directly above the nose and at the inside corners of the eyes. It is constant, worsening with activity and wet weather. Scans, MRI and CT are clear. Any chance this is allergy/sinus ?
- X-Rays
- Computed TomographyThere is an exciting new development in endoscopic sinus surgery called Image Guided Surgery, a technique which allows the surgeon to correlate exactly where he or she is operating with a previously performed CT scan. There are several manufacturers now including InstaTrak by GE,, BrainLAB, Medtronic (LandmarX) Fusion, and Stryker iNtellect ENT.. This system allows the surgeon to simultaneously visualize 4 different views on a monitor: the coronal, sagittal and axial CT scan images at the same time as the real time surgical endoscopic view. It is then possible to compare the surgically visualized anatomy with the same anatomy of the CT scans. The unique aspect of these systems is that the surgeon knows by looking at the monitor exactly where his instruments are during surgery on the CT visualization.
- OtolaryngologyThe most common reason to do surgery is due to failure of medical management after an appropriate period of time. In other words, symptoms persist despite optimal medical therapy. Absolute indications for surgery have been established by the American Academy of Otolaryngology-Head and Neck Surgery and include complete obstruction by polyps, spread of infection or abscess into the brain, the area surrounding the eye, or frontal sinus (Pott's puffy tumor), mucocele, fungal sinusitis, tumor or fluid leak from the brain. Other circumstances depend on whether medical management has been successful. It is critically important to recognize that the definition of "failure of medical management" is not well defined. It can mean a week of antibiotics or it can mean an extended evaluation and course of treatment for several months. Needless to say, the percentage of patients who need to have surgery is dependent on the extent of medical management. We typically will refer only a handful of patients for surgery in any given year.
- EczemaAllergies cause a wide range of symptoms, from the common problems that everyone has heard of such as a runny nose, nasal congestion, sneezing; watery, itchy, red eyes; and itchy ears, to less obvious problems like a tickle in the throat, cough, asthma, wheezing, shortness of breath, hives, eczema, bee sting reactions, and so forth. Fatigue is also common in allergy season. The older antihistamines which cause drowsiness didn't help with fatigue but now the newer antihistamines generally don't cause drowsiness.
- FungusFungus balls often involve the maxillary sinus and may present similarly to other causes of sinusitis including a foul smelling breath. In addition to radiological abnormalities, thick pus or a clay-like substance is found in the sinuses. There is no allergic mucin, but dense hyphae are found. There is no invasion. There is an inflammatory response in the mucosa. Upon looking into the sinus, the fungus ball can vary in size from 1 mm or smaller to a size which completely occupies the sinus. It may have a greenish-black appearance. Removal of the fungus ball is the typical treatment.
- Rashes
- Burns
- Physical Therapy
- AllergiesIt is important that you carefully choose the allergist that you will be working with. Much of the time the allergist may not be used to dealing with the problems that we have discussed previously. Allergy testing with fungi, immunodeficiency testing and IV antibiotics may be foreign to them.