Due to the coronavirus outbreak, our hours of operation have changed. For the foreseeable future, our office will be open:
Monday through Thursday with reduced hours
We are offering regular in-office visits, as well as telehealth appointments for a number of services. Please call (972) 566-8300 for more information.
If you are experiencing symptoms of cough, fever, shortness of breath/difficulty breathing, diarrhea, chills, muscle pains, loss of taste or smell, or have been exposed to someone who has tested positive with COVID-19, we ask that you kindly call to reschedule your appointment and instead call your primary care physician or visit your nearest emergency room.
If you are having a medical emergency, please call 9-1-1.


7777 Forest Lane, B432, Dallas, TX 75230

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Posts Tagged ‘Dr. Timothy Trone’

All about Sinus infection/Sinusitis

Thursday, May 30th, 2013

Sinus Infection Diagnosis | Dallas ENT Group | Dallas, TX

This is the time of year when many people are getting sick with a cold or flu and then develop nasal congestion and pressure. How do you know when you have a sinus infection? Do you need to see a doctor? This will attempt to help answer those questions.

Sinusitis: Swelling of the lining of the sinuses and nose. The sinuses are the hollow areas within the facial bones that are connected to the nasal openings. The sinuses are lined with mucous membranes, similar to the inside of the nose.

Symptoms: Nasal congestion, purulent discharge, dental pain, facial pain, especially if it’s worse when bending forward. Other signs include fever, fatigue, cough, ear pressure/fullness, bad breath and headache.

When to get help immediately: High fever > 102.5, sudden severe pain in the face or head, double vision or difficulty seeing, confusion or difficulty thinking clearly, swelling or redness around one or both eyes, stiff neck or shortness of breath.

Diagnosis: Highly predictive symptoms of a sinus infection include purulent rhinorrhea and nasal congestion with facial pressure/pain. The diagnosis is supported by the sensation of ear fullness, cough, difficulty smelling and headache. Symptoms that may suggest a bacterial sinus infection include: worsening of symptoms after initial improvement of symptoms. It is generally not possible to distinguish between viral and bacterial sinus infections in the first 10 days of illness even based on history, examination or radiology studies.

Most of the time radiologic tests such as x-rays or CT/Cat scans are not indicated for acute sinus infections. These radiological tests may show sinus fluid levels in both viral and bacterial sinus infections but it cannot distinguish between the two.

In general acute rhinosinusitis (ARS) is the most common type that we see in the medical clinic. It is a symptomatic inflammation of the nasal passages and paranasal sinuses lasting less than 4 weeks.

There are different classifications of sinusitis that are based on the length of symptoms.

1) Acute rhinosinusitis: symtpoms for less than 4 weeks

2) Subacute rhinosinusitis: symptoms for 4-12 weeks

3) Chronic rhinosinusitis: symptoms persist greater than 12 weeks

4) Recurrent acute rhinosinusitis: 4 or more episodes of ARS per year with resolution of symptoms in-between these episodes.

A sinus infection can be either viral or bacterial. Viral sinus infections usually last 7-10 days and most sinus infections are this type. Bacterial sinus infections usually (75%) go away on their own as well, but can take a month or more. In rare cases, patients with a bacterial sinus infection can develop a complication called orbital cellulitis.

It is very challenging for the doctor to determine whether a sinus infection is viral (like a common cold) or bacterial. Antibiotics may be helpful for the bacterial kind of sinus infection but won’t help the viral infection. Even though about most of the sinus infections are viral, 85-98% of the patients with sinus infections in the US are prescribed an antibiotic when seen in the clinic.

Acute bacterial infection occurs in only 0.5 to 2.0 percent of patients with sinus infections and virus is causing the symptoms 98-99.5% of the time.

How do you get a sinus infection? Viral sinusitis begins with direct contact of the virus into the eyes or nasal mucosa by respiratory droplets from someone else. Symptoms usually develop within the next day after exposure from someone else. Bacterial sinus infections occur when bacteria secondarily infect the inflamed sinus cavity. Most of the time this is a complication of a viral sinus infection but can also be a complication from with allergies, mechanical obstruction of the nose, swimming, intranasal cocaine use, impaired mucociliary clearance due to cystic fibrosis, or immunodeficiency.

You are more likely to develop a sinus infection if you smoke or you already have an impaired respiratory tract such as in cystic fibrosis.

Treatment: Since viral sinus infections usually resolve within 10 days, most of the time we use medications to treat symptoms with these symptoms without the use of antibiotics. An exception would be in the case of a patient who is getting worse after initial improvement or patients with severe symptoms are who are clearly worsening or are immunocompromised. For viral sinusitis, treatment aims to relieve the symptoms of nasal pressure/obstruction and runny nose. The medications do not shorten the duration of the illness in viral infections.

Options for treatment include:

1) Analgesics such as ibuprofen, naproxen or Tylenol

2) Topical steroid nasal spray such as Flonase, Rhinocort or Nasonex

3) Oral decongestant such as Sudafed or anti-inflammatory medication such as prednisone

4) Antihistamines such as Benadryl, Zyrtec, Allegra or Claritin

5) Zinc preparations have been used, but if sprayed in the nose they way cause difficulty with smell are not recommended.

6) Nasal saline rinses

Treatment of bacterial sinus infections may include antibiotics, however 40-60% of patients with bacterial sinus infections will clear their infection without antibiotics.

Antibiotics: Studies have shown nearly identical results in adults with the use of amoxicillin, Bactrim or erythromycin compared to other antibiotics. Most of the time we use Amoxicillin, either 875mg twice a day or 500mg three times a day for 10-14 days. If someone has an allergy to penicillin, Bactrim, doxycycline or other antibiotics might be chosen. There are some strains of S. pneumonia bacteria that are becoming resistant to amoxicillin.

This document is for informational purposes only, and should not be considered medical advice for any individual patient. If you have questions please contact your medical provider.

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Help, I have a sore throat! Is it Strep? Understanding pharyngitis

Tuesday, March 26th, 2013

Sore throat is one of the most common problems that people have in the winter when they come to the medical clinic. There are many different causes of a sore throat, including bacterial or viral infections. Although a sore throat usually resolves without any complications, there are times that antibiotic treatment is required. There are very rare causes of sore throat pain that can be serious or life threatening.

Pharyngitis Treatment | Dallas ENT Group | Dallas, TX

When to call the doctor: Since it’s tough to know your sore throat is caused by a virus or bacteria, I encourage you to call your doctor if one or more of the following are present: temperature > 101 degrees F or 38 degrees C, season is late fall, winter or early spring, you don’t have a cough, the age of the patient is between 5-15 years old, recent exposure to someone with strep throat, difficulty breathing/swallowing, your voice sounds muffled, they have a stiff neck or difficulty opening their mouth.

Causes of sore throat: Viruses are the most common cause of sore throat, but bacteria are another common cause. The causes of sore throat depend on the age of the patient as well as the season and geographic location. Many different viruses can cause swelling and throat pain. Most common viruses that cause sore throat also cause the common cold, but others include influenza, adenovirus, and Epstein-Barr virus (the cause of mononucleosis).

Symptoms of viral pharyngitis: Usually with a viral infection, the patient will have runny nose, nasal congestion and can even have irritation and/or redness of the eyes, cough, hoarseness, skin rash and even diarrhea. Viral infections can also cause fever that makes you feel miserable. A high fever does not mean that your you have a bacterial infection.

Group A streptococcus – (GAS): The bacteria that causes strep throat. Other bacteria can also cause sore throat, but group a strep is the most common. Up to 30% of children with sore throat will have strep throat. Winter and early spring are the most common times of the year when it occurs. It is the most common in school-age children and their young siblings.

Symptoms of Strep Throat: Sudden development of fever (temperature > 100.4 degrees F), headache, abdominal pain, nausea and vomiting, swollen glands in the neck, white patches of pus in the back or sides of throat, small red spots on the roof of the mouth. A cough and cold are not usually seen with strep throat.

Diagnosis: Most of the time the cause of the sore throat is a virus and does not require treatment with antibiotics. It is, however important to recognize and treat kids with strep throat to prevent complications of strep throat which can cause rheumatic fever. There are two types of tests that can help diagnose strep throat. One is a rapid strep test and the other is a throat culture. Both of these tests require a swab of the back of the throat to look for the strep bacteria. The throat culture is more accurate, but it takes 24-48 hours to get the results back. The rapid test isn’t quite as accurate but the benefit is that you know the results before going home from the clinic.

Treatment: The treatment of sore throat depends on the cause; strep throat is treated with antibiotic while viral pharyngitis is treated with rest, pain relievers and measure to make the patient more comfortable while the body heals. It is important to monitor for dehydration because some children with sore throat are reluctant to drink or eat due to pain.
Strep throat is usually treated with an antibiotic such as penicillin or similar antibiotic. After 24 hours of treatment, children can return to school most of the time. If they are having trouble swallowing or eating, they should not go to school and should be re-evaluated. The antibiotic is usually continued for a full 10 day course.

Anti-inflammatory medications such as naproxen, ibuprofen, dexamethasone or prednisone can be helpful to reduce the pain of sore throat. Oral rinses such as salt-water gargles, sprays, lozenges, and sipping warm liquids can also be helpful for sore throat pain.

Complications of strep throat: Most of the time strep throat itself isn’t dangerous. It can, however lead to serious complications such as the spread of the bacteria to the sinuses, skin, blood and middle ear. Strep throat can also lead to Scarlet fever (illness with rash), inflammation of the kidney (post-streptococcal glomerulonephritis), and even Rheumatic fever, which is a serious condition that can affect the heart, joints, nervous system and skin.

This document is for informational purposes only, and should not be considered medical advice for any individual patient. If you have questions please contact your medical provider.

If you would like to schedule an appointment at Dallas ENT Group please feel free to call us at (972) 566-8300 or visit our website to book an appointment online at www.dallasentgroup.com

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