COMMON ENT EMERGENCIES
University College of Dublin / St.Vincents University Hospital
Wael Hasan Special Lecturer in Otorhinolaryngology / Head & Neck Surgery
Overview
Ear Nose
Throat
Ear
Foreign Body Haematoma TM Perforation Temporal Bone Fractures Hearing Loss
Mastoiditis
1.
Foreign Bodies
FBs:
Insects, cotton, paper, organic material, small batteries Otalgia Otorrhea Infection, mucosal erosion, TM perforation
Signs & Symptoms:
Secondary complications:
Management
Kill any live insects Remove foreign body with micro alligator forceps Irrigation ( do not use if organic FB ) Antibiotics
2.
Auricular Haematoma
Caused by a trauma Fluctuant bluish swelling of auricle Complications:
Infection Abscess Cartilaginous necrosis Deformity
Auricular Haematoma
Management
Drainage Needle aspiration I &D ABX Compression Dressing
3.
Traumatic TM Perforation
Compression, instrumentation & blast injuries
Signs & Symptoms
Bloody Otorrhea Otalgia Hearing Loss Tennitus
Traumatic TM Perforation
Investigations
Otoscopy Hearing test
Management:
Close observation if perforation is small Patching Surgery
4.
Temporal Bone Fracture
Commonly following a blunt head injury
Signs & Symptoms:
Battles sign Raccoon eyes Haemotympanum Hearing loss Dizziness CSF otorrhea CN VII palsy
Temporal Bone Fracture
Longitudinal Fractures:
VII Nerve Palsy Conductive Hearing loss
Transverse Fractures:
VII Nerve Palsy SNHL Disequilibrium
Investigations:
CT temporal bone
5.
Acoustic Trauma
Sudden exposure (impact or blast) to noise Signs & Symptoms:
SHNL, tinnitus
Management:
Avoidance / Ear protection Corticosteroids, carbogen, vasodilators, diuretics, anticoagulants, plasma expanders
6.
Sudden Hearing Loss
Definition:
SNHL 30 dB over 3 contiguous frequencies within 3 days or less
Etiology :
Viral Vascular Trauma Autoimmune Neurologic
7.
Otitic Barotrauma
Inability to ventilate middle ear abnormal dysfunction of ET
Occur in rising ambient pressure (descent in flight / scuba diving)
Management:
Repeated Valsalva maneuver Topical nasal decongestants Myringotomy & PE tube
Acute Mastoiditis
Preceded by Acute otitis media Signs & Symptoms:
Severe pain, fever, swollen & tender mastoid area
Management:
Intravenous ABX Myringotomy PE tube
8.
Subperiosteal Abscess
Pinna pushed down & outward
Management:
Intravenous ABX I&D Mastoidectomy
Complications of ME infections 1.Intracranial
Complications of ME infections 2. Extracranial
Nose
Foreign body Nasal bone fractures Septal Haematoma
Epistaxis
Sinusitis
1.
Foreign bodies
Signs & Symptoms:
Purulent unilateral nasal discharge
Management:
Good visualization: headlamp & nasal speculum Alligator forceps should be used to remove cloth, cotton, or paper Other hard FB are more easily grasped using bayonet forceps or Kelly clamps, or they may be rolled out by getting behind it using an ear curette, single skin hook, or right angle ear hook
2.
Nasal Fracture
Caused by a direct trauma
Signs & Symptoms:
Deformity of nose Swelling, ecchymosis, epistaxis
Management
LA or GA Closed or Open reduction
3.
Septal Haematoma/Abscess
Causes:
Trauma, surgery
Signs & Symptoms:
Soft, fluctuant swelling of septum
Management:
Needle aspiration or I&D Bilateral nasal packing for several days Prophylactic antibiotics
4. Epistaxis
Local Causes:
Systemic Causes:
Trauma ,Nose picking , blow injury, surgery Dry air / Irritants Topical medications (steroids) Foreign body, Tumor, polyp
Blood diseases Hereditary hemorrhagic telangiectasia Drugs (anticoagulants) Hypertension
Epistaxis
Management:
A,B,C,D,E Medical therapy Digital Pressure Silver Nitrate Cautery Nasal Packing Electrocautery Vascular ligation Embolisation
5.
Sinusitis
Definition:
Acute:
Inflammation of the paranasal sinuses
Going on less than four weeks
Locations:
Subacute:
Frontal Ethmoidal Shenoidal Maxillary
48 weeks
Chronic:
Going on for 8 weeks or more
Sinusitis
Causes
Signs & Symptoms:
Bacteria
Streptococcus Pneumonia H. Influenza Anaerobes
Viruses
7 days
Nasal Congestion Rhinorrhea Facial Pains Headaches Anosmia Halitosis Malaise
Fungi Inflammatory conditions
Sinusitis
Investigations:
CT scan Sinoscopy
Management:
Anti congestants Antibiotics Drainage
Sinusitis
Complications:
Purulent rhinorrhea, fever, frontal/retro-orbital headache Personality change, lethargy, seizures, focal neurological deficits Cavernous sinus thrombosis, meningitis, extradural abscess, intracranial abscess & subdural empyema
Throat
Foreign body Quinsy Ludwigs Angina Epiglottitis Upper Airway Obstruction
1.
Quinsy - Peritonsillar Abscess
Pus forms between tonsillar capsule & superior constrictor muscle Group A Streptococcus Signs & Symptoms: Severe, unilateral sore throat fever Hot potato voice Uvula deviates to opposite side Swollen tonsils
Quinsy - Peritonsillar Abscess
Management:
FBC, ESR, CRP Throat Swab I.V. Antibiotics Needle aspiration or I&D
2.
Epiglottitis
Age 3-7 yrs old Organisms:
H. influenza type B Group A Streptococcus
Signs & Symptoms:
Severe sore throat & fever, dysphagia, drooling Stridor Breathing with raised chin & open mouth
Epiglottitis
Investigations:
Raised inflammatory markers Film lateral neck
Thumb shaped epiglottis
Management:
Avoid tongue depressor I.V. Antibiotics Secure Airway
3.
Ludwigs Angina
Rapid swelling cellulitis of the sublingual & submaxillary spaces Causes:
Dental infection, floor of mouth, salivary gland
Common organisms:
Streptococci, Bacteroides, S.aerues
Ludwigs Angina
Signs & Symptoms:
Fever, edema & erythema of neck under chin & floor of mouth Open mouth Tongue upward & backward Airway obstruction
Management:
Tracheostomy IV antibiotic I&D Tooth extraction
4.
Foreign Body Ingestion
Coins, batteries, fish bone, meat & bone pieces, dentures Signs & Symptoms: Pain Dysphagia Saliva pooling / Drooling
Management:
Removal Oesophagoscopy
5.
Inhaled Foreign Bodies
Sudden onset of coughing, wheezing or stridor Unilateral wheezing, poor chest movement & reduced breath sound CXR: Hyperinflation Infection Collapse
Management:
Heimlich maneuver Secure airway Endoscopic removal under general anesthesia
6.
Upper Airway Obstruction
Emergency tracheostomy in the case of Upper Airways Obstruction
F.B. in the larynx
Tumor in the larynx Trauma of the larynx Bilateral vocal cord paralysis
Upper Airway Obstruction
Signs & Symptoms
Wheeze
ILA
Aphonia
CUA
Loss of Breath Sounds CLA
Stridor
IUA
Questions
COMMON ENT EMERGENCIES
University College of Dublin / St.Vincents University Hospital
Wael Hasan Special Lecturer in Otorhinolaryngology / Head & Neck Surgery
