ent emergencies

ENT EmergenciesMohammed Suleiman Aljajeh

Phase V

20133422

NEAR EAST UNIVERSITYHOSPITAL

Overview

• Otology Disorders• Nasal Disorders• Facial, Oral and Pharyngeal Infections

Traumatic Disorders of the Auricle• Hematoma

- Direct trauma to the anterior auricle

- cartilaginous necrosis

Tx.- drain, antibiotics, bulky ear

dressing close follow up- Use posterior auricular

block for anesthesia

Aspiration of Auricular Hematoma

Otitis Externa• Infection and inflammation

caused by bacteria (pseudomonas, staph), and fungi

Tx.• removal of debris from the

external auditory canal • administration of topical medications to control edema

and infection

- ex. with antibiotic-steroid drops

Foreign Bodies in Ear Canal• Usually put in by patient,

some bugs fly in

TX.• kill bugs with mineral oil, or

lidocaine• remove with forceps, suction

or tissue adhesive

Tympanic Membrane Perforation• Hard to see – Hx of drainage

• Usually from middle ear pressure secondary to fluid

• Sometimes from external traumaTX.

• most heal uneventfully but all need otology follow-up

• treat with antibiotics• drops controversial but indicated for

purulent discharge• (avoid gentamycin drops because

ototoxicity)

Middle Ear• Serous Otitis Media - Eustachian tube

dysfunction • Otitis Media - infection of middle ear

effusion - viral and bacteriaTx.treat with decongestants & amoxicillin as the first-line antimicrobial agent of choice

Inner Ear• peripheral vertigo (vestibulopathy)

BPV, labyrhinthitis• - acute onset, no central signs, usually young, horizontal

nystagmus• Meniere’s - vertigo, sensorineural hearing loss, tinnitus• Treatment

- Meclizine , fluids, rest, Epley Maneuver

Acute Mastoiditis

Rx : Systemic antibiotics

Analgesia

URGENT REFERRAL

Features

Recent URTIEar dischargeFluctuant tender swellingFever

Nasal FractureTx:* apply ice to the nose and elevate the head to aid in reduction of any swelling present. * Nasal decongestants to reduce swelling and mucosal congestion.

Refer if:

Obvious deformity (5-7 days) Septal Haematoma

(URGENT)

EpistaxisAnterior

Etiologies• Trauma• Winter Syndrome, Allergies• Irritants - cocaine, sprays• Pregnancy (Mucosal

hyperemia due to hormonal changes)

EpistaxisManagement• Pain meds, lower BP, calm patient• Prepare ! (gown, mask, suction, speculum, meds and packing

ready)• Evacuate clots• Topical vasoconstrictor and anesthetic• Identify source

EpistaxisManagement

• Anterior Sites- Pressure +/- cautery and/or

tamponade

- all packs require antibiotic prophylaxis

Foreign Body in Nose

Rx : one attempt at removal only.

Do not use forceps for round objects

Urgent ENT referral

Orbital Cellulitis

Rx : Systemic antibiotics

Decongestants

Analgesia

URGENT ENT referral

URGENT EYE referral

URGENT CT sinuses

7th Nerve PalsyRx : Prednisolone 30mg

Acyclovir 200mg 5x/day

Hypermellose eye drop

Red bulging ear drum = URGENT ENT review

If not, Non urgent ENT review

If poor eye closure = Ophthalmology review

Facial InfectionsSinusitis

• Signs and symptoms- facial pain in sinus

distribution- purulent yellow-green

rhinorrhea- fever- CT more sensitive * Causative Organisms- gram positives and H. flu

(acute)- anaerobes, gram neg (chronic)

Facial InfectionsSinusitis• Treatment

acute – amoxilchronic - amoxil-clavulinic acid, clindamycin, quinolones

decongestants, analgesia, heat

• Complications

ethmoid sinusitis - orbital cellulits and abcess

Facial Cellulitis

• Most common strept and staph,

• Rarely H.Flu• Can progress rapidly

Tx.• Antibiotic regimens are

effective in more than 90% of patients

Peritonsillar Abcess• Complication of suppurative tonsillitis• Inferior - medial displacement of tonsil and uvula• dysphagia, ear pain, muffled voice, fever, trismus

• Treatment

- Antibiotics , +/-steroids

Angioedema• Occasionally life

threatening• Hereditary mostly

Tx.• Antihistamines & steroids

Any Questions ?

Thanks For Listening ….