ent emergencies
TRANSCRIPT
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 ….