ent emergencies 10 feb 2010

8/3/2019 ENT Emergencies 10 Feb 2010

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COMMON ENT EMERGENCIESUniversity College of Dublin / St.Vincents University Hospital

Wael Hasan

Special Lecturer in

Otorhinolaryngology / Head & Neck

Surgery


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Overview

Ear

Nose

Throat


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Ear

Foreign Body

Haematoma

TM Perforation

Temporal Bone Fractures

Hearing Loss

Mastoiditis


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1. Foreign Bodies FBs:

Insects, cotton, paper,

organic material, small

batteries

Signs & Symptoms:

Otalgia

Otorrhea

Secondary complications:

Infection, mucosal erosion,

TM perforation


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Management

Kill any live insects

Remove foreign body with

micro alligator forceps

Irrigation ( do not use if

organic FB )

Antibiotics


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2. Auricular Haematoma

Caused by a trauma

Fluctuant bluish swelling

of auricle

Complications: Infection

Abscess

Cartilaginous necrosis

Deformity


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Auricular Haematoma

Management

Drainage

Needle aspiration

I &D

ABX

Compression Dressing


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3. Traumatic TM Perforation

Compression, instrumentation &

blast injuries

Signs & Symptoms

Bloody Otorrhea

Otalgia

Hearing Loss

Tennitus


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Traumatic TM Perforation

Investigations

Otoscopy

Hearing test

Management:

Close observation if perforation is small

Patching

Surgery


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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


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Temporal Bone Fracture

Longitudinal Fractures:

VII Nerve Palsy

Conductive Hearing loss

Transverse Fractures:

VII Nerve Palsy

SNHL

Disequilibrium

Investigations:

CT temporal bone


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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


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6. Sudden Hearing Loss

Definition:

SNHL 30 dB over 3

contiguous frequencies within 3days or less

Etiology :

Viral Vascular

Trauma

Autoimmune

Neurologic


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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


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Acute Mastoiditis

Preceded by Acute otitis media

Signs & Symptoms:

Severe pain, fever, swollen & tender

mastoid area

Management:

Intravenous ABX

Myringotomy PE tube


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8. Subperiosteal Abscess

Pinna pushed

down & outward

Management:

Intravenous ABX

I&D

Mastoidectomy


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Complications of ME infections

1.Intracranial


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Complications of ME infections

2. Extracranial


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Nose

Foreign body

Nasal bone fractures

Septal Haematoma

Epistaxis

Sinusitis


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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


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2. Nasal Fracture

Caused by a direct trauma

Signs & Symptoms:

Deformity of nose

Swelling, ecchymosis, epistaxis

Management

LA or GA

Closed or Open reduction


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3. Septal Haematoma/Abscess

Causes:

Trauma, surgery

Signs & Symptoms:

Soft, fluctuant swelling ofseptum

Management:

Needle aspiration or I&D

Bilateral nasal packing forseveral days

Prophylactic antibiotics


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4. Epistaxis

Local Causes:

Trauma ,Nose picking ,blow injury, surgery

Dry air / Irritants

Topical medications(steroids)

Foreign body, Tumor,polyp

Systemic Causes:

Blood diseases

Hereditary hemorrhagic

telangiectasia

Drugs (anticoagulants)

Hypertension


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Epistaxis

Management:

A,B,C,D,E

Medical therapy

Digital Pressure

Silver Nitrate Cautery

Nasal Packing

Electrocautery

Vascular ligation

Embolisation


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5. Sinusitis

Definition:

Inflammation of the paranasal

sinuses

Locations:

Frontal

Ethmoidal Shenoidal

Maxillary

Acute:

Going on less than four

weeks

Subacute:

48 weeks

Chronic:

Going on for 8 weeks or

more


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Sinusitis

Causes

Bacteria

Streptococcus Pneumonia

H. Influenza

Anaerobes

Viruses

7 days

Fungi

Inflammatory conditions

Signs & Symptoms:

Nasal Congestion

Rhinorrhea

Facial Pains

Headaches

Anosmia

Halitosis Malaise


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Sinusitis

Investigations:

CT scan

Sinoscopy

Management:

Anti congestants

Antibiotics

Drainage


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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


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Throat Foreign body

Quinsy

Ludwigs Angina

Epiglottitis

Upper Airway Obstruction


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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


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Quinsy - Peritonsillar Abscess

Management:

FBC, ESR, CRP

Throat Swab

I.V. Antibiotics

Needle aspiration or I&D


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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 & openmouth


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Epiglottitis

Investigations:

Raised inflammatory markers

Film lateral neck

Thumb shaped epiglottis

Management:

Avoid tongue depressor

I.V. Antibiotics

Secure Airway


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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


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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


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4. Foreign Body Ingestion

Coins, batteries, fish bone,meat & bone pieces, dentures

Signs & Symptoms:

Pain

Dysphagia

Saliva pooling / Drooling

Management:

Removal

Oesophagoscopy


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5. Inhaled Foreign Bodies

Sudden onset of coughing,wheezing or stridor

Unilateral wheezing, poor chestmovement & reduced breathsound

CXR:

Hyperinflation

Infection

Collapse

Management:

Heimlich maneuver

Secure airway

Endoscopic removal undergeneral anesthesia


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6. Upper Airway Obstruction

Emergency tracheostomy in the case ofUpper Airways

Obstruction

F.B. in the larynx

Tumor in the larynx

Trauma of the larynx

Bilateral vocal cord paralysis


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Upper Airway Obstruction

Signs & Symptoms

Wheeze ILA

Loss of Breath Sounds

CLA

Aphonia CUA

Stridor IUA


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Questions


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COMMON ENT EMERGENCIESUniversity College of Dublin / St.Vincents University Hospital

Wael Hasan

Special Lecturer in

Otorhinolaryngology / Head & Neck

Surgery

ent emergencies 10 feb 2010

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