Ent Emergencies

ENT Emergencies

Mark E Reader DO, FAOCO

Epistaxis 

Anterior vs Posterior – Anterior more common in children – Posterior more common in older adults

Posterior more difficult to control  Check for ASA, anticoagulants, & herbs  Nasal canula / percutaneous O2  Trauma, tumor, foreign body, & environment 

Anterior Epistaxis 

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Usually anterior nasal septum (Kiesselbacks plexus) Inferior turbinate other location Easilly identified with nasal speculum Control with cauterization +/anterior pack

Posterior Epistaxis 

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Unable to visualize bleeding site Can lose large volume quickly Treatment options: – posterior/ anterior pack – Nasal endoscopy with cauterization – Artery ligation

Packing Tray

Posterior Epistaxis

Posterior Epistaxis

Septal Perforation

Septal Hematoma 

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Swelling of nasal septum that doesn’t respond to decongestant spray Need drained < 48 hrs Complications: – –

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Infection Saddle nose

Drain & pack, antibiotics

Septal Hematoma

Septal Hematoma

Septal Hematoma

Nasal Foreign Body 

Symptoms: – Usually brought in by mother – Unilateral rhinitis / epistaxis

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Diagnosis: – – –

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Nasal speculum Rhinoscopy X-ray

Treatment

Foreign Body Aspiration 

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Most prevalent under age 4 Smaller objects aspirated/ larger swallowed Laryngeal objects – potential airway emergency

Foreign Body cont. 

Remove in controlled fashion – Laryngeal: ASAP – Bronchial: same day of diagnosis – Esophageal: variable

Peritonsillar Abscess 

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Sudden increase in pain Difficulty swallowing Displacement of uvula Unilateral swelling of anterior tonsil pillar

Peritonsillar Abscess 

IV hydration – Antibiotic – Steroid

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Local anesthetic I&D

Peritonsillar Abscess

Epiglottitis  

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True emergency High index of suspicion Dx with X-ray & in OR

Auricular Hematoma 

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Blunt trauma (wrestler) Drain with temp drain/ packing with in 48hrs Antibiotics Complications: – Infection – Cauliflower ear

Auricular Hematoma

Auricular Hematoma

Foreign Body Ear 

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Emergency when associated with vertigo, profound hearing loss and/ or facial parallysis Do not irrigate organic material or with a perforation Otologic ear gtts / ENT eval

Tympanic Membrane Perforation 

Etiology – Infection, penetrating trauma, temporal bone fracture

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Check for conductive hearing loss with tuning fork Tx: Floroquinolone gtts, no H2O More serious injury with: profound SNHL,vertigo, or otorhea

TM Perforation cont.

Sudden Hearing Loss 

History – – – – – –

Timing Severity Location Inciting factors Medications Associated symptoms

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Exam – – – – –

Conversation Otoscopic Tuning fork CT Lab » » » »

VDRL Sed rate Lyme Blood glucose

Sudden Hearing Loss 

Treatment – Cause dependent – Early intervention may make a difference – May need to treat associated symptoms as well

Facial Trauma 

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Repair lacerations < 12 hrs Check distal neuro status Irrigate aggressively with minimal debridement Meticulous closure

Hematoma

Facial Fractures 

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R/O cervicle fracture and stabilize airway 1st Diagnose with exam/ XRay Reduce once swelling down Rx: Antibiotic and pain control

Nasal Fracture

Concluding Remarks