ENT Emergencies | 2023-2024 PDF

ENT Emergencies NEU ENT 2023-2024  Overview Otologic Disorders Nasal Disorders Facial, Oral and Pharyngeal Infections Airway Obstruction  Otologic Disorders Anatomy Auricle Ear canal Tympanic membrane Middle ear an...

ENT Emergencies NEU ENT 2023-2024  Overview Otologic Disorders Nasal Disorders Facial, Oral and Pharyngeal Infections Airway Obstruction  Otologic Disorders Anatomy Auricle Ear canal Tympanic membrane Middle ear and mastoid disorders Inner Ear Traumatic Disorders of the Auricle Hematoma - cartilaginous necrosis - drain, antibiotics, bulky ear dressing & close follow up Lacerations - single layer closure, pick up perichondrium, bulky ear dressing Use posterior auricular block for anesthesia Aspiration of Auricular Hematoma  Auricle Chondritis - Cellulitis ? - infectious, difficult to treat because poor blood supply, cover S. Aureus and pseudomonas - extra care in diabetics - inflammatory causes related to seronegative arthritis at times indistinguishable from infection usually the ear lobe is spared  Otitis Externa Infection and inflammation caused by bacteria (pseudomonas, staph), and fungi - treat with antibiotic-steroid drops - use wick for tight canals - diabetics can get malignant otitis externa (defined by the presence of granulation tissue)  Foreign Bodies in Ear Canal Usually put in by patient, some bugs fly in kill bugs with mineral oil, or lidocaine remove with forceps, suction or tissue adhesive  FOREING BODY IN THE NOSE Purulent discharge unilaterally Nose bleeding One side obstructed Move the foring body forward  Foreign Bodies in Ear Canal Children, individuals in mental retardation, adults using a cotton buds, Under the microscope, micro-tools required. More rare ear lavage. Contraindicated in perforated ear drums If there is edema, should be reduced. Alive foreign body must be removed earlier. A liquid solution of lidocaine or boric acid can be used as a liquid. Rarely need surgery.  Pharengeal Foreing Bodies Common in childhood, Foreign body to be seen in to mouth, Refuse to eat something, Children who cannot swallow saliva, Palpation intervention is contraindicated. Fishbone; tonsils or soft palate. Fleksiblnazofaringolarin goskop [FNFL]  LARYNGO-TRACHEO-BRONCHIAL FOREING BODIES Life Threatening Obstruction / Spazm Heimlich maneuver Laryngeo-tracheo (broncho)scopy in operating room conditions.  Tympanic Membrane Perforation Hard to see Usually from middle ear pressure secondary to fluid or barotrauma Sometimes from external trauma most heal but all need otology follow- up perforations with vertigo and facial nerve involvement need immediate care treat with antibiotics drops controversial but indicated for purulent discharge (avoid gentamycin drops)  Middle Ear Serous Otitis Media - Eustachian tube dysfunction - treat with decongestants, decompressive maneuvers Otitis Media - infection of middle ear effusion - viral and bacteria Mastoiditis - Venous connection with brain, need aggressive treatment (can lead to brain abcess or meningitis)  Inner Ear Peripheral vertigo (vestibulopathy) BPPV, labyrhinthitis - acute onset, no central signs, usually young, horizontal nystagmus Meniere’s - vertigo, sensorineural hearing loss, tinnitus Treatment - valium, fluids, rest, manipulation for BPPV  The Nose Vascular Supply - Anterior - branches of internal carotid - Posterior - distal branches of external carotid  Epistaxis Anterior 90% (Little’s Area) Kisselbach’s plexus - usually children, young adults Etiologies Trauma Winter Syndrome, Allergies Irritants - cocaine, sprays Pregnancy  Epistaxis Posterior 10% of all epistaxis - usually in the elderly Etiologies Coagulopathy Atherosclerosis Neoplasm Hypertension (debatable)  Epistaxis Management pain medications, lower Blood Pressure, calm patient Prepare ! (gown, mask, suction, speculum, meds and packing ready) Evacuate clots Topical vasoconstrictor and anesthetic Identify source  Epistaxis Management Anterior Sites - Pressure +/- cautery and/or tamponade - all packs require antibiotic prophylaxis  Epistaxis Posterior Packing Need analgesia and sedation require admission and 02 saturation monitoring  Epistaxis Complications severe bleeding hypoxia, hypercarbia sinusitis, otitis media necrosis of the columella or nasal ala  7th Nerve Palsy Most cases are idiopathic link to HSV - no proof steroids or antivirals are effective, but many advocate Consider Lyme’s Disease in endemic areas Surgical decompression indicated in the rare patient not improving by 2 weeks and ENOG out > 90%  Facial Infections Sinusitis Signs and symptoms - H/A, facial pain in sinus distribution - purulent yellow-green rhinorrhea - fever - CT more sensitive than plain films Causative Organisms - gram positives and H. Inf (acute) - anaerobes, gram neg (chronic)  Facial Infections Treatment Sinusitis acute - amoxil, septra chronic - amoxil-clavulinic acid, clindamycin, quinolones decongestants, analgesia, heat Complications ethmoid sinusitis - orbital cellulits and abcess frontal sinusitis - may erode bone (Potts Puffy Tumor, Brain Abcess)  Facial Cellulitis Most common strept and staph, Rarely H.Flu Can progress rapidly  Parotiditis Usually viral -paramyxovirus Bacterial - elderly, immunosuppressed - associated with dehydration - cover - Staph, anaerobes  Pharyngitis Irritants -reflux, trauma, gases Viruses - EBV, adenovirus Bacterial -GABHS, mycoplasma, gonorrhea, diptheria  Peritonsillar Abcess Complication of suppurative tonsillitis Inferior - medial displacement of tonsil and uvula dysphagia, ear pain, muffled voice, fever, trismus Treatment - Antibiotics, I&D, +/-steroids  Epiglottitis Clinical Picture Older children and adults decrease incidence in children secondary to vaccines Onset rapid, patients look toxic prefer to sit, muffled voice, dysphagia, drooling, restlessness  Epiglottitis Avoid agitation Direct visualization if patient allows soft tissue of neck - thumb print, valecula sign Prepare for emergent airway steroids Epiglottitis  Retropharyngeal Abcess Anterior to prevertebral space and posterior to pharynx Usually in children under 4 (lymphoid tissue in space) pain, dysphagia, dyspnea, fever swelling of retropharyngeal space on lateral x-ray Complications - mediastinitis  Masticator - Parapharyngeal Space Infection Infection of the lower molars invade masticator space Swelling, pain fever, TRISMUS Treatment IV antibiotics (PCN or Clindamycin) ENT admission  ANUG Acute Necrotizing Ulcerative Gingivitis Bacterial infection causing an acute necrotizing, destructive disease of periodontium Treatment - oral rinses - antibiotics (PCN, clindamycin, tetracycline)  Ludwigs Angina Rapidly progressive cellulitis of the floor of the mouth usually in elderly debilitated patients and precipitated by dental procedures massive swelling with impending airway obstruction Treatment ICU, antibiotics, airway management  Angioedema Ocassionally life threatening Heriditary and related to ACE inhibitors Antihistamines, steroids  Airway Obstruction Aphonia - complete upper airway Stridor - incomplete upper airway Wheezing - incomplete lower airway Loss of breath sounds- complete lower airway Questions and Answers