ENT emergencies

Question 1

what is looked for in a nasal trauma examination?

Answer 1

Bruising, Swelling
Tenderness
Deviation
Epistaxis
Infraorbital sensation
CNs

Question 2

how is a nasal fracture diagnosed?

Answer 2

Diagnosis clinical – investigations superfluous
Based on deviation / cosmesis
Breathing

Question 3

what are some complications of a nasal fracture?

Answer 3

Epistaxis – particularly ant ethmoid artery
CSF leak , meningitis
Anosmia – cribriform plate fracture

Question 4

how is a nose bleed managed?

Answer 4

Local Treatment
External Pressure to Nose
Ice
Cautery
Nasal Packing

Question 5

how is an acute nose bleed managed in a hospital setting?

Answer 5

Resuscitate on arrival if necessary

Arrest/slow flow: pressure, ice, topical vasoconstrictor +/- LA (Lignocaine + adrenaline, Co-phenylcaine)

Remove clot: suction, nose blowing

Anterior Rhinoscopy

Cautery / pack

30 degree rigid nasendoscopy

Cauterise vessel: silver nitrate / diathermy

Question 6

when does a CSF leak need repaired?

Answer 6

if not settled within 10 days

Question 7

what are some ear emergencies?

Answer 7

Pinna Haematoma
Ear Lacerations
Temporal bone fractures
Sudden sensorineural hearing loss

Question 8

how is a pinna haematoma treated?

Answer 8

Aspirate (usually done first but only once)
Incision and drainage
Pressure dressing
No good evidence which technique is best.

Question 9

what are the signs of a temporal bone fracture?

Answer 9

bruising- battle sign (bruising and erythema behind the ear)
check the condition of the TM, ear canal and CN VII

Question 10

what are the different classifications of a temporal bone fracture?

Answer 10

otic capsule involved (damage to cochlear and vestibula) (transverse)
or
optic capsule spared (longitudinal)

Question 11

what are the features of a longitudinal temporal bone fracture?

Answer 11

80%
Lateral blows
Fracture line parallels the long axis of the petrous pyramid
Bleeding from external canal due to laceration of skin and ear drum
Haemotympanum (conductive deafness)
Ossicular chain disruption (conductive deafness)
Facial palsy (20%)
CSF otorrhoea

Question 12

what are the features of a transverse temporal fracture?

Answer 12

20%
Frontal blows
Fracture at right angles to the long axis of the petrous pyramid
Can cross the internal acoustic meatus causing damage to auditory and facial nerves
Sensorineural hearing loss due to damage to 8th cranial nerve
Facial nerve palsy (50%) & Vertigo

Question 13

what is the management of a temporal bone fracture?

Answer 13

Often delayed as polytrauma
May need facial nerve decompression , If no recovery and EMG studies
May need to manage CSF leak , most settle but may need repair
May need hearing restoration, Either hearing aid or ossiculoplasty

Question 14

what are some possible causes of conductive hearing loss?

Answer 14

Fluid
TM Perforation
Ossicular problem

Question 15

is sudden sensorineural hearing loss emergent?

Answer 15

yes

Question 16

how is sensorineural hearing loss diagnosed?

Answer 16

webers test

Question 17

how is sudden sensorineural hearing loss treated?

Answer 17

Steroids 1mg/kg and consider intratympanic treatment

Question 18

how is a foreign body in the ear managed?

Answer 18

Can usually wait until urgent clinic for removal
Except watch batteries – remove immediately
Live animals – drown with oil can be removed next day

Question 19

what are some examples of neck emergencies?

Answer 19

Penetrating : Knife / GSW / MVA
Industrial accidents
Household accidents
Blunt
-MVA
-Sports injuries (clothesline tackle)

Question 20

where is zone 1 classification?

Answer 20

Bottom of the neck

Trachea
Oesophagus
Thoracic duct
Thyroid
Vessels – brachiocephalic, subclavian, common carotid, thyrocervical trunk
Spinal cord

Question 21

where is zone 2 classification

Answer 21

middle of neck

Larynx
Hypopharynx
CN 10,11,12
Vessels – carotids, internal jugular
Spinal Cord

Question 22

where is zone 3 classification?

Answer 22

top of the neck

Pharynx
Cranial Nerves
Vessels – Carotids, IJV, Vertebral
Spinal Cord

Question 23

what is the management of a neck stab wound?

Answer 23

FBC, G&S / XM
AP/Lateral neck - ?FB
CXR – haemo-pneumothorax, emphysema
CT Angiogram – vascular, pseudoaneurysm, laryngeal, aerodigestive tract ?
MR Angiogram ?
Urgent exploration – expanding haematoma, hypovolaemic shock, airway obstruction, blood in aerodigestive tract
Laryngoscopy, bronchoscopy, pharyngoscopy, and oesophagoscopy
Angiography – embolize, occlude

Question 24

what are the features deep neck space infection?

Answer 24

Extension of infection from tonsil or oropharynx into deeper tissues

History: sore throat, unwell, limited neck movement

Examination: Febrile, trismus, red / tender neck

Question 25

what are the features of quinsy?

Answer 25

different to tonsilitis
unilateral
change in voice
trismus
an abscess that forms between a tonsil and the wall of throat

Question 26

how is a deep neck space infection managed?

Answer 26

Admit
Iv access, bloods,
Fluid rehydration
Intravenous antibiotics, such as co-amoxiclav or clindamycin

May need theatre for incision & drainage
Airway compromise may be imminent so need to drain infection