ENT emergencies

Question 1

what do you look for in a nasal trauma examination?

Answer 1

Bruising, Swelling
Tenderness
Deviation
Epistaxis
Infraorbital sensation
CNs

Question 2

when do you review a nasal fracture to consider manipulation?

Answer 2

5-7 days post injury so swelling has gone down and you can see the extent of the fracture

manipulation should be done <3 weeks post injury

Question 3

what are complications of nasal fracture?

Answer 3

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

Question 4

what is the management for acute severe epistaxis?

Answer 4

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
300 rigid nasendoscopy
Cauterise vessel: silver nitrate / diathermy

Question 5

what is the systemic treatment of severe epistaxis?

Answer 5

Tranexamic acid
Reversal of effect of anticoagulants – may take time in case of antiplatelet agents
Correction of clotting abnormalities
Platelet transfusion
Treatment of hypertension

Question 6

what is the treatment for pinna haematoma?

Answer 6

aspirate first, if it comes back incise and drain
pressure dressing

Question 7

what do you look for in the history of a temporal bone fracture?

Answer 7

Injury mechanism
Hearing loss
Facial palsy
Vertigo
CSF leak
Associated injuries

Question 8

what is the management of external ear lacerations?

Answer 8

Debridement
Closure - Primary, reconstruction
Usually LA
Antibiotics - cartilage

Question 9

what do you look for on examination of temporal bone fracture?

Answer 9

Bruising – Battle sign
Condition of TM and ear canal
CN VII damage - test nerve
Hearing test

Question 10

what are the classifications of temporal bone fractures?

Answer 10

Longitudinal (most common) vs transverse
Otic capsule involved
Otic capsule spared

Question 11

describe the presentation of longitudinal temporal bone fractures

Answer 11

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

describe the presentation of transverse temporal bone fractures

Answer 12

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 are the most common causes of conductive hearing loss?

Answer 13

Fluid
TM Perforation
Ossicular problems

Question 14

what is the management of temporal bone fracture?

Answer 14

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 15

how to you treat sudden sensorineural hearing loss?

Answer 15

Steroids 1mg/kg and consider intratympanic treatment

Question 16

what is the most important test for sudden sensorineural hearing loss?

Answer 16

webers test

Question 17

what do you look for in the history of penetrating neck trauma?

Answer 17

Mechanism of injury
Pain - location, nature, intensity, onset, radiation
Aerodigestive tract - dyspnoea, hoarseness, dysphonia, dysphagia - haemoptysis
CNS problems - paraesthesias, weakness

Question 18

what is the management of penetrating neck injuries?

Answer 18

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 19

what is quinsy?

Answer 19

an abscess that forms between one of your tonsils and the wall of your throat

Question 20

what is the management of quinsy?

Answer 20

incision and drainage

Question 21

what is a deep neck space infection?

Answer 21

Extension of infection from tonsil or oropharynx into deeper tissues

Question 22

what are the history and examination findings in deep neck space infections?

Answer 22

History: sore throat, unwell, limited neck movement

Examination: Febrile, trismus, red / tender neck

Question 23

what is the management of deep neck space infection?

Answer 23

Admit
Iv access, bloods,
Fluid rehydration
Intravenous antibiotics, such as co-amoxiclav or clindamycin
If abscess is large or does not improve with treatment may need surgical incision and drainage