ENT Emergencies Flashcards
- true medical emergency
- sudden onset of decreased hearing, muffling or tinnitus
- normal exam
- STAT ENT referral, same day preferred
- needs audiology and high dose steroids: prednisone 60mg QD x 10 days
- must be done within 3 weeks or loss is permanent
Sudden hearing loss
- blood collection between skin and cartilage, usually caused by a sheering force
- needs to be drained in 7 days to avoid cauliflower ear deformity. Not an emergency
- drainage musst have compression fo 7 days or hematoma will reaccumulate
Auricular hematoma
- not an emergency
- usually related to a cartilage piercing
- antibiotics need to cover for pseudomonas
- oral ciprofloxacin for 7-10 days, ENT follow-up
- if fluctuant area, call END for I&D
Perichondritis/ auricular cellulitis
- otorrhea without a tube: a wet draining ear
- ear canal erythema and edema may also be present. Hearing is usually mostly preserved. Pain is minimal
- may also impact the tympanic membrane, difficult tto tell but rarely concomitant with otitis media
- tx: cortisporin, ciprodex or cipro HC drops ( 4 drops BID for 7-10 days)
Otitis Externa
when to put in a wick?
- pain more than you would expect
- canal swollen so drops can’t penetrate
- have a low thresh hold
- always add drops immediately
- ciprodex or ciproHC drops
- ENT follow up in 2-4 days
add oral ciprofloxacin if any concerna bout redness or pain in auricle
subjective findings:
- pain, fever, fussiness, decreased hearing
objective findings
- dull, injected, erythematous, effusion, buldign
antibiotics
- amoxicillin, augment, omnicef
Otits Media
- preceding upper respiratory infection symptoms
- decreased hearing acutity (muffled underwater sensation) WITHOUT otalgia (ear pain)
- no inflammatory findings (without erythema, injection, bulging)
- treat with flonase (makse sure administration is accurate) and autoinsufflation (ear popping 5-10 times per day)
- ENT follow up in 2-4 weeks with audiology
Otitis media with effusion
- otalgia (ear pain) decreased hearing acuity then otorrhea (ear drainage)
- often otitis media diagnosis has already been made
- treat with oral antibiotics, add ofloxacin drops
Otitis Media with Acute TM perforation
Treatment of otitis media with tubes looks like what?
If tympanostomy tube otorrhea (TTO) for 7 days or less
- use drops: ofloxacin, ciprodex or ciproHC
If TTO for 7 days or more, or failing drops
- use drops as above PLUS orals: augmentin or omnicef
For a red ear… with a functioning tube and NO otorrhea
- No antibiotic treatment is necessary
- not an emergency
- treat with ofloxacin drops for 7 days
- dry ear precautions
- ENT follow-up in 7-10 days, then again in 4-6 weeks
traumatic TM perforation
- most bleed happen in the anterior septum
- most have an inciting event: sneezing, picking, aggressive blowing, nasal steroid use, injury, drugs
- most bleeds stop with adequate pressure and afrin
- risk factors: age, hypertension, anticoagulation, winter, anatomic abnormality, dilated vessels on anterior septum, recurrent injury
Epistaxis
Unilateral acute facial weakness
Bell’s palsy
unilateral herpetic rash
shingles
unilateral actue facial weakness, unilateral herpetic rash, hearing loss
tx: vatrex plus prednisone (same as sudden hearing loss protocol)
Ramsey-Hunt Syndrome
