ENT Emergencies Flashcards
ENT emergencies of the ear (2)
foreign bodies
malignant otitis externa
ENT emergencies of the Nose/Sinus (5)
foreign bodies epistaxis nasal fracture septal hematoma complications of sinusitis
ENT emergencies of the oropharynx (2)
Ludwig’s angina
Peritonsillar abscess
ENT emergency of the salivary gland (1)
sialoadenitis
Which ENT emergency is usually visualized easily and has a primary symptoms of pain?
foreign body in the ear
If there is a live insect in the patients ear, what should you do first?
Immobilize insect with 2% Lidocaine or mineral oil
How to remove a foreign body in the ear
Alligator forceps
sometimes suction
can try irrigation
If deeply impacted FB, may need to refer to ENT
sometimes FB removal rqrs general anesthesia or conscious sedation
Cauliflower Ear: 2 sporty aliases
Wrestler’s ear, boxer’s ear
(U) cause of cauliflower ear
blunt trauma
What is cauliflower’s ear and does it need to be treated?
Cauliflower’s ear is hematoma of the pinna
if untreated, it may result in cartilage necrosis, chronic scarring & deformity
Laceration of the Pinna: characteristics, what to watch for & how to tx
(U) bleeds a lot
Make sure there is no injury to the canal & internal ear
Watch out for hemotomas
If laceration needs to be repaired, (U) a running suture is best
How can one obtain perichondritis?
- ear piercing, particularly to upper third of the pinna can result in ear infections
- cartilage is avascular, improper healing can predispose to infection (Pseudomonas and Staph)
Which two microbes are common in perichondritis?
Pseudomonas
Staph aureus
Signs/sxs of perichondritis
pain, erythema & localized warmth
Perichondritis treatment: why and what
infections can spread rapidly & lead to deformity
Antibiotics required; surgical debridement
Malignant Otitis Externa: broad 1 line definition
invasive infection that involves the temporal bone!!!!
In whom do we see Malignant Otitis Externa
IMMUNOCOMPROMISED PATIENTS (diabetics, elderly, systemic malignancy, long term steroid use)
Malignant Otitis Externa primary pathogen
Pseudomonas aeruginosa
Malignant Otitis Externa a/w which symptoms
severe, unrelenting ear pain that is worse at night
a/w purulent otorrhea
As Malignant Otitis Externa spreads, what 3 things may be seen
trismus
cervical adenompathy
CN palsies
Malignany Otitis Externa: clinical presentation & dx
ear canal edematous & erythematous w/granulation tissue
CT scan will be DIAGNOSTIC
Malignant Otitis Externa: ENT referral for which situations
admission
IV antibiotics: Imipenem or ciprofloxacin or ceftidime
Mastoiditis: definition
extension of otitis externa or acute otitis media into mastoid air cells
Mastoiditis: signs & symptoms
suspect w/slow resolution of sxs
Mastoid tenderness with edema & erythema
Deep temporal pain
Mastoiditis: diagnostic studeis
CT is BEST diagnostic study
plain x-rays might show density in mastoid airspace but may nito be discernible until 2 weeks after onset of mastoid infection
Mastoiditis: Tx & prognosis
- Hospitalize & start on IV Abx (Vancomycin or Nafcillin/Oxacillin)
- typmanocentesis for fluid to culture
- mastoidectory required if complications
prognosis is good :)
What is the most likely etiology of malignant otitis externa?
Pseudomonas
Epistaxis: most common etiology
& other causes of epistaxis
TRAUMA is most common
others: FB, irritants (cig smoke), HTN, nose picking,
meds (ASA, NSAIDS, anticoagulants)
hematologic disorders; hemophilia, leukemia, platelet dysfunction, thrombocytopenia
Epistaxis physical exam (3 management elements)
- sitting position preferable to supine
- initial management: direct pressure for a minimum of 5 mins
- ensure hemodynamic stability & airway patency
Epistaxis: equipment used is in physical exam
- bright light source (headlight)
- nasal speculum
- adequate suction
- adequate protection against blood exposure (goggles, apron, gloves)
- adjustable chair (ENT or dental chair)
Epistaxis: usual source of bleeding in kids
Kiesselbach’s Plexus
anteriorly on the nasal septum branch of the labial artery
Epistaxis: adult usual source of bleeding
in septum, but more posterior than kids
Epistaxis: elderly usual source of bleeding
elderly (U) most difficult to identify & control
branch of the MAXILLARY ARTERY
POSTERIOR, harder to visualize
more bleeding, more systemic factors
Anterior nose bleed tx
Topical vasoconstrictors: 2%Neo-synephrine spray, 4% cocaine spray or solution on cotton pledgets
Cautery: chemical (silver nitrate), hemostatic packing material-Gelfoam or Surgicel, electrocautery
Anterior packing: petrolatum-impregnated gauze packed firmly in the anterior nares with forceps, leave for 48 hours (preformed nasal tampon may be used)