ENT Emergencies

Question 1

Which is prefered if you are not an experienced surgeon and need an immediate surgical airway? Why?
Cricothyrotomy or tracheotomy?

Answer 1

Cric - easier and less bloody , only a knife

Question 2

During a cric while you are putting in the endotracheal tube, make sure you do not push it past the ______?

Answer 2

Carina

Question 3

What is the name of the congenital disorder in which the nasal choana is occluded by soft tissue, bone or both.
How does it present unilaterally vs bilaterally?
Which one is the emergency and what can be done prior to surgery to help?

Answer 3

Choanal atresia.
Unilateral: unilateral mucopurulent discharge
Bilateral: neonate unable to breath - emergency bc newborns are obligate nasal breathers. A montgomergy nipple can be used.

Question 4

Syndrome common in young, muscular, overweight men with short necks. Why can this be a problem?

Answer 4

Macroglossia

Can result in difficult laryngeal exposure, and therefore difficult to intubate.

Question 5

What is another name for congenital micrognathia?

Why can this be a problem?

Answer 5

Pierre Robin Syndrome - can result in difficult laryngeal exposure, and therefore difficult to intubate.

Question 6

This infection of the floor of the mouth most commonly caused by infection of the teeth that can cause the tongue to be pushed up and back, obstructing the airway

Answer 6

Ludwig’s angina

Question 7

Ludwig’s angina present with unilateral or bilateral neck swelling? Also redness, pain and fever
How can you treat it?

Answer 7

1. Unilateral
2. Incision and drainage of the abscess over the submandibular swelling with abx covering oral cavity anaerobes. usually require awake tracheotomy due to rapid infection

Question 8

In Ludwig’s angina, if teeth of the 2nd and 3rd molars are abscess, the pus will go into the (sublingual or submandibular space)?
This may spread to where?

Answer 8

Submandibular (the molar roots are behind and below the mylohyoid)
Parapharyngeal space.

Question 9

In Ludwig’s angina, if the first molar is abscessed, the pus will go into the (sublingual or submandibular space)?

Answer 9

Sublingual (the molar root is above and in front of the mylohyoid)

Question 10

What is the etiology of acute supraglottic swelling?

What can this result in?

Answer 10

Functional or quantitative deficiency of C1-esterase inhibitor.
Can cause dramatic swelling of the tongue, pharyngeal tissues, and supraglottic airway.

Question 11

How can you treat acute supraglottic/angioneurotic edema?

Answer 11

IV steroids, H1 and H2 histamine blockers.

Question 12

What is this sign called?
Manifestation of an oedematous and enlarged epiglottis which is seen on lateral soft-tissue radiograph of the neck, and it suggests a diagnosis of acute infectious epiglottitis.

Answer 12

Thumb sign

Question 13

Acute supraglottic swelling/epiglottis present with noisy breathing, high fever, drooling, and a characteristic posture described as ________

Answer 13

Sitting upright with jaw thrust forward

Question 14

Epiglottis can occur as a result of what infection?

Why is this less common?

Answer 14

1. H. influenzae

2. Vaccine against H influenza

Question 15

What is this? Collection of purulence in the space bw tonsil and pharyngeal constrictor.
Tx?

Answer 15

Peritonsillary abscess

Tx: drain/aspirate, pain control, abx, possible tonsillectomy

Question 16

Patients with peritonsillar abscess will usually have untreated sore throat for several days that gets worse on one side. What are other hallmark signs of peritonsillar abscess?

Answer 16

Full anterior tonsillar pillar
Uvular deviation away from side of abscess
Hot potato voice
Trismus (diff to open jaw)

Question 17

What type of forceps are used to extract foreign bodies in the pharynx or laryngeal inlet?
Why would you need suction?

Answer 17

Magill

Patient will usually vomit.

Question 18

What is an explanation for a child with unexplained cough or pneumonia?

Answer 18

Foreign body aspiration

Question 19

A ball valve obstruction (block flow of gas in 1 direction, but allow flow in in the other) results in hypo or hyperinflation of the obstructed lobe?

Answer 19

Hyperinflation

Question 20

What is the fungal infection of the sinonasal cavity that occurs in immunocompromised hosts (BM transplants or chemo) called?

Answer 20

Mucormycosis

Question 21

Why is there significant mortality assoc w/mucormycosis and in who?

Answer 21

can be invasive (grows into blood vessels –> thrombosis and distal ischemia –> tissue necrosis)
Pts: diabetics (poor glucose regulation who become acidotic). Also pts w/renal failure.

Question 22

How does mucormycosis spread?

Answer 22

sinuses –> nose, eye, palate –> optic nerve –> brain

Question 23

1. How does mucormycosis present?
2. What does it look like on biopsy?
3. How to treat?

Answer 23

1. facial pain (black turbinates due to necrosis of mucosa)
2. acutely branching nonseptate hyphae
3. Immediate correction of acidosis (metabolic stabilization) so general anesthesia is tolerated –> debride (radical maxillectomy/orbital exenteration)
   Amphotericin B

Question 24

Where does epistaxis most commonly occur?

Most common initiating event for these nosebleeds

Answer 24

Anterior part of the septum (Kiesselbach’s plexus)

Digital trauma

Question 25

How to tx nosebleeds in kids and adults with hypertension and epistaxis?

Answer 25

oxymetazoline or phenylephrine (topical vasoconstriction) nasal spray and digital pressure for 5–10 min

Question 26

Possible causes of epistaxis besides digital trauma?

Answer 26

occult bleeding disorder;
Cocaine abuse
Adults with hypertension and arthritis

Question 27

Bleeding from the back of the nose in an adolescent MALE is considered to be ____ until proven otherwise

Answer 27

Juvenile nasopharyngeal angiofibroma

Question 28

adults with hypertension and epistaxis should be tx w/med to dec BP so diastolic is below ____ mgHg

Answer 28

90

Question 29

what does methycellulose coated w/abx ointment do for epistaxis? how long do you use it?

Answer 29

can be placed in the nose to prevent further trauma and allow mucosal surfaces to heal. Put in for 3-5 days

Question 30

If bleeding isnt stopped ___ is used as a pressure method to stop the bleeding.
If anterior and unilateral patients may go home.
If bilateral then patients need to be admitted

Answer 30

Packing for 3-5 days

Question 31

Severe nosebleeds can lead to what?

Answer 31

hypovolemia

significant anemia

Question 32

Severe infection of the external auditory canal caused by ____ organisms

Answer 32

1. Necrotizing otitis externa/malignant otitis externa

2. pseudomonas

Question 33

Necrotizing otitis externa can spread to the ___ bone which is called ___ and can extend to __

Answer 33

temporal
osteomyelitis
base of the skull

Question 34

necrotizing otitis externa commonly occurs in what type of patients?

Answer 34

older patients with diabetes (traumatic instrumentation or irrigating wax) or AIDS patients

Question 35

presentation of necrotizing otitis externa

Answer 35

deep ear pain, temporal headaches, purulent drainage and granulatino tissues at bony cartilaginous jcn in EAC and facial nn
Cranial neuropathies

Question 36

How do you diagnose and tx necrotizing otitis externa?

Answer 36

Dx: CT scan of the bone w/bone windows; technetium bone scan shows hot spot.
Tx: glucose control, aural hygiene, topical antipseudomonal abx (QUINOLONES), hyperbaric o2

Question 37

Sudden SNHL is idiopathic, unilatearl and occurs in less than ___ hours. It is a medical emergency!

Answer 37

72

Question 38

1. Sudden SNHL etiology.

2. Most common tx

Answer 38

1. viral infection or a disorder of inner ear circulation due to vascular disease.
2. tapered course of oral corticosteroids and/or intratympanic corticosteroid injections