ENT Emergencies

Question 1

What must be excluded in nasal fractures?

Answer 1

septal haematomas - in the perichondrium

Question 2

How are nasal fractures treated?

Answer 2

digital manipulation up to 3 weeks after the event

Question 3

What are the possible complications of nasal fractures?

Answer 3

CSF leak - can lead to meningitis
epistaxis - heavy then stops due to artery spasming (anterior ethmoid artery)
anosmia - due to cribiform plate fracture

Question 4

Why is epitaxis so common in the nose?

Answer 4

no squamous epithelium over the vasculature to protect it

Question 5

How is epitaxis managed?

Answer 5

topical vasoconstrictor
local anaesthetic
ice
pressure
anterior rhinoscopy
30 degree rigic nasendoscopy
cauterise vessel by silver nitrate/diathermy
rapid rhino packs
remove clot through suction

Question 6

What is the managment if an epitaxis cannot be controlled?

Answer 6

consider arterial ligation

Question 7

When does a CSF leak need repair?

Answer 7

after 10 days

Question 8

How is a pinna haematoma managed?

Answer 8

pressure dressings and drainage

Question 9

When would you give antibiotics to a laceration on the ear?

Answer 9

if it affects the cartilage

Question 10

What are the two types of temporal bone fractures?

Answer 10

longitudinal - most common

transverse

Question 11

Describe longitudinal temporal bone fractures?

Answer 11

otic capsule involved
usually from lateral blows
can cause conductive hearing loss through haemotympanum or ossicular chain disruption
20% result in facial palsy
fracture line is parallel to the long axis of the petrous pyramid

Question 12

Describe transverse temporal bone fractures?

Answer 12

otic capsule not involved
frontal or behind blows
can cause sensorineural hearing loss due to CN VIII damage
50% result in facial palsy and vertigo
fracture line is at right angles to the long axis of the petrous pyramid
can cross the IAM which damages the nerves

Question 13

What are the signs/investigations of a temporal bone fracture?

Answer 13

battle sign
hearing tests
look at the TM and ear canal

Question 14

What is the management of a temporal bone fracture?

Answer 14

hearing aids

facial nerve decompression

Question 15

What is sensorineural hearing loss treated with?

Answer 15

predisolone 60mg

Question 16

When should forgein bodies be removed?

Answer 16

if they are round batteries - can burn through the skin

Question 17

What is Zone 1 in neck trauma?

Answer 17

trachea
oesophagus
thoracic duct
thyroid
brachiocephalic 
subclavian
common carotid
thyrocervical trunk
spinal cord

Question 18

What is Zone 2 in neck trauma?

Answer 18

larynx
hypopharynx
CN 10, 11, 12
carotids
internal jugular
spinal cord

Question 19

What is Zone 3 in neck trauma?

Answer 19

pharynx 
cranial nerves
carotids
internal jugular vein
vertebrae
spinal cord

Question 20

What is the most common neck zone to reveive trauma?

Answer 20

zone 1

Question 21

What are the investigations done for neck trauma?

Answer 21

FBC, G&S, XM
AP/Lateral neck Xray
CXR for haemopneumothorax and empysema
CT angiogram - pseudoaneurysm
MRA - magnetic resonance angiography

Question 22

How does a deep neck space infection present?

Answer 22

extension of infection from tonsil or oropharynx into deeper tissue
sore throat
unwell
limited neck movement

Question 23

What are the signs of deep neck space infections?

Answer 23

febrile
trismus - reduces jaw opening
red/tender neck

Question 24

What is the management of deep neck space infections?

Answer 24

fluid resuscitation
IV antibiotics
incision and drainage

Question 25

What are the signs of an orbital fracture?

Answer 25

pain
diplopia
decreased visual acuity
periorbital echymosis
hypoaesthesia in the infraorbital region
oedema
enopthalmos
restriction of ocular movement 
bony step of orbital rim

Question 26

What sign is seen on a CT scan of an orbital fracture?

Answer 26

teardrop sign

Question 27

When would an orbital fracture be surgically repaired?

Answer 27

entrapment
large defect
significant enopthalmus