ENT emergencies

Question 1

Common ear emergencies

Answer 1

• Otitis externa (swimmer’s ear)
• acute otitis media
• foreign body
• perforated eardrum
• sudden hearing loss

Question 2

Otitis externa presentation

Answer 2

• hx of trauma or swimming
• itching and pain
• drainage, hearing loss
• swelling, erythema, fever, lymphadnopathy

Question 3

Otitis externa causes

Answer 3

• Localized: staph
• Diffuse: pseduomonas
• fungal
• allergic
• seborrheic

Question 4

Otitis externa tx

Answer 4

• cleansing/debridement (typically fungal)
• drops
• oral abx
• wick
• pain meds
• neomycin-boric acid powder
• culture

Question 5

Otitis externa emergency

Answer 5

• sx: diplopia, facil paralysis

- comorbitites: DM, immunocompromised

Question 6

Acute otitis media presentation

Answer 6

• children age 2
• fever, pain, irritability, purulent drainage, other URI sx
• HEARING LOSS

Question 7

Acute otitis media organism causes

Answer 7

• viral

- bacterial: s. pneumococcus, h. influenza, m. catarrhalis

Question 8

Acute otitis media tx

Answer 8

• abx if bacterial

- myringotomy tubs: recurrent infections, hearing loss, speech delay

Question 9

Acute otitis media complications

Answer 9

• acute: mastoiditis, suppurative labyrinthitis, brain abscess
• late: cholesteatoma

Question 10

Mastoiditis presenation

Answer 10

• fever/toxicity
• pain, fluctuance over mastoid
• prominent pinna
• facial paralysis, vertigo, mental status changes

Question 11

Mastoiditis tx

Answer 11

• intravenous abx
• CT scan
• surgery: mastoidectomy

Question 12

Aural foreign body

Answer 12

• Presentation: hx, pain, drainage
• Ex: beads/toys, cotton, wax, insects
• Rx: removal, possible drops

Question 13

Perforated TM presentation

Answer 13

• infectious following acute OM: fever, pain, otorrhea
• traumatic
• asymptomatic

Question 14

Perforated TM tx

Answer 14

• infectious: drops, Abx
• Traumatic: observe
• asymptomatic
• hearing test

Question 15

Perforated TM emergencies

Answer 15

• vertigo
• sensorineural hearing loss
• facial paralysis

Question 16

Nasal foreign body

Answer 16

• presentation: hx, unilateral purulent rhinorrhea

- tx: remove

Question 17

Epistaxis

Answer 17

• anterior: septal bleeding, self limited, more common

- posterior

Question 18

Epistaxis causes

Answer 18

• trauma
• spontaneous
• associated factors: HTN, poor clotting, meds

Question 19

Epistaxis tx

Answer 19

• supportive: saline nasal spray, humidification, ointment
• packing, cautery
• surgical

Question 20

Acute sinusitis presentation and tx

Answer 20

• Presentation: rhinorrhea, facial/teeth pain, congestion

- Tx: abx, mucolytics, nasal steroids

Question 21

Acute sinusitis complications

Answer 21

• orbit: preseptal cellulitis - cavernous sinus thrombosis

- intracranial: meningitis - brain abscess

Question 22

Common throat emergencies

Answer 22

• peritonsillar abscess
• foreign body
• croup
• epiglottitis
• bronchiolitis

Question 23

Causes of peritonsillar abscess

Answer 23

• bacterial: cellulitis to abscess

- strep, staph, anaerobes

Question 24

Peritonsillar abscess presentation

Answer 24

• fever, sore throat, trismus, hot potato voice
• UNILATERAL symptoms (sore throat, ear pain)
• bulging tonsil, uvular deviation

Question 25

Peritonsillar abscess tx

Answer 25

- drainage: I&D, quinsy tonsillectomy - abx - steroids to take swelling down (pt comfort)

Question 26

Foreign body throat

Answer 26

- presentation: young child or eldery, witnessed chocking, asthma, pna, chronic cough - tx: x-ray, fiberoptic laryngoscopy, angiogram if in tonsil bed, removal in OR

Question 27

Epiglottitis presentation

Answer 27

- children age 2-6: fever, toxicity, sore throat, dysphagia, inspiratory stridor, rapid progression to airway obstruction - Adults: less severe

Question 28

Epiglottitis cause

Answer 28

- h. influenza type B (classical children) | - staph, strep, penumococci

Question 29

Epiglottitis dx

Answer 29

- history or PE - lateral neck x-ray - fiberoptic laryngoscopy

Question 30

Epiglottitis tx

Answer 30

- secure airway - IV abx - steroids - children you need to take to OR stat

Question 31

Laryngotracheobronchitis (croup) presentation

Answer 31

- children 6 months to 3 yrs - winter - milder URI sx - barking cough, biphasic stridor

Question 32

Croup cause

Answer 32

- viral: parainfluenza, adenovirus - secondary bacterial infection - swelling of subglottis - low humidity

Question 33

Croup dx

Answer 33

- H&P | - lateral and P-A x-rays: subglottic narrowing

Question 34

Croup tx

Answer 34

- humidification, hydration, oxgyen - RACEMIC EPINEPHRINE - abx: only w/ secondary infection - steroids - airway control

Question 35

Bronchiolitis presentation

Answer 35

- infants <18 months - URI followed by respiratory distress - cough, wheezing

Question 36

Bronchiolitis cause

Answer 36

- respiratory syncitial virus - parainfluenza 3 - other viruses

Question 37

Bronchiolitis tx

Answer 37

- supportive care: oxygen, hydration | - Ribavirin

Question 38

Head and Neck Trauma

Answer 38

- septal hematoma - auricular hematoma (wrestlers) - lacerations - mandible fx - clear rhinorrhea (unilateral)