ENT emergencies Flashcards
Damage to cartilage is an…
ENT emergency
What can cause a haematoma?
Cartilaginous necrosis
How do you treat a haematoma?
Drain
Abx
Bulky dressing
Ear anaesthesis?
Block great auricular nerve in post-auricular region
Treatment of chondritis (cellulitis):
Difficult to treat due to poor blood supply
Cover S. Aureus and Pseudomonas
Extra care in diabetes
Differential of chondritis?
Inflammation from sero-ve arthritis
Features of otitis externa:
Ear canal infection and inflammation
Bacteria (pseudomonas and staph) and funghi
Treat with Abx-steroid drops
Use wick for tight canals
ENT diabetic complication:
Malignant otitis externa - granulation tissue
Management of FB in ear canal:
Kill bugs with mineral oil/lidocaine
Suction/tissue adhesive
Involve ENT specialist
What in the history can indicate tympanic membrane perforation?
History of drainage
When does perforation of the tympanic membrane warrant immediate referral?
Perforation with vertigo and facial nerve involvement
What causes tympanic membrane perforation?
Middle ear pressure
Fluid or barotrauma
Management of tympanic membrane perforation?
Oral Abx - drops for purulent but avoid gentamicin
Most heal but all need ENT follow up
Name 3 significant middle ear conditions:
Serous otitis media
Otitis media
Mastoiditis
Sign of mastoiditis?
Mastoid bulging and tenderness
What is serous otitis media and how do you manage it?
Eustachian tube dysfunction
Manage with decongestants and decompression
Sign of otitis media:
Fluid behind the tympanic membrane
Risk with mastoiditis:
Can lead to brain abscess/meningitis due to the venous connection with the brain
Name 2 types of vestibulopathy (peripheral vertigo):
BPPV
Labyrinthitis
Signs of vestibulopathy (peripheral vertigo):
Acute onset
No central signs
Young patient
Horizontal nystagmus
Symptoms of Meniere’s disease:
Vertigo
Sensorineural hearing loss
Tinnitus
Differential between Meniere’s and peripheral vertigo?
Meniere’s causes sensorineural hearing loss and tinnitus
How do you treat Meniere’s disease?
Antihistamine
Prochlorpenazine
Fluids and rest
Epley manoeuvre
What is the arterial supply to the anterior nose?
Internal carotid
What is the arterial supply to the posterior nose?
Distal branches of the external carotid
Where does anterior epistaxis originate 90% of the time?
Kisselbach’s plexus (Little’s area)
What does anterior epistaxis require?
Abx prophylaxis, pressure +/- tamponade
What may cause CNVII palsy?
Lyme disease
HSV
Management of CNVII palsy?
60-80mg prednisone and antivirals
Surgical decompression if not improving by 2 weeks and electroneurography
Treatment for sinusitis:
Amoxicillin, doxycycline
Decongestants and analgesia
Complications of sinusitis:
Ethmoid sinusitis leading to orbital cellulitis and abscess
Frontal sinusitis may erode bone (Pott’s puffy tumour and brain abscess)
Features of parotiditis:
Usually viral (paramyxovirus)
Bacterial in elderly and immunocompromised
Assoc with dehydration
Cover staph and anaerobes
What organisms can cause pharyngitis?
Viruses: EBV, adenovirus, rhinovirus
Bacteria: Group A-beta haemolytic strep, mycoplasma, gonorrhoea, diphtheria
What is a complication of suppurative tonsilitis?
Peritonsillar abscess
Signs of peritonsillar abscess:
Inferior-medial displacement if tonsils and uvula
Symptoms of peritonsillar abscess:
Dysphagia Ear pain Muffled voice Fever Trismus
Treatment of peritonsillar abscess?
Abx
I and D
+/- steroids
Signs and symptoms of epiglottitis:
Rapid onset, looks toxic Prefer to sit Muffled voice Dysphagia Drooling Restlessness Thumbprint of Vallecula sign Epiglottis >8mm in adults for acute epiglottitis
Treatment of epiglottitis?
Prepare for emergent airway
IV cefotaxime +/- steroids
Adrenaline nebulisers
What causes breathing problems in retropharyngeal abscess?
Swelling in the retropharyngeal anterior to pre-vertebral space
Why can retropharyngeal abscess occur in children <4?
Lymphoid tissue occupies the space
Symptoms of retropharyngeal abscess:
Pain
Dysphagia
Dyspnoea
Fever
Management of retropharyngeal abscess:
Lateral neck X-ray
CT with contrast
Complication of retropharyngeal abscess?
Mediastinitis
What is Ludwig’s angina?
Rapidly growing cellulitis on the floor of the mouth causing airway obstruction
History of dental procedures
Caused be strep. viridans and happens in the elderly
Treatment of Ludwig’s angina?
Intubation/tracheostomy/airway-compromised-ICU admission
Abx
What can cause angioedema?
Hereditary
ACE inhibitors
Management of angioedema:
Antihistamines and steroids
Observe every 4-6 hours
What does aphonia suggest?
Complete upper airway obstruction
What does stridor suggest?
Incomplete upper airway obstruction
What does wheezing suggest?
Incomplete lower airway obstruction
Management of wheezing?
Salbutamol + ipratropium/steroids
What does loss of breath sounds indicate?
Complete lower airway obstruction e.g. from fluid in the bronchus
