ENT Emergencies (Dr. Mao)

Question 1

presentation of otitis external

Answer 1

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

Question 2

What organism may cause otitis externa in a localized infection such as a furuncle?

Answer 2

staph

Question 3

which organism overwhelmingly causes otitis externa

Answer 3

psuedomonas

Question 4

What are other causes of otitis externa

Answer 4

fungal, allergic (eczematoid, flaky), seborrheic

-these are more difficult to treat

Question 5

treatment of otitis externa

Answer 5

• cleansing, debridement
• drops (cipro, cortisporin)
• oral abx, wick, pain meds

Question 6

How is tx in otitis externa different with fungal cause?

Answer 6

abx and drops make fungal infections worse, so you have to dry it out

Question 7

What are sx of otitis external when it becomes an emergency

Answer 7

diplopia, facial paralysis

Question 8

comorbitities of otitis externa emergency

Answer 8

diabetes, immunocompromised

Question 9

Acute Otitis Media presentation (sx, and age group)

Answer 9

• children age 2
• fever, pain, irritability, purulent drainage, other URI sx
• hearing loss

Question 10

causative organisms of acute otitis media

Answer 10

viral

-bacterial - s. pneumococcus, H. influenza, M. catarrhalis

Question 11

tx for acute otitis media

Answer 11

• abx if bacterial

- myringotomy tubes

Question 12

When would you give myringotomy tubes for acute otitis media

Answer 12

(often in children)

• recurrent infections
• hearing loss, speech delay

Question 13

Acute complications of acute otitis media

Answer 13

Can spread to following regions and cause:

• mastoiditis
• suppurative labyrinthitis
• brain abscess

Question 14

Late complication of acute otitis media

Answer 14

cholesteatoma

Question 15

Clinical features of mastoiditis

Answer 15

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

Question 16

Treatment of mastoiditis

Answer 16

• IV abx
• CT scan
• surgery: mastoidectomy

Question 17

Presentation of an Aural Foreign Body

Answer 17

-hx, pain, drainage

Question 18

Examples of aural foreign bodies

Answer 18

beads/toys, cotton, wax, insects

Question 19

Treatment for aural foreign body

Answer 19

removal, possible drops

Question 20

presentation of perforated tympanic membrane

Answer 20

• infectious following acute OM: fever, pain, otorrhea
• traumatic
• asymptomatic (people might not know)

Question 21

treatment of infectious tympanic membrane

Answer 21

drops, abx

Question 22

treatment of traumatic tympanic membrane

Answer 22

observe

Question 23

emergencies associated with perforated TM

Answer 23

• vertigo
• sensorineural hearing loss
• facial paralysis

Question 24

Presentation of hearing loss

Answer 24

• hx

- associated tinnitus or vertigo

Question 25

Two types of sudden hearing loss

Answer 25

conductive vs. sensorineural

Question 26

Treatment for sudden hearing loss

Answer 26

-audiogram, steroids?, antivirals? other

Question 27

Presentation of nasal foreign body

Answer 27

- hx | - unilateral purulent rhinorrhea

Question 28

treatment of nasal foreign body

Answer 28

remove

Question 29

Anterior epistaxis

Answer 29

- septal bleeding | - self limited and more common

Question 30

Two types of epistaxis

Answer 30

anterior and posterior

Question 31

causes of epistaxis

Answer 31

- trauma | - spontaneous

Question 32

associated factors of epistaxis

Answer 32

HTN, poor clotting, medications

Question 33

epistaxis tx

Answer 33

- supportive (saline nasal spray, humidification, ointments) - packing - cautery - surgery if nothing else helps (may clot off artery)

Question 34

presentation of acute sinusitis

Answer 34

- rhinorrhea - facial and teeth pain - congestion

Question 35

tx of acute sinusitis

Answer 35

abx, mucolytics, nasal steroids

Question 36

complications of acute sinusitis

Answer 36

Near your eye and brain so you can have orbital and cranial complications

Question 37

Orbital complications of acute sinusitis

Answer 37

- more common complications | - preseptal cellulitis-->cavernous sinus thrombosis (high mortality rate..50%?)

Question 38

intracranial complications of acute sinusitis

Answer 38

meningitis --> brain abscess

Question 39

Cause of Peritonsillar Abscess

Answer 39

``` bacterial infections (cellulitis of tonsils can lead to an abscess) -can be strep, staph, anaerobes (usually mixed) ```

Question 40

sx of peritonsillar abscess

Answer 40

- usual tonsillitis sx but usually unilateral - fever, sore throat, trismus (can't open mouth all the way), hot potato voice (muffled) - bulging tonsil, uvular deviation - usually referred ear pain on affected side

Question 41

treatment of peritonsillar abscess

Answer 41

- drainage (I&D or quinsy tonsillectomy) - abx - steroids for inflammation- helps pt feel better

Question 42

Presentation of foreign body throat

Answer 42

- young child or elderly - witnessed choking event - asthma, pneumonia, chronic cough

Question 43

treatment of throat foreign body

Answer 43

- xray (only sometimes object is radiopaque) - fiberoptic laryngoscopy (if you feel like it's something you would be able to see like a fish bone) - angiogram if in tonsil bed - removal in OR

Question 44

age epiglottitis is normally seen

Answer 44

children age 2-6 | less severe in adults

Question 45

sx of epiglottitis

Answer 45

- fever, toxicity, sore throat, dysphagia - inspiratory stridor, rapid progression to A/W obstruction - often leaning forward, drooling

Question 46

Why is epiglottitis seen less often now?

Answer 46

vaccine for H. influenza type B (HIB vaccine)

Question 47

What are some causes of epiglottitis

Answer 47

- classically HIB, esp. children | - in adults, can be staph, strep, pneumococci

Question 48

Diagnosis of epiglottitis

Answer 48

- h & p - lateral neck x-ray (look for thumb print sign) - fiberoptic laryngoscopy

Question 49

tx of epiglottitis

Answer 49

- secure A/W - IV abx - steroids

Question 50

Name for Croup

Answer 50

Laryngotracheobronchitis

Question 51

Presentation of croup

Answer 51

- barking seal cough - biphastic stridor (trouble breathing in and breathing out) - winter - children - milder URI sx

Question 52

Where is the problem with stridor

Answer 52

upper airway problem

Question 53

causes of laryngotracheobronchitis

Answer 53

- viral (parainfluenza, adenovirus) - swelling of subplots - low humidity - can get secondary bacterial infection

Question 54

Dx of croup

Answer 54

h & p | -lateral and PA XR looking for subglottic narrowing

Question 55

tx of croup

Answer 55

- humidification (epi infused), hydration, oxygen - abx - steroids (used a lot! to get swelling down) - A/W control is most important

Question 56

Bronchiolitis presentation

Answer 56

-infants

Question 57

Where is problem with bronchiolitis

Answer 57

lower resp problem

Question 58

causes of bronchiolitis

Answer 58

- respiratory syncitial virus - parainfluenza 3 - other viruses

Question 59

tx of bronchiolitis

Answer 59

- oxygen, hydration, bronchodilator | - not an A/W probl, but a resp prob

Question 60

What are some conditions to look for in Head & Neck Trauma

Answer 60

- septal hemotoma (collection of blood in the septum) - auricular hematoma (wrestlers) - lacerations - mandible fractures - clear rhinorrhea

Question 61

What could clear rhinorrhea after head trauma indicate?

Answer 61

Could be spinal fluid; could increase risk of meningitis, etc

Question 62

tx for septal hematoma

Answer 62

drain and dress so it doesn't recollect

Question 63

tx for auricular hematoma

Answer 63

needs to be incised and put compressive dressing so it doesn't recollect

Question 64

why are mandible fractures more emergent?

Answer 64

especially if it involves the teeth because this break often involves a mucosal break (very dirty area) so higher risk of infection