ENT Emergencies (Dr. Mao) Flashcards
presentation of otitis external
- hx of trauma or swimming
- itching, pain
- drainage, hearing loss
- swelling, erythema, fever, lad
What organism may cause otitis externa in a localized infection such as a furuncle?
staph
which organism overwhelmingly causes otitis externa
psuedomonas
What are other causes of otitis externa
fungal, allergic (eczematoid, flaky), seborrheic
-these are more difficult to treat
treatment of otitis externa
- cleansing, debridement
- drops (cipro, cortisporin)
- oral abx, wick, pain meds
How is tx in otitis externa different with fungal cause?
abx and drops make fungal infections worse, so you have to dry it out
What are sx of otitis external when it becomes an emergency
diplopia, facial paralysis
comorbitities of otitis externa emergency
diabetes, immunocompromised
Acute Otitis Media presentation (sx, and age group)
- children age 2
- fever, pain, irritability, purulent drainage, other URI sx
- hearing loss
causative organisms of acute otitis media
viral
-bacterial - s. pneumococcus, H. influenza, M. catarrhalis
tx for acute otitis media
- abx if bacterial
- myringotomy tubes
When would you give myringotomy tubes for acute otitis media
(often in children)
- recurrent infections
- hearing loss, speech delay
Acute complications of acute otitis media
Can spread to following regions and cause:
- mastoiditis
- suppurative labyrinthitis
- brain abscess
Late complication of acute otitis media
cholesteatoma
Clinical features of mastoiditis
- fever, toxicity
- pain, fluctuance over mastoid
- prominent pinna
- facial paralysis, vertigo, mental status changes
Treatment of mastoiditis
- IV abx
- CT scan
- surgery: mastoidectomy
Presentation of an Aural Foreign Body
-hx, pain, drainage
Examples of aural foreign bodies
beads/toys, cotton, wax, insects
Treatment for aural foreign body
removal, possible drops
presentation of perforated tympanic membrane
- infectious following acute OM: fever, pain, otorrhea
- traumatic
- asymptomatic (people might not know)
treatment of infectious tympanic membrane
drops, abx
treatment of traumatic tympanic membrane
observe
emergencies associated with perforated TM
- vertigo
- sensorineural hearing loss
- facial paralysis
Presentation of hearing loss
- hx
- associated tinnitus or vertigo
Two types of sudden hearing loss
conductive vs. sensorineural
Treatment for sudden hearing loss
-audiogram, steroids?, antivirals? other
Presentation of nasal foreign body
- hx
- unilateral purulent rhinorrhea
treatment of nasal foreign body
remove
Anterior epistaxis
- septal bleeding
- self limited and more common
Two types of epistaxis
anterior and posterior
causes of epistaxis
- trauma
- spontaneous
associated factors of epistaxis
HTN, poor clotting, medications
epistaxis tx
- supportive (saline nasal spray, humidification, ointments)
- packing
- cautery
- surgery if nothing else helps (may clot off artery)
presentation of acute sinusitis
- rhinorrhea
- facial and teeth pain
- congestion
tx of acute sinusitis
abx, mucolytics, nasal steroids
complications of acute sinusitis
Near your eye and brain so you can have orbital and cranial complications
Orbital complications of acute sinusitis
- more common complications
- preseptal cellulitis–>cavernous sinus thrombosis (high mortality rate..50%?)
intracranial complications of acute sinusitis
meningitis –> brain abscess
Cause of Peritonsillar Abscess
bacterial infections (cellulitis of tonsils can lead to an abscess) -can be strep, staph, anaerobes (usually mixed)
sx of peritonsillar abscess
- 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
treatment of peritonsillar abscess
- drainage (I&D or quinsy tonsillectomy)
- abx
- steroids for inflammation- helps pt feel better
Presentation of foreign body throat
- young child or elderly
- witnessed choking event
- asthma, pneumonia, chronic cough
treatment of throat foreign body
- 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
age epiglottitis is normally seen
children age 2-6
less severe in adults
sx of epiglottitis
- fever, toxicity, sore throat, dysphagia
- inspiratory stridor, rapid progression to A/W obstruction
- often leaning forward, drooling
Why is epiglottitis seen less often now?
vaccine for H. influenza type B (HIB vaccine)
What are some causes of epiglottitis
- classically HIB, esp. children
- in adults, can be staph, strep, pneumococci
Diagnosis of epiglottitis
- h & p
- lateral neck x-ray (look for thumb print sign)
- fiberoptic laryngoscopy
tx of epiglottitis
- secure A/W
- IV abx
- steroids
Name for Croup
Laryngotracheobronchitis
Presentation of croup
- barking seal cough
- biphastic stridor (trouble breathing in and breathing out)
- winter
- children
- milder URI sx
Where is the problem with stridor
upper airway problem
causes of laryngotracheobronchitis
- viral (parainfluenza, adenovirus)
- swelling of subplots
- low humidity
- can get secondary bacterial infection
Dx of croup
h & p
-lateral and PA XR looking for subglottic narrowing
tx of croup
- humidification (epi infused), hydration, oxygen
- abx
- steroids (used a lot! to get swelling down)
- A/W control is most important
Bronchiolitis presentation
-infants
Where is problem with bronchiolitis
lower resp problem
causes of bronchiolitis
- respiratory syncitial virus
- parainfluenza 3
- other viruses
tx of bronchiolitis
- oxygen, hydration, bronchodilator
- not an A/W probl, but a resp prob
What are some conditions to look for in Head & Neck Trauma
- septal hemotoma (collection of blood in the septum)
- auricular hematoma (wrestlers)
- lacerations
- mandible fractures
- clear rhinorrhea
What could clear rhinorrhea after head trauma indicate?
Could be spinal fluid; could increase risk of meningitis, etc
tx for septal hematoma
drain and dress so it doesn’t recollect
tx for auricular hematoma
needs to be incised and put compressive dressing so it doesn’t recollect
why are mandible fractures more emergent?
especially if it involves the teeth because this break often involves a mucosal break (very dirty area) so higher risk of infection
