HENT Treatments Flashcards
1st line treatment for Otitis Externa
Topical antimicrobials
- acetic acid
- QUINOLONES
- sulfonamides
- aminoglycosides
Other treatments for otitis externa
- Topical corticosteroids
- Systemic Abx for severe infection
Treatments for Malignant Otitis Externa
IV Abx - CIPROFLOXACIN (1ST LINE)
Treatment for acute Otitis Media
ABX!!
Amoxicillin = 1st line in kids
Augmentin = 1st line in adults
PCN allergy: Cephalosporins, Doxycycline, or Azithromycin
When do you just observe for otitis media treatment?
- healthy children
- age 6-24 months
- unilateral non-severe pain
- age >24 months with non-severe pain, unilateral or bilateral
Treatment for ruptured TM
ABX!!
Amoxicillin or Augmentin
Treatment for chronic otitis media
Refer to ENT for surgical repair / tympanostomy tubes
Treatment for mastoiditis
Broad spectrum IV antibiotics + Myringotomy
Treatment for cholesteatoma
Surgical repair
Treatment for acute OM in a patient with tympanostomy tubes?
Ciprodex (fluoroquinolone combination steroid drops)
Uncomplicated unilateral AOM in a child > 6 months
Observe / Amoxicillin
Uncomplicated, unilateral AOM in an adult
Augmentin
Unilateral ruptured TM in a child > 6 months
Amoxicillin
Uncomplicated AOE in a child > 6 months or an adult
Ciprodex
Unilateral AOM in a child > 6 months with recurrent OM recently treated with antibiotics
Augmentin or 2nd/3rd gen Cephalosporin
Unilateral or bilateral OME in a child > 6 months or an adult
Antihistamine, decongestant, monitor
Treatment for conductive hearing loss?
Refer to ENT
Treatment for sensorineural hearing loss?
Refer to ENT
Cochlear implants
Hearing aids
Treatment for Acoustic Neuroma?
Refer to ENT
- Surgical resection
- Radiation
- Observation
Treatment for tinnitus?
Dependent on cause
Treatment for barotrauma?
PREVENTION!
- oral decongestants
- swallowing
- ear plugs
- ventilation tubes
Treatment of injury
- Surgical repair
- Abx if TM is perforated
- Analgesics
What requires an urgent referral to ENT?
Barotrauma + vertigo + hearing loss
When would you treat an auricular hematoma with a needle aspiration?
<2cm and/or present <24 hours
When would you treat an auricular hematoma with an I&D?
> 2cm up to 7 days old
Treatment for BPPV?
- EPLEY MANEUVER
Meds used with high frequency of episodes
- 1st line: Antihistamines
- Benzodiazepines
Surgery for severe cases
Treatment for vestibular neuritis?
- 10 day Prednisone taper
- Meclizine 25-50mg q8h
OR
Diphenhydramine 25mg q6-q8h
Can Ménière’s disease be cured?
NO! You can relieve symptoms but will not “fix” the underlying disease
Treatments for Meniere’s disease?
Lifestyle adjustments (low salt)
Diuretics
Antiemetics (MECLIZINE)
Anxiolytics
Antihistamines
TCAs
Treatment for persistent postural perceptual dizziness?
SSRI/NRI (Effexor)
Vestibular rehab
Cognitive behavioral therapy
Treatment for mild/episodic allergic rhinitis?
- 1st line: oral antihistamine
- nasal antihistamine
- glucocorticoid nasal spray
Treatment for mod/severe allergic rhinitis?
- glucocorticoid nasal spray
- oral antihistamines
- Montelukast
- Systemic glucocorticoid
- Allergen immunotherapy
Treatment for bacterial infectious rhinosinusitis?
ABX!
- Augmentin
- Doxycycline
- Levofloxacin
Treatment for chronic rhinosinusitis?
- intranasal saline
- intranasal steroids
Treatment for nasal polyps?
Refer to ENT
- 1st line: intranasal glucocorticoid
Treatment for epistaxis
- Conservative measures
- Cautery
- Nasal packing
- AUGMENTIN (prevent TSS)
What types of nasal packing can be used to treat anterior epistaxis?
- Nasal tampons (Merocel)
- Gauze packing (Xeroform)
- Nasal balloon catheters (Rapid Rhino)
- Thrombogenic foams/gels
What types of nasal packing can be used to treat posterior epistaxis?
- Nasal balloon catheters: Rapid Rhino, EpiStat, Foley Cath
Treatment for foreign bodies in the nose?
- Positive pressure
- instrumentation (Katz extractor, Alligator forceps)
Treatment for asymptomatic, minimal swelling, no septal deviation or hematoma?
None
Treatment for a nasal fracture without hematoma?
Follow up with ENT in 3-5 days
Treatment for a septal hematoma?
ENT consult
Treatment for viral infectious rhinosinusitis?
Symptomatic
What is the treatment for GABHS?
- 1st line: Penicillin V 250mg po TID or 500mg BID x 10 days
OR
Cefuroxime acetil 250mg bid x 5-10 days - PCN allergy: erythromycin, azithromycin 500mg QD x 3 days
- Unable to take PO meds: single IM benzathine PCN
What is the treatment for peritonsillar abscess?
ABX
- Less severe: Amoxicillin, Augmentin, Clindamycin
- More severe: parenteral Amoxicillin, Amoxicillin-sulbactam, Clindamycin
Needle aspiration
I&D
Tonsillectomy
What is the treatment for a retropharyngeal abscess?
Begin with conservative Abx
- Bactrim, Clindamycin, Vancomycin, Linezolid, Augmentin
If Abx fail, surgical I&D
What is the treatment for Ludwig’s angina?
- AIRWAY PROTECTION
- Broad spectrum IV Abx: Unasyn or Clindamycin
- IV steroids
What is the treatment for Epiglottis?
- STABILIZE AIRWAY
- Humidified O2
- IV ABX (2 DRUG REGIMEN)
3rd gen cephalosporin + Vancomycin
What is the treatment for Croup?
- DEXAMETHASONE (steroid)
- antipyretics for fever/pain
- humidified RA
Treatment of laryngitis > 2 weeks without symptoms of URI?
Refer to ENT (suspect cancer)
Treatment for xerostomia?
- Eliminate med that is causing if possible
- promote gum chewing
- encourage oral hydration
- OTC saliva substitutes
- Cholinergic agonist
- Pilocarpine hydrochloride (Salagen)
Treatment for mucocele affecting speech, feeding or discomfort?
Surgical removal of entire lesion + minor salivary gland
Treatment for oral ranulas?
Surgical removal of sublingual gland
Treatment for plunging ranulas?
Surgical removal of sublingual gland
Treatment for sialolithiasis?
- Conservative
- Sialogogues
- Hydration
- NSAIDs
- Warm compress
- Massage gland
- Remove anticholinergic med
- Abx only if bacterial
Treatment for bacterial sialadenitis?
IV Abx - Nafcillin + Flagyl or Unasyn
Supportive
IF SYMPTOMS DO NOT IMPROVE OR REOCCUR REFER TO ENT
Treatment for viral sialadenitis?
Symptomatic treatment
Prevention (MMR vaccine)
What meds do you prescribe for dental prophylaxis?
1st line: Amoxicillin
PCN allergic: Cephalexin, Cefadroxil, Azithromycin, Clarithromycin, Doxycycline
Treatment for gingivitis?
- Effective tooth brushing and flossing
- Regular dental visits
Treatment for gingival hyperplasia?
- Meticulous oral hygiene
- Regular cleanings
- May require gum resection surgery
Treatment for ANUG?
- ABX: Metronidazole, Augmentin, Clindamycin
- Debridement
- Chlorohexidine rinses
- Augmented oral hygiene
Treatment for periodontitis?
- Effective brushing and flossing
- Stop tobacco, cannabis & other irritants
- Dental referral for deep root scaling
Treatment for leukoplakia >3 weeks?
REFER TO ENT FOR EVAL AND BIOPSY
Treatment for aphthous stomatitis?
mild forms - no treatment
Can use topical or intralesional steroids
Treatment for herpes labialis?
Systemic antiviral agents - acyclovir or valacyclovir
Treatment for Coxsackie A virus?
Supportive
Treatment for pyogenic granulomas?
Conservative surgical excision
Treatment of geographic tongue?
No treatment
Treatment of a bony tori?
Surgical removal only if it affects oral function, interferes with denture fabrication or is subject to recurrent trauma or ulceration
Treatment of candidiasis?
Topical or systemic antifungals:
- Nystatin swish swallow
- Clotrimazole
- Fluconazole
Treatment of lichen planus?
- Asymptomatic - no treatment
- Topical corticosteroid gels or mouth rinses