Rhinology Emergencies

Question 1

Examples of nasal emergencies

Answer 1

-Epistaxis
=Anterior from Kiesselbach’s plexus/ Little’s area supplied by external carotid
=Posterior more profuse and deeper structures
-Foreign bodies
-Complications of acute sinusitis
-Nasal fractures and their complications

Question 2

Initial treatment for epistaxis

Answer 2

-First aid
=Sit with torso forward and mouth open and pinch
=Suction clot
=Spray LA
=Pinching and ice
=Naseptin and Vaseline for lubrication

-Nasal preparation and inspection
=Headlight and thudicum’s speculum
=Rigid Nasendoscope

Question 3

Direct therapy for epistaxis (see bleeding point)

Answer 3

-Cautery
=Silver nitrate (do not try if INR>2, local pressure with LA, dry area, 3-5 secs, around bleeder then on it), topical anaesthetic spray
=Diathermy probe

-Local pressure
=Small merocell pack
=Sugicell/ alginate dressing

IF SUCCESSFUL
=Home if safe with Naseptin
=Advice: rest, squeezing, picking, first aid

Question 4

Indirect therapy for epistaxis

Answer 4

-Merocell Packing
-BIPP/ Vaseline pack
-Post nasal balloon
-Post nasal packing
-Vessel ligation

IF PACKED
-Admit
-IV access (FBC, G+S so coag, UE, LFT)
-Antibiotics?
-If rebleeds > vessel ligation/ embolisation (sphenopalatine)

Question 5

Describe foreign body emergencies

Answer 5

-Children / Learning difficulties
Airway risk?
-One good try
=Correct restraint
=Good light
=Correct instrument
-If fails – GA ?when

Question 6

Describe nasal fractures

Answer 6

-Rarely need acute assessment
=5-7 days post injury
=MUA 2-3 weeks (earlier in children)

-Epistaxis
=Occasionally severe (Ant/Post Ethmoids)

-Septal Haematoma
=Deviation/Haematoma? Ballot

Question 7

Presentation and treatment of septal haematoma

Answer 7

-Bilateral, red boggy swelling (haematoma between septal cartilage and overlying perichondrium)
-Sensation of nasal obstruction
-Pain
-Rhinorrhoea

1. Analgesia/ anaesthetic
2. Incise
3. Suction
4. Drain
5. Pack
6. Antibiotics

-Saddle nose deformity if septal necrosis

Question 8

Common organisms in acute/ chronic sinus infection

Answer 8

-S. pneumoniae
-H. Influenza
-Moraxella catarrhalis
-S. aureus
-Anaerobic bacteria

Question 9

Complications of sinusitis

Answer 9

-Periorbital cellulitis
-Potts puffy tumour
-Intracranial sepsis

Question 10

Describe periorbital cellulitis

Answer 10

-Vision threatening (compartment syndrome)
-Ophthalmology review
-Acuity, colour, diplopia

-Early CT scanning (if patient confused, urgent CT brain and neurosurgical review for intracranial collection)

-Topical decongestant
-Nasal swab
-IV Ab’s
-Surgical drainage

Question 11

Describe Intra-cranial sepsis

Answer 11

-Frontal sinus infection
-Extradural abscess
-Meningitis

-CT scanning
-Early discussion with neurosurgery
-Drainage of sinuses
-Prolonged IV ab’s

Question 12

Describe Pott’s Puffy Tumour

Answer 12

-Frontal sinus infection
-Osteomyelitis of frontal bone
-Boggy frontal swelling

-CT scanning
-Surgical drainage
-IV ab’s

Question 13

Causes of epistaxis

Answer 13

-Trauma
-Insertion of foreign body
-Bleeding disorders
=Immune thrombocytopenia
=Waldenstrom’s macroglobulinaemia
-Juvenile angiofibroma (benign tumour that is highly vascularised in adolescent males)
-Cocaine
-Hereditary haemorrhagic telangiectasia
-Granulomatosis with polyangiitis