Post on 07-Apr-2018
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COMMON ENT EMERGENCIESUniversity College of Dublin / St.Vincents University Hospital
Wael Hasan
Special Lecturer in
Otorhinolaryngology / Head & Neck
Surgery
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Overview
Ear
Nose
Throat
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Ear
Foreign Body
Haematoma
TM Perforation
Temporal Bone Fractures
Hearing Loss
Mastoiditis
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1. Foreign Bodies FBs:
Insects, cotton, paper,
organic material, small
batteries
Signs & Symptoms:
Otalgia
Otorrhea
Secondary complications:
Infection, mucosal erosion,
TM perforation
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Management
Kill any live insects
Remove foreign body with
micro alligator forceps
Irrigation ( do not use if
organic FB )
Antibiotics
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2. Auricular Haematoma
Caused by a trauma
Fluctuant bluish swelling
of auricle
Complications: Infection
Abscess
Cartilaginous necrosis
Deformity
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Auricular Haematoma
Management
Drainage
Needle aspiration
I &D
ABX
Compression Dressing
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3. Traumatic TM Perforation
Compression, instrumentation &
blast injuries
Signs & Symptoms
Bloody Otorrhea
Otalgia
Hearing Loss
Tennitus
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Traumatic TM Perforation
Investigations
Otoscopy
Hearing test
Management:
Close observation if perforation is small
Patching
Surgery
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4. Temporal Bone Fracture
Commonly following a
blunt head injury
Signs & Symptoms:
Battles sign
Raccoon eyes
Haemotympanum
Hearing loss
Dizziness
CSF otorrhea
CN VII palsy
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Temporal Bone Fracture
Longitudinal Fractures:
VII Nerve Palsy
Conductive Hearing loss
Transverse Fractures:
VII Nerve Palsy
SNHL
Disequilibrium
Investigations:
CT temporal bone
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5. Acoustic Trauma
Sudden exposure (impact or blast) to noise
Signs & Symptoms:
SHNL, tinnitus
Management: Avoidance / Ear protection
Corticosteroids, carbogen, vasodilators, diuretics, anticoagulants,
plasma expanders
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6. Sudden Hearing Loss
Definition:
SNHL 30 dB over 3
contiguous frequencies within 3days or less
Etiology :
Viral Vascular
Trauma
Autoimmune
Neurologic
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7. Otitic Barotrauma
Inability to ventilate middle ear
abnormal dysfunction of ET
Occur in rising ambient pressure
(descent in flight / scuba diving)
Management: Repeated Valsalva maneuver
Topical nasal decongestants
Myringotomy & PE tube
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Acute Mastoiditis
Preceded by Acute otitis media
Signs & Symptoms:
Severe pain, fever, swollen & tender
mastoid area
Management:
Intravenous ABX
Myringotomy PE tube
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8. Subperiosteal Abscess
Pinna pushed
down & outward
Management:
Intravenous ABX
I&D
Mastoidectomy
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Complications of ME infections
1.Intracranial
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Complications of ME infections
2. Extracranial
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Nose
Foreign body
Nasal bone fractures
Septal Haematoma
Epistaxis
Sinusitis
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1. Foreign bodies
Signs & Symptoms:
Purulent unilateral nasal discharge
Management:
Good visualization: headlamp & nasal speculum
Alligator forceps should be used to remove cloth, cotton, or paper
Other hard FB are more easily grasped using bayonet forceps or Kelly
clamps, or they may be rolled out by getting behind it using an ear
curette, single skin hook, or right angle ear hook
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2. Nasal Fracture
Caused by a direct trauma
Signs & Symptoms:
Deformity of nose
Swelling, ecchymosis, epistaxis
Management
LA or GA
Closed or Open reduction
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3. Septal Haematoma/Abscess
Causes:
Trauma, surgery
Signs & Symptoms:
Soft, fluctuant swelling ofseptum
Management:
Needle aspiration or I&D
Bilateral nasal packing forseveral days
Prophylactic antibiotics
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4. Epistaxis
Local Causes:
Trauma ,Nose picking ,blow injury, surgery
Dry air / Irritants
Topical medications(steroids)
Foreign body, Tumor,polyp
Systemic Causes:
Blood diseases
Hereditary hemorrhagic
telangiectasia
Drugs (anticoagulants)
Hypertension
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Epistaxis
Management:
A,B,C,D,E
Medical therapy
Digital Pressure
Silver Nitrate Cautery
Nasal Packing
Electrocautery
Vascular ligation
Embolisation
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5. Sinusitis
Definition:
Inflammation of the paranasal
sinuses
Locations:
Frontal
Ethmoidal Shenoidal
Maxillary
Acute:
Going on less than four
weeks
Subacute:
48 weeks
Chronic:
Going on for 8 weeks or
more
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Sinusitis
Causes
Bacteria
Streptococcus Pneumonia
H. Influenza
Anaerobes
Viruses
7 days
Fungi
Inflammatory conditions
Signs & Symptoms:
Nasal Congestion
Rhinorrhea
Facial Pains
Headaches
Anosmia
Halitosis Malaise
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Sinusitis
Investigations:
CT scan
Sinoscopy
Management:
Anti congestants
Antibiotics
Drainage
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Sinusitis
Complications:
Purulent rhinorrhea, fever, frontal/retro-orbital headache
Personality change, lethargy, seizures, focal neurological deficits
Cavernous sinus thrombosis, meningitis, extradural abscess,intracranial abscess & subdural empyema
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Throat Foreign body
Quinsy
Ludwigs Angina
Epiglottitis
Upper Airway Obstruction
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1. Quinsy - Peritonsillar Abscess
Pus forms between tonsillar capsule &
superior constrictor muscle
Group A Streptococcus
Signs & Symptoms:
Severe, unilateral sore throat
fever
Hot potato voice
Uvula deviates to opposite side
Swollen tonsils
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Quinsy - Peritonsillar Abscess
Management:
FBC, ESR, CRP
Throat Swab
I.V. Antibiotics
Needle aspiration or I&D
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2. Epiglottitis
Age 3-7 yrs old
Organisms: H. influenza type B
Group A Streptococcus
Signs & Symptoms: Severe sore throat & fever, dysphagia,
drooling
Stridor
Breathing with raised chin & openmouth
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Epiglottitis
Investigations:
Raised inflammatory markers
Film lateral neck
Thumb shaped epiglottis
Management:
Avoid tongue depressor
I.V. Antibiotics
Secure Airway
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3. Ludwigs Angina
Rapid swelling cellulitis of
the sublingual &
submaxillary spaces
Causes:
Dental infection, floor of
mouth, salivary gland
Common organisms:
Streptococci, Bacteroides,
S.aerues
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Ludwigs Angina
Signs & Symptoms:
Fever, edema & erythema of neck
under chin & floor of mouth
Open mouth
Tongue upward & backward
Airway obstruction
Management:
Tracheostomy
IV antibiotic
I&D
Tooth extraction
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4. Foreign Body Ingestion
Coins, batteries, fish bone,meat & bone pieces, dentures
Signs & Symptoms:
Pain
Dysphagia
Saliva pooling / Drooling
Management:
Removal
Oesophagoscopy
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5. Inhaled Foreign Bodies
Sudden onset of coughing,wheezing or stridor
Unilateral wheezing, poor chestmovement & reduced breathsound
CXR:
Hyperinflation
Infection
Collapse
Management:
Heimlich maneuver
Secure airway
Endoscopic removal undergeneral anesthesia
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6. Upper Airway Obstruction
Emergency tracheostomy in the case ofUpper Airways
Obstruction
F.B. in the larynx
Tumor in the larynx
Trauma of the larynx
Bilateral vocal cord paralysis
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Upper Airway Obstruction
Signs & Symptoms
Wheeze ILA
Loss of Breath Sounds
CLA
Aphonia CUA
Stridor IUA
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Questions
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COMMON ENT EMERGENCIESUniversity College of Dublin / St.Vincents University Hospital
Wael Hasan
Special Lecturer in
Otorhinolaryngology / Head & Neck
Surgery