ENT Emergencies

Mark E Reader DO, FAOCO

 Epistaxis
 Anterior vs Posterior
– Anterior more common in children
– Posterior more common in older adults
 Posterior more difficult to control
 Check for ASA, anticoagulants, & herbs
 Nasal canula / percutaneous O2
 Trauma, tumor, foreign body, &
environment
 Anterior Epistaxis
 Usually anterior nasal
septum (Kiesselbacks
plexus)
 Inferior turbinate other
location
 Easilly identified with
nasal speculum
 Control with
cauterization +/-
anterior pack
 Posterior Epistaxis
 Unable to visualize
bleeding site
 Can lose large volume
quickly
 Treatment options:
– posterior/ anterior
pack
– Nasal endoscopy with
cauterization
– Artery ligation
Packing Tray
Posterior Epistaxis
Posterior Epistaxis
Septal Perforation
 Septal Hematoma
 Swelling of nasal
septum that doesn’t
respond to
decongestant spray
 Need drained < 48 hrs
 Complications:
– Infection
– Saddle nose
 Drain & pack,
antibiotics
Septal Hematoma
Septal Hematoma
Septal Hematoma
 Nasal Foreign Body
 Symptoms:
– Usually brought in by
mother
– Unilateral rhinitis /
epistaxis
 Diagnosis:
– Nasal speculum
– Rhinoscopy
– X-ray
 Treatment
 Foreign Body Aspiration
 Most prevalent under
age 4
 Smaller objects
aspirated/ larger
swallowed
 Laryngeal objects –
potential airway
emergency
 Foreign Body cont.
 Remove in controlled
fashion
– Laryngeal: ASAP
– Bronchial: same day of
diagnosis
– Esophageal: variable
 Peritonsillar Abscess
 Sudden increase in
pain
 Difficulty swallowing
 Displacement of uvula
 Unilateral swelling of
anterior tonsil pillar
 Peritonsillar Abscess
 IV hydration
– Antibiotic
– Steroid
 Local anesthetic
 I&D
Peritonsillar Abscess
 Epiglottitis

 True emergency
 High index of
suspicion
 Dx with X-ray & in
OR
 Auricular Hematoma
 Blunt trauma
(wrestler)
 Drain with temp drain/
packing with in 48hrs
 Antibiotics
 Complications:
– Infection
– Cauliflower ear
Auricular Hematoma
Auricular Hematoma
 Foreign Body Ear
 Emergency when
associated with
vertigo, profound
hearing loss and/ or
facial parallysis
 Do not irrigate organic
material or with a
perforation
 Otologic ear gtts /
ENT eval
Tympanic Membrane Perforation
 Etiology
– Infection, penetrating
trauma, temporal bone
fracture
 Check for conductive
hearing loss with tuning
fork
 Tx: Floroquinolone gtts,
no H2O
 More serious injury with:
profound SNHL,vertigo,
or otorhea
TM Perforation cont.
 Sudden Hearing Loss
 History  Exam
– Timing – Conversation
– Severity – Otoscopic
– Location – Tuning fork
– Inciting factors – CT
– Medications – Lab
– Associated symptoms » VDRL
» Sed rate
» Lyme
» Blood glucose
 Sudden Hearing Loss
 Treatment
– Cause dependent
– Early intervention may
make a difference
– May need to treat
associated symptoms
as well
 Facial Trauma
 Repair lacerations <
12 hrs
 Check distal neuro
status
 Irrigate aggressively
with minimal
debridement
 Meticulous closure
Hematoma
 Facial Fractures
 R/O cervicle fracture
and stabilize airway 1st
 Diagnose with exam/
X-Ray
 Reduce once swelling
down
 Rx: Antibiotic and
pain control
Nasal Fracture
Concluding Remarks