By :

dr. Fifin Pradina Duhitatrissari Sp.THT-KL

FK UNISMA/RSI UNISMA
Otologic Disorders
Nasal Disorders
Facial, Oral and Pharyngeal Infections
Airway Obstruction
 Auricle
 Ear canal
 Tympanic membrane
 Middle ear and mastoid disorders
 Inner Ear
 Hematoma
- cartilaginous necrosis
- drain, antibiotics, bulky ear
dressing close follow up
 Lacerations - single layer
closure, pick up
perichondrium, bulky ear
dressing
Use posterior auricular block
for anesthesia
 Chondritis - Cellulitis ?
- infectious, difficult to treat
because poor blood supply, cover
S. Aureus and pseudomonas
- extra care in diabetics
- inflammatory causes related to
seronegative arthritis at times
indistinguishable from infection
usually the ear lobe is spared
 Infection and inflammation
caused by bacteria
(pseudomonas, staph), and fungi
- treat with antibiotic-steroid drops
- use wick for tight canals
- diabetics can get malignant otitis
externa (defined by the presence
of granulation tissue)
 Usually put in by patient,
some bugs fly in
 kill bugs with mineral oil, or
lidocaine
 remove with forceps, suction
or tissue adhesive
 Hard to see – Hx of drainage
 Usually from middle ear pressure secondary to
fluid or barotrauma
 Sometimes from external trauma
 most heal uneventfully but all need otology
follow-up
 perfs with vertigo and facial nerve
involvement need immediate referral
 treat with antibiotics
 drops controversial but indicated for purulent
discharge (avoid gentamycin drops)
 Serous Otitis Media - Eustachian tube
dysfunction - treat with decongestants,
decompressive maneuvers
 Otitis Media - infection of middle ear
effusion - viral and bacteria
 Mastoiditis - Venous connection with
brain, need aggressive treatment (can
lead to brain abcess or meningitis)
 peripheral vertigo (vestibulopathy)

BPV, labyrhinthitis
 - acute onset, no central signs, usually young, horizontal nystagmus
 Meniere’s - vertigo, sensorineural hearing loss, tinnitus
 Treatment

- valium, fluids, rest, manipulation for BPV

 Vascular Supply
- Anterior - branches of
internal carotid
- Posterior - distal
branches of external
carotid
 90% (Little’s Area) Kisselbach’s plexus - usually children, young adults

Etiologies
 Trauma, epistaxis digitorum
 Winter Syndrome, Allergies
 Irritants - cocaine, sprays
 Pregnancy
 10% of all epistaxis - usually in the elderly
 Etiologies
 Coagulopathy
 Atherosclerosis
 Neoplasm
 Hypertension (debatable)
 Pain meds, lower BP, calm patient
 Prepare ! (gown, mask, suction, speculum, meds and packing ready)
 Evacuate clots
 Topical vasoconstrictor and anesthetic
 Identify source
Anterior Sites
- Pressure +/- cautery and/or
tamponade
- all packs require antibiotic
prophylaxis
 Need analgesia and
sedation
 require admission and 02
saturation monitoring
 severe bleeding
 hypoxia, hypercarbia
 sinusitis, otitis media
 necrosis of the columella or nasal ala
 Most cases are idiopathic
- link to HSV
- no proof steroids or antivirals are
effective, but many advocate
 Consider Lyme’s Disease in endemic
areas
 Surgical decompression indicated in
the rare patient not improving by 2
weeks and ENOG out > 90%
 Signs and symptoms

- H/A, facial pain in sinus

distribution
- purulent yellow-green
rhinorrhea
- fever
- CT more sensitive than plain
films
 Causative Organisms

- gram positives and H. flu (acute)

- anaerobes, gram neg (chronic)
 Treatment

acute - amoxil, septra

chronic - amoxil-clavulinic acid,
clindamycin, quinolones
decongestants, analgesia, heat
 Complications

ethmoid sinusitis - orbital cellulits and

abcess
frontal sinusitis - may erode bone (Potts
Puffy Tumor, Brain Abcess)
 Most common strept and
staph,
 Rarely H.Flu
 Can progress rapidly
 Usually viral
-paramyxovirus
 Bacterial
- elderly, immunosuppressed
- associated with dehydration
- cover - Staph, anaerobes
 Irritants

-reflux, trauma, gases

 Viruses

- EBV, adenovirus
 Bacterial

-GABHS, mycoplasma, gonorrhea, diptheria

 Complication of suppurative tonsillitis
 Inferior - medial displacement of tonsil and uvula
 dysphagia, ear pain, muffled voice, fever, trismus
 Treatment

- Antibiotics, I&D, +/-steroids

 Older children and adults
 decrease incidence in children
secondary to HIB vaccine
 Onset rapid, patients look toxic
 prefer to sit, muffled voice,
dysphagia, drooling, restlessness
 Avoid agitation
 Direct visualization if patient allows
 soft tissue of neck

- thumb print, valecula sign

 Prepare for emergent airway, best achieved in a controlled setting
 Unasyn, +/- steroids
Epiglottitis
 Anterior to prevertebral space and
posterior to pharynx
 Usually in children under 4
(lymphoid tissue in space)
 pain, dysphagia, dyspnea, fever
 swelling of retropharyngeal space on
lateral x-ray
 Complications - mediastinitis
 Infection of the lower molars
invade masticator space
 Swelling, pain fever,
TRISMUS
 Treatment
IV antibiotics (PCN or
Clindamycin)
ENT admission
 Bacterial infection causing an acute
necrotizing, destructive disease of
periodontium
 Treatment
- oral rinses
- antibiotics (PCN, clindamycin,
tetracycline)
 Rapidly progressive cellulitis of the
floor of the mouth
 usually in elderly debilitated patients
and precipitated by dental procedures
 massive swelling with impending
airway obstruction
 Treatment
ICU, antibiotics, airway management
 Ocassionally life
threatening
 Heriditary and related to
ACE inhibitors
 Antihistamines, steroids
and doxepin
 Aphonia - complete upper airway
 Stridor - incomplete upper airway
 Wheezing - incomplete lower airway
 Loss of breath sounds- complete lower airway