Вы находитесь на странице: 1из 51

ENT Emergencies

Azwar
ENT Surgeon
Medical Faculty of Syiah Kuala
University/Zainoel Abidin Hospital

Overview
Otologic Disorders
Nasal Disorders
Facial, Oral and Pharyngeal

Infections
Airway Obstruction

THE EAR

Otologic Anatomy
Auricle
Ear canal
Tympanic

membrane
Middle ear &
mastoid

Inner Ear

Otitis Externa
Discharge, pain, hearing loss,

itching
Commonest organisms:
S Aureus
Ps Aeruginosa
Proteus

Predisposing factors:
Water
Cotton buds
Eczema

Treatment:

Topical antibiotics
Aural toilet
Analgesia

Otitis Externa - Variants

Fungal

Malignant OE
- Diabetes
- VII palsy

Malignant Otitis Externa


Risk factor Diabetes
Granulomatous polypoid otitis externa
Disproportionately severe pain
Associated features:
Cranial nerve involvement VII, IX, X, XI, XII

Treatment:
Topical antibiotics and aural toilet
i.v. antibiotics
Hyperbaric oxygen

Otitis Externa when to


refer
Refer if: Non responsive
Canal oedematous
Needs aural toilet
Suspicion of malignant OE

Acute Otitis Media


Symptoms:
Pain
Hearing loss

Rx :

Discharge
Pain subsides

Systemic antibiotics

Analgesia
Decongestants

Acute Otitis Media


When to refer?:

Failure of resolution

Persistent discharge
Complications
VII palsy
Mastoiditis

Acute Mastoiditis
Features
Recent URTI
Ear discharge
Blunting of postaural sulcus
Fluctuant tender swelling
Fever

Rx : Systemic antibiotics
Analgesia
URGENT REFERRAL

Perichondrial Haematoma
Rx :

Systemic antibiotics

Analgesia
URGENT REFERRAL for
incision & drainage

Aspiration of Auricular Hematoma

Perichondrial Cellulitis
Rx :

Systemic antibiotics

Analgesia REFERRAL to
ENT if no response after
24hr

Cauliflower Ear

Bead in ear
Rx :

one attempt at
removal only.
Try syringing with warm
water
Do not use forceps for
round objects
Non urgent ENT referral

Insect in Ear
Rx :

Kill insect with


olive oil
Then try syringing with
warm water
Urgent ENT referral

Tympanic Membrane Perforation


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

Bloody Otorrhoea
Causes
Otitis externa/media
Trauma (local)
Trauma (head injury)
Postoperative

THE NOSE

Nasal Fracture
Rx :

Exclude other max-fax


fractures
Exclude CSF rhinorrhoea
Analgesia

Refer if: Obvious deformity


(5-7 days)
Septal Haematoma
(URGENT)

Septal Haematoma

Normal Inferior Turbinate

IT

Septum

Epistaxis

Littles Area

Epistaxis
Children: Recurrent self limiting bleeds
Risk factors URTIs, digital trauma

Adults:
Traumatic
Anterior bleed
Littles area
Recurrent, self-limiting
Posterior bleed
Elderly
Medical comorbidities (hypertension, aspirin, warfarin)
More severe
Admission

Epistaxis Management
Pain meds, lower BP, calm patient
Prepare ! (gown, mask, suction, speculum,

meds and packing ready)


Evacuate clots
Topical vasoconstrictor and anesthetic
Identify source

Epistaxis management

Anterior Sites
- Pressure +/- cautery
and/or tamponade
- all packs require
antibiotic
prophylaxis

Tampon
Bellocq tampon

Foreign Body in Nose


Rx :

one attempt at removal

only.
Do not use forceps for round
objects
Urgent ENT referral

THE THROAT

Normal tonsils

Acute tonsillitis

Tonsillitis
Rx :

Penicillin V/ Metronidazole

Analgesia

Refer if: Complete dysphagia


Quinsy

Peritonsiller abcess

Aspiration
Incision

Foreign body - throat

Fish Bone in Tonsil

Fish Bones & Xray


Very Opaque:
Cod, Haddock, Cole fish,
Lemon sole, Gurnard
Moderate Opaque:
Grey Mullet, Plaice, Monkfish,
Red Snapper
Not Opaque:
Herring (Kipper), Salmon,
Mackerel, Trout, Pike

Epiglottitis

Epiglottitis
Children life threatening
Adults supraglottitis
Symptoms

Fever
Recent URTI
Sitting forwards, drooling
Sore throat
Plummy voice
Dysphagia

Causative organism:
Children: H Influenzae type B
Adults: Broad range of

respiratory pathogens

Stridor
Rx :

Oxygen

Adrenaline Nebulisers
Steroids
Antibiotics

URGENT ENT Ref.


URGENT Anaesthetic Ref.
URGENT Paed. Ref.

Emergency Tracheotomy

Cricothyroidotomy