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ENT Emergencies

ENT Emergencies. Sonbolestan m.d otorhynolaryngologist. THE EAR. Perichondrial Haematoma. Rx : Systemic antibiotics Analgesia URGENT REFERRAL for incision & drainage. Cauliflower Ear. Perichondrial Cellulitis. Rx : Systemic antibiotics Analgesia

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ENT Emergencies

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  1. ENT Emergencies Sonbolestan m.d otorhynolaryngologist

  2. THE EAR

  3. Perichondrial Haematoma Rx : Systemic antibiotics Analgesia URGENT REFERRAL for incision & drainage

  4. Cauliflower Ear

  5. Perichondrial Cellulitis Rx : Systemic antibiotics Analgesia REFERRALto ENT if no response after 24hr

  6. Otitis Externa - Features • Discharge, pain, hearing loss, itching • Commonest organisms: • S Aureus • Ps Aeruginosa • Proteus • Predisposing factors: • Water • Cotton buds • Eczema • Treatment: • Topical antibiotics • Aural toilet • Analgesia

  7. Otitis Externa - Variants Fungal Malignant OE • Diabetes • VII palsy

  8. 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

  9. Otitis Externa – when to refer Refer if: Non responsive Canal oedematous Needs aural toilet Suspicion of malignant OE

  10. KaposiSarcoma

  11. Kaposi sarcoma

  12. Acute Otitis Media Symptoms: Pain Discharge Hearing loss Pain subsides Rx : Systemic antibiotics Analgesia Decongestants

  13. Acute Otitis Media • When to refer?: • Failure of resolution • Persistent discharge • Complications • VII palsy • Mastoiditis

  14. Acute Mastoiditis Features Recent URTI Ear discharge Blunting of postaural sulcus Fluctuant tender swelling Fever Rx : Systemic antibiotics Analgesia URGENT REFERRAL

  15. 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

  16. Insect in Ear Rx : Kill insect with olive oil Then try syringing with warm water Urgent ENT referral

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

  18. Skull Base Fracture Rx : Do not examine ears with an auriscope. Admit under the head injury team Non urgent ENT referral UnlessVII Palsy – ENT EMERGENCY

  19. Case: Facial Palsy • 65yr old female • 3/52 history right facial weakness • What are the key points that must be established in your clinical approach?

  20. Case: Facial Palsy Key points • Establish whether UMN or LMN • Try and find a cause Forehead sparing = UMN Thorough examination

  21. Facial nerve palsy - causes UMN (forehead sparing): CVA, MS, Ca LMN (complete): Intracranial Acoustic neuroma G-Barre TB Neurosarcoid Glomus tumour Lyme disease Intratemporal Trauma Acute otitis media Malignant otitis externa Ramsey-Hunt syndrome SCC Cholesteatoma Extracranial Trauma Malignant parotid tumour Idiopathic = Bell’s Palsy

  22. Facial Nerve Palsy (Bell’s) Rx : Prednisolone 30mg Acyclovir 200mg 5x/day Hypermellose eye drops Lacrilube ointment Red bulging ear drum = URGENT ENT review If not, Non urgent ENT review If poor eye closure = Ophthalmology review

  23. THE NOSE

  24. Nasal Fracture Rx : Exclude other max-fax fractures Exclude CSF rhinorrhoea Analgesia Refer if: Obvious deformity (5-7 days) Septal Haematoma (URGENT)

  25. Septal Haematoma

  26. Normal Inferior Turbinate IT Septum

  27. Epistaxis

  28. Little’s Area

  29. Epistaxis • Children: Recurrent self limiting bleeds • Risk factors – URTIs, digital trauma • Adults: • Traumatic • Anterior bleed • Little’s area • Recurrent, self-limiting • Posterior bleed • Elderly • Medical comorbidities (hypertension, aspirin, warfarin) • More severe • Admission

  30. Epistaxis Rx : RESUSCITATE FBC, G&S, Clotting Local pressure (Cautery) Nasal Packing

  31. Nasal Packing BIPP MerocelTM Rapid RhinoTM

  32. How NOT to pack a nose!!!

  33. Foreign Body in Nose Rx : one attempt at removal only. Do not use forceps for round objects Urgent ENT referral

  34. Orbital cellulitis – Chandler’s classification Grade 1 Periorbital cellulitis (preseptal) Grade 2 Orbital cellulitis (postseptal) Grade 3 Subperiosteal abscess Grade 4 Intraorbital abscess Grade 5 Cavernous sinus thrombosis

  35. Subperiosteal abscess – Chandler’s grade 3

  36. Orbital Cellulitis Rx : Systemic antibiotics Decongestants Analgesia URGENT ENT referral URGENT EYE referral URGENT CT sinuses

  37. THE THROAT

  38. Normal tonsils

  39. Acute tonsillitis

  40. Tonsillitis Rx : Penicillin V/ Metronidazole Analgesia FBC, Paul Bunnel, LFT Refer if: Complete dysphagia Quinsy

  41. Quinsy

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