brief presentation about what could you face as a G.P in ER

1. ENT EmergenciesMohammed Suleiman Aljajeh
Phase V
20133422
NEAR EAST UNIVERSITY
HOSPITAL

2. Overview
• Otology Disorders
• Nasal Disorders
• Facial, Oral and Pharyngeal Infections

3. Traumatic Disorders of the Auricle
• Hematoma
- Direct trauma to the anterior
auricle
- cartilaginous necrosis
Tx.
- drain, antibiotics, bulky ear
dressing close follow up
- Use posterior auricular
block for anesthesia

4. Aspiration of Auricular Hematoma

5. Otitis Externa
• Infection and inflammation
caused by bacteria
(pseudomonas, staph), and fungi
Tx.
• removal of debris from the
external auditory canal
• administration of topical
medications to control edema
and infection
- ex. with antibiotic-steroid drops

6. Foreign Bodies in Ear Canal
• Usually put in by patient,
some bugs fly in
TX.
• kill bugs with mineral oil, or
lidocaine
• remove with forceps, suction
or tissue adhesive

7. Tympanic Membrane Perforation
• Hard to see – Hx of drainage
• Usually from middle ear pressure
secondary to fluid
• Sometimes from external trauma
TX.
• most heal uneventfully but all need
otology follow-up
• treat with antibiotics
• drops controversial but indicated for
purulent discharge
• (avoid gentamycin drops because
ototoxicity)

8. Middle Ear
• Serous Otitis Media - Eustachian tube
dysfunction
• Otitis Media - infection of middle ear
effusion - viral and bacteria
Tx.
treat with decongestants &
amoxicillin as the first-line
antimicrobial agent of choice

9. Inner Ear
• peripheral vertigo (vestibulopathy)
BPV, labyrhinthitis
• - acute onset, no central signs, usually young, horizontal
nystagmus
• Meniere’s - vertigo, sensorineural hearing loss, tinnitus
• Treatment
- Meclizine , fluids, rest, Epley Maneuver

10. Acute Mastoiditis
Rx : Systemic antibiotics
Analgesia
URGENT REFERRAL
Features
Recent URTI
Ear discharge
Fluctuant tender swelling
Fever

11. Nasal Fracture
Tx:
* apply ice to the nose and
elevate the head to aid in
reduction of any swelling
present.
* Nasal decongestants to reduce
swelling and mucosal
congestion.
Refer if:
Obvious deformity
(5-7 days) Septal Haematoma
(URGENT)

12. Epistaxis
Anterior
Etiologies
• Trauma
• Winter Syndrome, Allergies
• Irritants - cocaine, sprays
• Pregnancy (Mucosal
hyperemia due to hormonal
changes)

13. 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

14. Epistaxis
Management
• Anterior Sites
- Pressure +/- cautery and/or
tamponade
- all packs require antibiotic
prophylaxis

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

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

17. 7th Nerve Palsy
Rx : Prednisolone 30mg
Acyclovir 200mg 5x/day
Hypermellose eye drop
Red bulging ear drum =
URGENT ENT review
If not, Non urgent ENT review
If poor eye closure =
Ophthalmology review

18. Facial Infections
Sinusitis
• Signs and symptoms
- facial pain in sinus
distribution
- purulent yellow-green
rhinorrhea
- fever
- CT more sensitive
* Causative Organisms
- gram positives and H. flu
(acute)
- anaerobes, gram neg (chronic)

19. Facial Infections
Sinusitis
• Treatment
acute – amoxil
chronic - amoxil-clavulinic
acid, clindamycin, quinolones
decongestants, analgesia, heat
• Complications
ethmoid sinusitis - orbital
cellulits and abcess

20. Facial Cellulitis
• Most common strept and
staph,
• Rarely H.Flu
• Can progress rapidly
Tx.
• Antibiotic regimens are
effective in more than
90% of patients

21. Peritonsillar Abcess
• Complication of suppurative tonsillitis
• Inferior - medial displacement of tonsil and uvula
• dysphagia, ear pain, muffled voice, fever, trismus
• Treatment
- Antibiotics , +/-steroids

22. Angioedema
• Occasionally life
threatening
• Hereditary mostly
Tx.
• Antihistamines & steroids

23. Any Questions ?
Thanks For Listening ….