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ENT Emergencies

ENT Emergencies. Paul Chatrath Consultant ENT Surgeon Barking Havering & Redbridge Hospitals NHS Trust 21 st January 2009. THE EAR. Otitis Externa - Features. Discharge, pain, hearing loss, itching Commonest organisms: S Aureus Ps Aeruginosa Proteus Predisposing factors: Water

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ENT Emergencies

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  1. ENT Emergencies Paul Chatrath Consultant ENT Surgeon Barking Havering & Redbridge Hospitals NHS Trust 21st January 2009

  2. THE EAR

  3. 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

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

  5. 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 > 6/52 • Hyperbaric oxygen

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

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

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

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

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

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

  12. Cauliflower Ear

  13. 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

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

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

  16. 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

  17. 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?

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

  19. 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

  20. 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

  21. THE NOSE

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

  23. Septal Haematoma

  24. Normal Inferior Turbinate IT Septum

  25. Epistaxis

  26. Little’s Area

  27. 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

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

  29. Nasal Packing BIPP MerocelTM Rapid RhinoTM

  30. How NOT to pack a nose!!!

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

  32. 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

  33. Subperiosteal abscess – Chandler’s grade 3

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

  35. THE THROAT

  36. Normal tonsils

  37. Acute tonsillitis

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

  39. Quinsy

  40. Foreign body - throat

  41. Fish Bone in Tonsil

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