1. Common ENT Emergencies
Arun Badi, MD, PhD, FAAP
Board Certified ENT and Sleep Medicine
Dallas ENT Group

2. Don’t forget these medical maxims:
ABCs – C also stands for Control the bleeder.
First do no harm.
Don’t forget that the ear, nose and throat are attached to the rest of the body
If they feel better, they heal better
There is a reason they call them “vital” signs
Chance favors the prepared mind
Know your backup, have an evaluation plan

3. Golden Rules
4 principle questions of ENT history you must always ask about.
I call these the Golden 4
 Shortness of Breath
Hoarseness (Or voice change)
Difficulty Swallowing (Dysphagia. Odynophagia = painful swallowing)
Stridor (Noisy Breathing)

4. Overview Otologic Disorders Nasal Disorders
Facial, Oral and Pharyngeal Infections
Airway Obstruction

5. Otologic Disorders Anatomy
Auricle
Ear canal
Tympanic membrane
Middle ear and mastoid disorders
Inner Ear

6. Traumatic Disorders of the Auricle
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

7. Auricle 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

9. Otitis Externa
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)

11. Foreign Bodies in Ear Canal
Usually put in by patient, some bugs fly in
kill bugs with mineral oil, or lidocaine
Emergency if it is organic matter, insect or corrosive chemical or battery.

14. Tympanic Membrane Perforation
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)

16. Middle Ear
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)

18. Inner Ear peripheral vertigo (vestibulopathy) BPV, labyrhinthitis
- acute onset, no central signs, usually young, horizontal nystagmus

19. The Nose

20. Epistaxis Anterior Etiologies
90% (Little’s Area) Kisselbach’s plexus - usually children, young adults
Etiologies
Trauma, epistaxis digitorum
Winter Syndrome, Allergies
Irritants - cocaine, sprays
Pregnancy

21. Epistaxis Posterior 10% of all epistaxis - usually in the elderly
Etiologies
Coagulopathy
Atherosclerosis
Neoplasm
Hypertension (debatable)

22. 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

23. Sinusitis

25. Orbital Infections Sinusitis
Treatment
acute - amoxil, septra
chronic - amoxil-clavulinic acid, clindamycin, quinolones
decongestants, analgesia, heat

26. 7th Nerve Palsy
Most cases are idiopathic
- link to HSV -

27. Facial Infections Sinusitis
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)

28. Facial Cellulitis Most common strept and staph, Rarely H.Flu
Can progress rapidly

29. Parotiditis Usually viral -paramyxovirus Bacterial
- elderly, immunosuppressed
- associated with dehydration
- cover - Staph, anaerobes

30. Pharyngitis Allergies Irritants -reflux, trauma, gases Viruses
- EBV, adenovirus
Bacterial
-GABHS, mycoplasma, gonorrhea, diptheria

33. Peritonsillar Abcess Complication of suppurative tonsillitis
Inferior - medial displacement of tonsil and uvula
dysphagia, ear pain, muffled voice, fever, trismus

34. Epiglottitis Clinical Picture
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

35. Epiglottitis 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

37. Masticator - Parapharyngeal Space Infection
Infection of the lower molars invade masticator space
Swelling, pain fever, TRISMUS
Treatment
IV antibiotics (PCN or Clindamycin)
ENT admission

38. Angioedema Ocassionally life threatening
Heriditary and related to ACE inhibitors
Antihistamines, steroids and doxepin

39. Airway Obstruction Aphonia - complete upper airway
Stridor - incomplete upper airway
Wheezing - incomplete lower airway
Loss of breath sounds- complete lower airway

40. Foreign Body Airway
Heimlich Heimlich
Heimlich

41. Questions and Answers