This document discusses various ear, nose, and throat problems that may present in the emergency department. It covers conditions like airway obstruction, stridor, epistaxis, foreign bodies in the nose, vertigo, sudden sensorineural hearing loss, perichondritis, mastoiditis, otitis externa, otitis media, and traumatic ear perforations. For each problem, it provides details on symptoms, examinations, differential diagnoses, and management principles. The document aims to educate physicians on evaluating and treating common ENT emergencies.

1. Ear, Nose & Throat Problems In
the Emergency Department
MTD LAKSHAN
MBBS (Col) MS (Oto) DOHNS (Eng) FEB ORL HNS (Europe) FRCS ORL HNS (UK)
Member of American Board of Otolaryngology and Head and Neck Surgery
Consultant ENT and Head and Neck Surgeon

2. Housekeeping
• Lots of pictures : Best not to write
down
• Fully interactive:
• Slides :
www.learnent.net/teachings
• A Link will be sent for you to
answer questions

3. Emergency / Casualty

4. 1

5. Airway Obstruction

6. Stridor / Stertor

7. Airway Adequacy

8. 1. Stridor
2. Respiratory Rate
3. Recessions and accessory
muscles
4. Pulse rate
5. Cyanosis
5

9. What is the least important sign in
acute airway obstruction?
1. Stridor
2. Intercostal recession
3. Cyanosis
4. Increased RR
5. Increased PR

10. 1. Help - Anaesthetists, ENT, Safe
Environment
2. Support Airway
3. O2
4. Nebulisations
5. Steroids
6. Heliox
7. Airway Interventions: Oral
airway, NP airway,
Cricothyroidotomy, ETT,
Tracheostomy
Mx

11. Rhinology

12. 1. Epistaxis
2. FB
3. Nasal Bone fracture
4. Septal Haematoma
5. Orbital Cellulitis
5

13. Epistaxis

14. Principles

15. 3
1. Resuscitation
2. Arrest Bleeding
3. Cause

17. What is the
eponymous
name of this
area?

19. Epistaxis Ladder

20. Epistaxis Ladder
• Pressure (Ice)
• Cautery with Silver Nitrate
• Anterior Packing - Merocel, Rapid-rhino,
BIPP
• Posterior Packing
• Proprietary PNS balloons
• Foley’s Catheter
• OT
• Arterial Ligation
• Sphenopalatine, ant. ethmoidal, maxillary,
Ext. Carotid

24. 13 year old boy presented with severe epistaxis.
This is the CT scan axial cut.
What is the most possible diagnosis?

30. Ear

31. 1. Vertigo
2. SSNHL
3. Perichondritis
4. Mastoiditis
5. FB in the ear
6. Otitis Externa
7. Otitis Media
8. Traumatic Perforations
9. Perichondrial Haematoma
9

32. Vertigo

33. Vertigo / Dizziness
Pattern
Single Episode
Multiple Episodes
Chronic Dizziness

34. Acute Vertigo
Syndrome
1. Vertigo
2. Nystagmus
3. Nausea and Vomiting
4. Unsteady gait
5. Motion intolerance

35. Head Impulse Test

36. Cover Test for Skew Deviation

37. HINTS INFARCT

38. INFARCT
Head Impulse –
Impulse Negative
Nystagmus –
Fast phase Alternating
Tests for Skew Deviation –
Re-fixate on Cover Testing

41. Sudden SNHL

42. Pictures

60. Throat

75. Summary
One Real Emergency
Rhinology conditions
Ear Conditions
Throat related conditions : throat, larynx

76. Thank You
Dr. MTD Lakshan
MBBS (Col) MS (Oto) DOHNS (Eng) FEB ORL HNS FRCS ORL HNS
Consultant ENT and Head and Neck Surgeon
@ mtdlakshan
email lakshent@gmail.com