The document provides an overview of various ear, nose, and throat emergencies that may present to an ENT department. It outlines the typical symptoms, causes, and treatment approaches for conditions such as hematoma of the auricle, otitis externa, tympanic membrane perforations, epistaxis, sinusitis, peritonsillar abscess, angioedema, and more. For many of these issues, the recommended treatment involves antibiotics, analgesics, decongestants, and referral to specialists like ENT, ophthalmology or urgent CT imaging as warranted by the clinical situation.

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 ….