Lecture 1: ENT

Treatment of auricular hematoma

Incision & Drainage with compressive bolsters

Antibiotics: Staph coverage

Mastoiditis

Can be otitis media complication

Displaced pinna

Subperiosteal abscess

Petrous apicitis: Abducen’s palsy (CN 6) and Retro-orbital/mastoid pain

Facial paralysis (CN 7)

Labyrinthitis (CN8): Vertigo/Hearing loss/Nystagmus

Sudden Sensorineural Hearing Loss

Rapidly progressing (less than 3 days)

No trauma

Etiology: Viral or Vascular

Ear examination is normal

Hearing loss, aural fullness, tinnitus, vertigo

Asymmetric audiogram/tuning forks

2/3 recover hearing

Initial severity and responsiveness to corticosteroids help predict outcome

Malocclusion and open bite

Midface Fracture

Septal Hematoma

Nasal fracture

Chin hypesthesia & floor of mouth hematoma

Mandible Fracture

Raccoon eyes

Temporal Bone Fracture

Malar depression

Zygoma Fracture

Inability to perform an upward gaze

Orbital Floor Fracture

Bell’s Palsy

Acute facial paralysis

Herpes Simplex Virus (HSV)

Neural edema within the sheath of the temporal bone

Acute/rapid onset

No hearing loss or vertigo

Facial or ear pain is possible but less common

Corticosteroids and antivirals (acyclovir)

Eye Care is most important:

Patient education

Lubrication/tear replacement/eye closure

Ophthalmology consultation

Prognosis:

85% recover in 3 weeks

15% recover in 3-6 months

Synkinesis and residual weakness in 10-15%

Ramsay Hunt Syndrome

Aka Herpes Zoster Oticus

Shingles of the geniculate ganglion

Differentiation from Bell’s Palsy:

Severe pain accompanies facial paralysis

Vesicular eruption: Face, Ear or external auditory canal/TM, Palate

Hearing loss and vertigo in 10-40%

Worse prognosis vs Bell’s

60% normal recovery

Worse if complete paralysis

Otitis Externa Treatment

Ototopical agents

Epistaxis 

Anterior Epistasis:

Keisselbach’s Plexus aka Little’s Area

Spray with decongestant (ie oxymetazoline)

Pressure (10 minutes or more)

Silver nitrate

Anterior packing

Posterior:

Posterior packing

Endoscopy, arterial ligation, embolization

Sphenopalatine artery or ethmoid arteries

Invasive Fungal Rhinosinusitis 

Immunocompromised patient:

Uncontrolled diabetic

Oncologic patient (neutropenia)

Few symptoms - discharge, pain

Intranasal exam - blackened mucosa

CT/ MRI to evaluate invasion

Amphotericin B and debridement

Prognosis - very poor:

Correct underlying immunodeficiency:

Control blood sugar

Granulocyte stimulating factor

Microbes in deep neck space infection

Most common is Strep and Staph

Gram negative

Ludwig’s Angina

Submandibular/sublingual infection

Secure airway early

Rapid progression common

Respiratory distress

Angioedema

Acute painless mucosal edema: Face, lips, tongue, larynx

Airway obstruction

Etiology: ACE Inhibitor - most common

Foreign Body Aspiration

History very important

Young child - <3 years old

Paroxysm of coughing

Nuts, plastic toy, popcorn

Examination - negative (40%-50%)

Radiology- 80% radiolucent

Chest x-ray normal (10%-34%)

Inspiratory/ expiatory x-ray

Fluoroscopy

Rigid bronchoscopy

Diagnostic and therapeutic

Children:

Symptoms often subtle

Drooling, sore throat

Coin (#1), Food

Adult:

Diagnosis straightforward

Associated esophageal pathology

Fishbone, meat, denture

Foreign Body Aspiration Radiology

Air-trapping on the affected side seen as hyperinflation on expiratory view (or unilateral atelectasis if complete obstruction)

Croup vs Epiglottis

Croup: Subglottic narrowing

Epiglottis: Epiglottic swelling