ENT: Not Just Epistaxis
A fantastic talk by senior ENT Registrar, Dr Anthony Rotman, about what we can do, what they can do and what we can do together.
OTITIS EXTERNA
Treat for 7 days if uncomplicated or 10 days of complicated or diabetic patient
avoid trauma and keep dry
insert wick
Perforated ear drum + OE: avoid sofradex (risk of ototoxicity), treat with ciprofloxacin
MALIGNANT OTITIS EXTERNA
May progress to osteomyelitis of temporal bone or skull base
Reg flags: Completely stenosed canal
Cellulitis of the pinna or peri-auriclar area
Ipsilateral severe head pain
Ipsilateral cranial nerve involvement
Weber test Rinne test
SUDDEN ONSET SENSORINEURAL HEARING LOSS
unilateral
may be irreversible of not recognised
Treatment: High dose steroids (may require intratympanic steroids) – do not delay for audiogram!
Early audiogram – notify ENT reg and will arrange for Wednesday (Sunshine) or Thursday (Footscray) or privately
EPISTAXIS
stepwise management: local pressure
vasoconstrictors: cotton wool or spray cophenylcaine
reverse coagulopathy
cautery: beware complication of septal perf or vestibular stenosis
packing: Rapid Rhino – ensure completely inserted
surgery – endoscopic/open/angiographic embolisation
removing clot may restart bleeding
minimal evidence for antibiotics but consider staph cover
“Nasopore” dissolveable pack in theatre fridge
POTT’S PUFFY TUMOUR
- Sinusitis PLUS facial swelling is NOT normal
POST TONSILLECTOMY BLEED
suction clot ONLY if impairing airway
cophenylcaine spray – may be complicated with throat anaesthesia and aspiration risk
– 1% adrenaline on gauze apply pressure with Magill forceps onto tonsillar fossa
Tranexamic acid gargle then swallow for local and systemic effect (crush 500mg tablet with saline)
ADMIT – esp kids as less blood volume and smaller airway
SUPRAGLOTTITIS
stridor + hoarse voice = problem in the larynx
usually unilateral (on scope)
may be associated with retropharyngeal collection, quinsy, sialadenitis
management: Sit patient up
Hydrocortisone 100-250mg IV
Nebulised adrenaline 5mg
consider high flow nasal prongs to keep airway open