Vous êtes sur la page 1sur 27

ENT EMERGENCIES

DR MOHAMMAD ALMAYOUF ASSOCIAT CONSULTANT ENT

EPISTAXIS
5-10% of the population experience an episode of epistaxis each year.

Blood supply: -Sphenopalatine artery -Greater palatine artery -Superior Labial artery -Anterior Ethmoid artery -Posterior Ethmoid artery

EPISTAXIS

EPISTAXIS

EPISTAXIS
Site of bleeding: Anterior
Kesselbachs Plexus

Posterior
Woodruffs Plexus

EPISTAXIS
Precipitating factors; Local: exposure to dry and
cold air current, trauma, neoplasm, Foreign Bodies.

Systemic:

Medication, HTN,

Vascular diseases, Coagulopathy.

EPISTAXIS
Initial Management
ABC, AMPLE HISTORY, Physical exam Anterior rhinoscopy Endoscopic rhinoscopy Obtain lab study.

EPISTAXIS
MANAGEMENT:
Control the cause. Transfuse if needed. Local medication Pressure application Nasal pack; anterior or posterior

EPISTAXIS
Embolization Surgery
Endoscopic, open.

Sudden Sensorineural Hearing Loss


Definition:
30 dB or greater SNHL over at least three contiguous audiometric frequencies occurring within 3 days or less.

Sudden Sensorineural Hearing Loss


Highest incidence in 50-60 years olds Lowest incidence in 20-30 years olds M=W 2% bilateral 90% of cases are idiopathic

Sudden Sensorineural Hearing Loss


History
Time course Associated symptoms Vertigo/dizziness Aural fullness Tinnitus Ototoxic drug use Symptoms of URTIs H/O head trauma, straining, sneezing, nose blowing, intense noise exposure H/O flying or SCUBA diving

Sudden Sensorineural Hearing Loss


PMH:
Autoimmune disorders Vascular disease Malignancies Neurologic conditions Hypercoagulable states Sickle cell disease

PSH:
stapedectomy or other otologic surgeries

Sudden Sensorineural Hearing Loss


Physical,
head and neck exam, tunning fork, cranial nerves.

Audiogram MRI

Laboratory testing
CBC,ESR, VDRL

Sudden Sensorineural Hearing Loss


TREATMENT
90% of cases will be Idiopathic.
Treat with steroid within the 1st 3 days.

Treat known causes by addressing the underlying condition.

Temporal Bone fracture


The temporal bone is the most complex bone in the human body. It houses many vital structures, including the cochlear and vestibular end organs, the facial nerve, the carotid artery, and the jugular vein. Motor vehicle accidents are the cause of 31% of temporal bone fractures.

Temporal Bone fracture


Classification Longitudinal fractures:
80% of Temporal Bone Fractures Lateral Forces along the petrosquamous suture line. 15-20% Facial Nerve involvement EAC laceration

Temporal Bone fracture


Transverse fractures
20% of Temporal Bone Fractures Forces in the Antero-Posterior direction 50% Facial Nerve Involvement EAC intact

Temporal Bone fracture


Management;
ABC, AMPLE HISTORY. PRIMARY SURVEY HEAD AND NECK EXAM CRANIAL NERVES

Temporal Bone fracture


Imaging study: CT CT CISTERNOGRAPHY MRI

Temporal Bone fracture


Medical treatment:
Stabilize the pt condition Delayed facial n paralysis CSF leak.

Surgical treatment
Ossiculoplasty, cochlear implant, facial n decompression, control of CSF leak,

AIRWAY EMERGENCIES
Bilateral choanal atresia

Epiglottitis

AIRWAY EMERGENCIES
Angioedema

Ludwig angina

AIRWAY EMERGENCIES
Laryngeal trauma
Blunt trauma Penetrating trauma

Thank you