ENT emergencies

Question 1

What is important to ascertain from the history in nasal trauma?

Answer 1

Mechanism of injury - fight, sports, falls
When
LOC
Epistaxis
Breathing

Question 2

What should be examined in nasal trauma?

Answer 2

Bruising
Swelling
Tenderness
Deviation 
Epistaxis
Infraorbital sensation 
Cranial nerves

Question 3

What needs to be excluded in nasal trauma and why?

Answer 3

Septal haematoma - this indicates that the blood supply to the nasal cartilage is compromised, needs to be excised as can lead to necrosis and a septal abscess

Question 4

How is a nasal fracture diagnosed?

Answer 4

Clinical - based on deviation

Review in ENT clinic 5-7 days post-injury

Question 5

What are complications of a nasal fracture?

Answer 5

Epistaxis - esp the anterior ethmoidal artery
CSF leak; can lead to meningitis
Anosmia - cribriform plate fracture

Question 6

Why can noses bleed so much?

Answer 6

Highly vascular organ secondary to incredible heating/humidification requirements
Vascular runs just under mucosa
Arterial to venous anastomoses
ICA and ECA blood flow

Question 7

What arteries make up kisselbach’s area?

Answer 7

Sphenoplatine artery (maxillary artery)
Ant. and post. ethmoidal arteries (ophthalmic artery)
Superior labial artery (facial artery)
Greater palatine artery (maxillary artery)

Question 8

What is the management of epistaxis?

Answer 8

Local treatment 
External pressure to nose
Ice
Cautery
Nasal packing

Question 9

What management can be performed in hospital for epistaxis?

Answer 9

Arrest flow: pressure, ice, topical vasoconstrictor +/- LA 
Remove clot, sucion, nose blowing
Cautery, pack
30 degrees rigid nasendoscopy
Cauterise vessels 
FBC, G&S
Arterial ligation

Question 10

How long does it take a CSF to settle usually?

Answer 10

10 days

Question 11

A fracture to where can lead to a CSF leak?

Answer 11

Cribriform plate

Question 12

What are ear emergencies?

Answer 12

Pinna haematoma
Ear laceration
Temporal bone fracture
Sudden sensorineural hearing loss

Question 13

What can a pinna haematoma lead to?

Answer 13

Subperichondrial haematoma leading to “cauliflower ear” due to calcium deposition

Question 14

How is a pinna haematoma treated?``

Answer 14

Aspirate haematoma
Incision and drainage
Pressure dressing

Question 15

What commonly causes lacerations to the ear?

Answer 15

Blunt trauma
Avulsion
dog bites
Tissue loss

Question 16

How are lacerations to the ear managed?

Answer 16

Debridement
Primary closure or reconstruction
Usually local anaesthetic
Need washout with antibiotics if cartilage is seen

Question 17

Where is a common site on the temporal bone for a fracture?

Answer 17

Prerion suture

Question 18

What is the common history of a temporal bone fracture?

Answer 18

Injury mechanism
Hearing loss
Facial palsy
Vertigo
CSF leak

Question 19

What can be seen on examination of a temporal bone/ basilar skull fracture?

Answer 19

Battles sign
Condition of TM and ear canal
VII - facial movements
Hearing test

Question 20

How can temporal bone fractures be classified?

Answer 20

Longitudinal vs transverse
Otic capsule involvement
Otic capsule sparing

Question 21

Describe a longitudinal temporal bone fracture?

Answer 21

Lateral blow
Fracture line parallels the long axis of the petrous pyramid
Bleeding from external canal due to laceration of the skin and ear drum
Hemotympanum (conductive deafness)
Ossicular chain disruption
Facial palsy

Question 22

Describe a transverse fracture?

Answer 22

Frontal blows
Fracture at right angles to the long axis of the petrous pyramid
Can cross the internal acoustic meatus causing damage to the auditory and facial nerves
Sensorineural hearing loss due to damage of the 8th CN
Facial nerve palsy and vertigo

Question 23

What needs to be suspected in a conductive hearing loss?

Answer 23

Fluid
TM perforation
Ossicular probelm

Question 24

How is a temporal bone fracture managed?

Answer 24

Facial nerve decompression
Manage CSF leak
Hearing restoration

Question 25

How is a sudden sensorineural hearing loss assessed?

Answer 25

Weber test
Steroids
RULE OF 3s: within 3 days in one ear of at least 30 dbs at 3 different frequencies

Question 26

What foreign body needs to be removed immediately?

Answer 26

Batteries

Question 27

What is classified as a zone 1 neck injury?

Answer 27

Trachea
Oesophagus
Thoracic duct
Thyroid
Vessels - brachiocephalic, subclavian, common carotid, thyrocervical trunk
Spinal cord

Question 28

What is classified as a zone 2 neck injury?

Answer 28

Larynx
Hypopharynx
CN 10,11,12
Vessels - carodits, internal jugular
Spinal cord

Question 29

What is classified as a zone 3 neck injury?

Answer 29

Pharynx
Cranial nerves
Vessels - carotids, IJV, vertebral
Spinal cord

Question 30

What needs to be taken in the history of a neck injury?

Answer 30

Mechanism
Pain: location, intensity, onset, radiation
Aerodigestive tract: dyspnoea, hoarseness, dysphonia, dysphagia, haemoptysis
CNS: paraesthesia, weakness

Question 31

What investigations should be done in a neck injury?

Answer 31

FBC, group and save, cross match
AP/lateral neck 
CXR - hemopneumothorax, emphysema
CT angiogram - vascular, pseudoaneurysm, laryngeal aerodigestive tract
MRA

Question 32

How should a neck injury be managed?

Answer 32

Urgent exploration: expanding haematoma, hypovolaemia shock, airway obstruction, blood in aerodigestive tract
Laryngoscopy, bronchoscopy, pharyngoscopy and oesophagoscopy
Angiography - eoblize, occlude

Question 33

What can a deep neck space infection lead to?

Answer 33

From tonsil into deeper tissues

Mediastinal abscess

Question 34

How should a deep neck infection be managed?

Answer 34

Fluid resuscitation
IV antibiotics
Incision and drainage of neck space

Question 35

What needs to be done if you suspect a foreign object has been swallowed?

Answer 35

AP and lateral x-ray views

Question 36

What will a CT of an orbital blow out fracture look like?

Answer 36

Tear drop sign

Medial wall and floor injuries