Makindo Medical Notes Comprehensive Medical Encyclopedia | Education for Healthcare Professionals

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ENT Emergency	Clinical Presentation	Diagnostic Tests	Treatment
Epistaxis (Nosebleed)	Bleeding from one or both nostrils. Can range from mild to severe, potentially leading to significant blood loss. May be associated with trauma, hypertension, or coagulopathy.	Clinical examination to localize the bleeding site (anterior or posterior). Blood tests including CBC, coagulation profile if recurrent or severe. Endoscopy may be used for difficult-to-localize bleeding.	Direct pressure on the nostrils for 10-15 minutes. Topical vasoconstrictors (e.g., oxymetazoline) and nasal packing for anterior bleeds. Cauterization (chemical or electrical) for localized bleeding points. Posterior packing or surgical ligation for severe or posterior epistaxis.
Peritonsillar Abscess (Quinsy)	Severe sore throat, usually unilateral. Difficulty swallowing, trismus (inability to open the mouth fully), and "hot potato" voice. Fever and swelling of the tonsillar area with uvular deviation.	Clinical examination, including inspection of the oropharynx. Ultrasound or CT scan if the diagnosis is unclear.	Needle aspiration or incision and drainage of the abscess. Broad-spectrum antibiotics (e.g., amoxicillin-clavulanate, clindamycin). Pain management and supportive care, including hydration.
Acute Epiglottitis	Rapid onset of sore throat, dysphagia (difficulty swallowing), and drooling. Stridor, muffled voice, and high fever. Severe cases may present with respiratory distress and cyanosis.	Clinical diagnosis based on symptoms and signs. Lateral neck X-ray may show "thumbprint sign" (swollen epiglottis). Direct visualization with laryngoscopy should be performed with caution in a controlled environment (e.g., OR).	Immediate airway management; intubation may be necessary. IV antibiotics (e.g., ceftriaxone or cefotaxime). Corticosteroids may be used to reduce inflammation. Close monitoring in an ICU setting.
Foreign Body in the Airway	Sudden onset of choking, coughing, or respiratory distress. Stridor, wheezing, or decreased breath sounds on one side. Possible cyanosis and inability to speak if the airway is completely obstructed.	Chest X-ray may show the foreign body, especially if radiopaque. Bronchoscopy is both diagnostic and therapeutic, allowing visualization and removal of the foreign body.	Immediate Heimlich maneuver for complete obstruction in a conscious patient. Urgent bronchoscopy to remove the foreign body. Supportive care including oxygen administration and monitoring for complications.
Sudden Sensorineural Hearing Loss (SSNHL)	Rapid onset of hearing loss in one ear, often noticed upon waking. May be associated with tinnitus, ear fullness, or vertigo.	Audiometry to confirm the diagnosis and assess the severity of hearing loss. MRI to rule out acoustic neuroma or other intracranial pathology.	High-dose corticosteroids, either oral or intratympanic, are the first-line treatment. Prompt referral to an ENT specialist for further evaluation and management. Hyperbaric oxygen therapy may be considered in some cases.
Ludwig’s Angina	Severe, rapidly spreading cellulitis of the submandibular space. Swelling of the floor of the mouth, difficulty swallowing, and drooling. Potential airway compromise due to tongue elevation and displacement.	Clinical examination focusing on airway assessment. CT scan of the neck to assess the extent of the infection.	Immediate IV antibiotics (e.g., clindamycin or penicillin plus metronidazole). Surgical drainage if abscess formation is present. Airway management may require intubation or tracheostomy in severe cases.
Nasal Fracture	Nasal pain, swelling, and deformity following trauma. Epistaxis (nosebleed) and difficulty breathing through the nose. Periorbital ecchymosis (bruising around the eyes) may be present.	Clinical examination for deformity, tenderness, and nasal patency. Nasal speculum examination to rule out septal haematoma. Facial X-ray or CT scan if there is concern for associated facial fractures.	Ice packs and analgesia to reduce swelling and pain. Reduction of the fracture may be necessary, ideally within 7-10 days. Management of any associated injuries, such as septal haematoma, to prevent complications.
Acute Mastoiditis	Ear pain, fever, and swelling behind the ear (postauricular swelling). Protrusion of the auricle and tenderness over the mastoid process. May follow untreated or inadequately treated otitis media.	CT scan of the temporal bone to assess the extent of the infection. CBC and blood cultures if systemic symptoms are present.	IV antibiotics (e.g., ceftriaxone or vancomycin) to cover common pathogens. Myringotomy (incision in the eardrum) for drainage of middle ear fluid. Mastoidectomy may be required if there is no response to medical treatment or if complications develop.
Malignant Otitis Externa	Severe ear pain, otorrhea (discharge), and hearing loss. Granulation tissue in the ear canal on otoscopic examination. Common in immunocompromised patients, particularly those with diabetes.	CT or MRI of the temporal bone to assess the extent of the infection. CBC, blood cultures, and culture of the ear discharge.	Prolonged course of IV antibiotics (e.g., ciprofloxacin) targeting Pseudomonas aeruginosa. Pain management and strict glycaemic control in diabetic patients. Surgical debridement may be necessary in severe cases or if there is progression despite antibiotics.

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