18. Emergencies and Primary Measures in the ear, nose and throat. Foreign Bodies. Anatomy and physiology of the Esophagus. Corrosive Esophagitis. Treatment.

Question 1

What are the EAR / OTOLOGIC EMERGENCIES & their PRIMARY MEASURES?

Answer 1

1) Bleeding from the ear canal = Investigated to confirm INTEGRITY of TM / Ossicular Chain / Inner Ear

2) Damage to TM / Ossicular Chain = IMMEDIATE Evaluation via Specialist

3) Inflammation of Ear are considered EMERGENCIES IF = Process TRASCENDS Ear Boundaries (Mastoiditis / Brain Abscess / Meningitis / Sepsis)

4) Signs of INNER EAR Involvement = Labyrinthitis / HL / Vertigo

5) Auricular Inflammations CARRY RISK of Cartilage Damage

6) Acute Vestibulocochlear Dysfunction = HL / Tinnitus / Vertigo (Immediate Diagnosis / Therapy)

Question 2

What are the NOSE / SINONASAL EMERGENCIES & their PRIMARY MEASURES?

Answer 2

1) Nose Bleed / Epistaxis = MOST COMMON!

2) Acute Sinusitis = IF Inflammation spreads to Orbit / Eye / Meninges of Frontal Lobe (Immediate!)

3) Inflammation of External Nose = Cause Cartilage Liquefaction, due to RISK of Angular Vein Thrombosis / Cerebral Venous Thrombosis

4) Septal Hematomas /Abscesses = AFTER Nasal Trauma, require IMMEDIATE attention

5) Fractures of Nasal Bone / Zygoma / Orbital Floor / Intranasal Foreign Bodies

Question 3

What are the THROAT (Oropharyngeal / Laryngotracheal) EMERGENCIES & their PRIMARY MEASURES?

Answer 3

1) OROPHARYNGEAL
a. Inflammatory Complications of Tonsillitis = Peritonsillar / Parapharyngeal Abscess

b. Post-Op Bleeding AFTER Tonsillectomy

c. Erosion of BVs via Malignant Tumors can provoke MASSIVE Bleeding

d. Impalement Injuries = Creates NIDUS for Abscess Formation

e. Bilateral Choanal Atresia (Newborns) Require IMMEDIATE INTUBATION, as they’re nose breathers, esp during feeding

2) LARYNGOTRACHEAL
- OBSTRUCTION of Airways via Swelling / Tumor / Foreign Body / Blood, Secretions

• Require EMERGENCY Airway intervention via Intubation / Tracheotomy

Question 4

What are FOREIGN BODIES of Larynx?

Answer 4

• Aspirated FBs are found 4x MORE in RIGHT Bronchus&raquo_space;> Left
• Peanuts (Swell in Airway) / Watermelon Seeds / Tablets (Adults)

0 SYMPTOMS
- Immediate Coughing Fit
- Dyspnoea
- Stridor
- Pain

** Larger FBs IMPACTED in Larynx, may cause DEATH from ASPHYXIATION

** Smaller FBs cause Hoarseness / Cough

0 DIAGNOSIS = Radiographs to determine LOCATION of ASPIRATED FB

Question 5

Describe the ANATOMY of the Oesophagus

Answer 5

• Begins at UPPER Oesophageal Sphincter (C6 / C7 Vertebrae)
• Terminates at Gastric Media in Plane of T10 Vertebrae

0 LAYERS of OESOPHAGEAL WALL
- Mucosa = Stratified / Non-keratinising Squamous

• Submucosa
• Muscularis = Inner Circular / Outer Longitudinal Muscle Fibres
• Adventitia

Question 6

What is the BLOOD SUPPLY of the Oesophagus?

Answer 6

0 BLOOD SUPPLY
- Cervical Part = Inferior Thyroid Artery

• Thoracic Oesophagus = Aorta / Intercostal Arteries
• Abdominal Oesophagus = Left Gastric Artery / Inferior Phrenic Artery
• Venous Blood in Neck = Inferior Thyroid Vein
• Thoracic / Abdominal Drainage = Azygos / Hemiazygos / Oesophageal Veins

Question 7

What is the LYMPHATIC DRAINAGE & INNERVATION of the Oesophagus?

Answer 7

0 LYMPH DRAINAGE
- Posterior Mediastinum LN
- Pulmonary Hilum LN

0 INNERVATION
- Upper / Cervical par = Branches from Recurrent Nerve

• Lower Part = Vagus Nerve
• BELOW Tracheal Bifurcation = Oesophageal Plexus (2 Vagus Nerves)

Question 8

What is the PHYSIOLOGY of the Oesophagus?

Answer 8

3 Physiologic CONSTRICTIONS:
a. Upper = At Oesophageal Inlet BTW Cricoid Cartilage AND Cricopharyngeal

b. Middle = Aortic Arch CROSSES OVER Tracheal Bifurcation

c. Lower = Oesophagus PIERCES the Diaphragm

1) VOLUNTARY INITIATED Oral Phase of Swallowing FROM INVOLUNTARY Pharyngeal Phase / Oesophageal Phase

2) Controlled via Reflex Mechanisms

3) Oesophageal Phase
(i) Primary Peristaltic Wave, in response to moving bolus thru Pharynx

(ii) Secondary Peristaltic Wave = Triggered in Oesophagus via PRESSURE of Bolus AGAINST Oesophageal Wall

Question 9

What is CORROSIVE OESOPHAGITIS?

Answer 9

• Accidental / Suicidal Ingestion of CAUSTIC Substances
• Household Cleaners / Bleach / Washing Soda
• Harmful DUE to, ALKALI Medium
• Damage DEPENDS ON Concentration of Substance
• Affects MIDDLE / LOWER 3rd of Oesophagus

Question 10

What is the PATHOGENESIS of CORROSIVE OESOPHAGITIS?

{Acute, Subacute, Chronic Phases}

Answer 10

1) ACUTE Stage
- First 10 Days from ingestion
- Acute Necrosis w/ Mucosal Blurring
- Dilated Atonic Oesophagus

2) SUBACUTE Stage
- 10 - 20 Days AFTER Ingestion
- Oesophageal Ulceration

3) CHRONIC Stage
- AFTER 21 Days
- Oesophageal Inflammation
- HEALED via FIBROSIS

Question 11

What are the 3 DEGREES OF BURN in CORROSIVE OESOPHAGITIS?

Answer 11

1st Degree = Mucosal Hyperemia / Oedema

2nd Degree
- Small Bleeding
- Exudates
- Ulcers
- Pseudo-membrane

3rd Degree
- Mucosal Slough
- DEEP Ulcers
- Massive Bleedings
- COMPLETE Obstruction
- Perforation

Question 12

What are the SYMPTOMS and TREATMENT for CORROSIVE OESOPHAGITIS?

Answer 12

0 SYMPTOMS
- Oropharyngeal / Epigastric Pain
- Dysphagia
- Hypersalivation
- Vomiting
- Haematemesis

0 TREATMENT
- EMERGENCY Surgery IF = Signs of Perforation / Mediastinitis / Peritonitis

• Gastrointestinal Endoscopy WITHIN FIRST 24h

a) 1st Degree Burns
- 48h Observation
- Oral Feeding once Px swallows painlessly
- Endoscopy on Months 1,2 and 8th

b) 2nd / 3rd Degree Burns
- Fluid Therapy
- Antibiotics
- Nutrition
- PPIs
- Aerosolised Steroids
- Tracheostomy / Intubation
- Endoscopic Oesophageal Stenting