ENT Emerg Flashcards
(31 cards)
Tx of Hematoma of the Pinna
I and D
Pressure dressing and 48 hr f/u
Abx pphx
Best way to remove cerumen impaction
Ear irrigation- if cerumn is hard use softners (debrox, cerumenex, docusate)
Whst can you use to help dissolve a styrofoam foreign body, superglue or cyanoacrylate?
acetone
Abx if trauma during foreign body removal to ear
dexamethasone
When does otitis externa become chronic
> 6 wk
otitis externa with progression to include deeper tissues / structures, hx of DM or immunocompromised
Necrotizing / malignant otitis externa
Otitis externa tx
Topical- non-ototoxic only, antibiotic drops (pseudomonas), analgesics
Oral antibiotics
Admission for necrotizing
Abx for otitis externa
Acetic acid solution
Neomycin, polymyxin B, and hydrocortisone (Cortisporin Otic). Suspension if TM ruptured
Ofloxacin (Floxin Otic). 3-4 drops bid or Ciprodex (ciprofloxacin/dexamethasone)
Acetic acid in aluminum acetate (Domeboro)-drying agent (Eczema etiology only)
Tinactin/ Micatin solution (Fungal etiology only)
Clotrimazole 1% solution
Etiology of mastoiditis
S. pneumoniae, S. pyogenes, S. aureaus
Tx of mastoiditis
ENT consultation
Admission
IV antibiotics: Cefotaxime, 1 g IV q 24 h, or ceftriaxone, 1-2 g IV q 24 hours
If TM perforated what side does weber lateralize to?
side of perf
TM perf tx
Keep ear dry
Refer to ENT and audiology
TM perforation from infectious etiology- Cortisporin Otic Suspension 1 drop qid, Ciprofloxacin Ophthalmic (Ciloxan) 1 drop qid
Traumatic TM perforation- no Abx needed
Urgent referral if hearing loss and/or vertigo
Surgical repair typically not needed
abrupt onset of pain, feeling of fullness in ear, conductive hearing loss, dizziness, tinnitus, vertigo, nausea/vomiting, transient facial paralysis, TM rupture with Valsalva maneuver, crying in children
Barotrauma
Barotrauma etiology
Air travelers, scuba diving, decompression, hyperbaric oxygen chambers, or rapid pressure change, or
blast injuries
Barotrauma tx
open the eustachian tube: chew gum, Valsalva maneuver, yawn, infants/kids should drink something during the landing/takeoff, divers descend and ascend slowly
Meds: antihistamines, decongestants, antibiotics to prevent infection, if barotrauma is severe, surgery
Middle Ear Hematoma tx
Watchful waiting
No antibiotics unless signs of infection develop
Follow-up with ENT and audiometry
Middle Ear Hematoma prognosis
Hearing can go back to baseline if the ossicles have not been fractured or dislocated
Hearing should return to normal in 6-8 weeks
Etiology of AOM
Streptococcus or parainfluenza or RSV
AOM tx
1st line: Amoxicillin 500 mg p.o. tid x 7-10 days
2nd line: Augmentin 875 mg p.o. bid x 7-10 days;
Ceftin 500 mg p.o. bid x 7-10 days
Penicillin allergic patients: Azithromycin, Clarithromycin, Clindamycin
Peripheral Vertigo Management
IV hydration (for patients with prolonged nausea or poor fluid intake)
1st line: Meclizine (Antivert) 25-50 mg po q 8-12 hours or Diazepam (Valium) 5-10 mg IV or 2-4 mg IM or transdermal scopolamine 0.5mg patch if patient unable to tolerate liquids
Anticholingerics: diphenhydramine (Benadryl) 50 mg IM or PO q 6-8 hours, dimenhydrinate (Dramamine) 50-100 mg IM or PO q 4 hours, promethazine (Phenergan) 25 mg PO, PR, or IV every 6-8 hours
Vertigo Management
d/c w/ mod improvement of sx and can tolerate liquids
if central- mgmt for underlying cause
vertigo prognosis
symptoms can last several hours to 1 week but may persist for 4-5 weeks
Labyrinthitis mgmt
Sx tx
Visual-vestibular exercises for prolonged causes
Lie still with eyes closed in darken room during acute
attack
Medications: for vertigo, abx, antivirals
unilateral hearing loss, tinnitus and vertigo with sudden onset and short (1-24 h) duration (intense, recurrent, vertigo associated with nausea and vomiting and distress, ear pressure, nystagmus during attacks)
Meniere’s Disease
