4. Nasal Fracture
Exclude intra-cranial, orbital and other facial
injuries
If epistaxis present, apply first-aid measures
Need to exclude septal haematoma (requires urgent
drainage)
Isolated nasal fractures can be managed as
outpatient
5. Nasal Fracture
Investigation
Request for ‘Nasal Bone Xray’
Nasal XR - medicolegal reason
In more serious injury - skull and facial XR
CT scan - useful for maxillofacial fractures and to
exclude other injuries
7. Nasal Fracture
Management
Need for M&R within 14 days of injury
Refer to ENT outpatient to await reduction of
oedema to enable assessment of nasal bone
alignment
If epistaxis stops and no other significant
injuries, provide outpatient ENT follow-up
within 1 week of nasal injury
8.
9. A. Epistaxis
Local causes
Idiopathic (90%)
Traumatic ( fracture, foreign body, nose picking )
Infection
Inflammatory ( rhinitits, sinusitis )
Tumour ( rare )
Iatrogenic (Nasal Surgery)
12. Epistaxis
Kiesselbach plexus
Located on exposed anterior part of septum
Upper portion
ICA ( anterior and posterior ethmoidal arteries )
Lower portion
ECA ( Greater palatine, sphenopalatine, superior labial
arteries )
13. Epistaxis - First Aid
Sit up with head forward
Pinch the nose firmly with thumb and fingers for >
5min (Cartilaginous part)
Breathe through mouth
Ice pack on forehead
Ice cubes to suck
14. Epistaxis - Management
Assess blood loss
Resuscitation, i.v. access
Base line blood investigation
GXM
Medication - sedative or anti-hypertensive
20. Post-Tonsillectomy bleed
Management& small clot evident
If no active bleed
observe
If large clot, need to remove clot to access if
bleeding
If active bleeding:
Attempt haemostasis at A&E/Clinic
Haemostasis under G.A.
23. Ear Emergencies
Admission Criteria
Most ear cases can be reviewed in the next ENT
outpatient clinic
Following needs urgent admission:
Acute Mastoiditis
Acute perichondritis of the pinna
Any ear infection/trauma with facial nerve palsy
24. Ear Cases Seen at A&E
1.
2.
3.
4.
5.
6.
7.
Impacted ear wax
Traumatic TM Perforation
Otitis Externa
Otitis Media
Sudden Sensorineural Hearing Loss
Foreign Body Ear
Miscellaneous
26. Traumatic TM Perforation
If no other serious head injuries, can be followed up
as outpatient
1 week TCU
Keep ears dry
Antibiotics not required
Obtain outpatient referral for review
27. Otitis Externa
Treatment :
Aural toilet
Topical antibiotic ± steroid ear drops
Oral antibiotic for severe cases
Obtain outpatient referral for review
28. Acute Otitis Media
Common in children
Fever, ear- pain
TM - red & bulging
Otitis media can only be diagnosed if the TM is
visualised!
29. Acute Otitis Media
Treatment
Topical nasal decongestant
Analgesia
Oral anti-histamine
Antibiotics if patient toxic
Obtain outpatient referral for review
30. Chronic Otitis Media (effusion)
Oral antibiotics to prevent infection
If nasal symptoms present, treat with nasal
decongestants
Valsalva manouvre
31. Chronic Otitis Media (effusion)
Need to exclude NPC
If persist for more than 2 months, may need
myringotomy and ventilation tube insertion
Can be managed in ENT outpatient clinic
32. Chronic Suppurative Otitis Media
(CSOM)
Aural toilet
Topical ± oral antiobiotics
Keep ears dry
Elective Myringoplasty if perforation does not heal
Can be managed in ENT outpatient clinic
33. Sudden Sensorineural Hearing Loss
Loss of hearing of > 30 dB over 3 days, over at
least 3 frequencies
Sudden onset of hearing loss
Normal ear examination
Diagnose SNHL with tuning fork tests or puretone audiogram
34. Sudden Sensorineural Hearing Loss
Refer to next ENT outpatient clinic
Cover with oral prednisolone 1mg/kg if no
contraindication
Acyclovir 800mg 5x/day for 5 days, if onset within 1
week
60. Deep Neck Infection
Neck swelling
Sore throat, odynophagia, trismus
Immunocompromised
Fever, unwell
Lateral neck XR
Airway control
Admission for CT, KIV I&D
61. Deep Neck
Infection
•Normal retropharyngeal
space on lateral neck XR is
up to 1 vertebral body
width from C5 and below.
Widened
retropharyngeal space
on lateral neck XR
•Up to half a vertebral
body width from C1 to C4
is normal
85. FB Throat
>50% of ingested FB cannot be found!
Discharge with symptomatic treatment
Cover with antibiotics if diabetic patient or
immunocompromised
FB advice
Chest pain, fever, increasing symptoms
86. FB Throat
Can be seen in next ENT clinic if:
No FB found on detailed examination
No chest pain
Symptoms mild