ENT EmergenciesOtological Emergencies

Sariu Ali didi

Anatomy of the Ear

Pinna:PerichondritisAuricular Hematoma

Sudden Sensory neural Hearing loss

Middle EarTrauma to TMAOMAcute mastoiditis

EAC:Foreign bodyMalignant Otitis Externa

Ear emergencies include

Auricular Hematoma

Rx : aspiration with an 18-gauge needle or

incision and drainagecompressive dressing for a week to

allow the cartilage to readhere to the perichondrium.

Coverage with an antistaphylococcal antibiotic is recommended.

Collection of blood between the cartilage and its perichondrium.The haematoma prevents proper oxygenation of the cartilage, resulting in necrosis and a cauliflower ear.Complications:

InfectionCauliflower ear

Perichondritis

Ifection secondary to hematomas, laceration or surgical incision.

Organism: pseudomonas and mixedSx : Red, hot, painful pinna

Abcess can form btwn prichondrium and cartliage leading to necrosis of cartilage.

Rx : systemic antibiotics local application of 4%alluminium acetate

compression.

Necrotizing otitis externaSever infection of the external auditory

canal.Caused by pseudomonas organismsRisk factors : DM, immunosuppression

infection spreads to the temporal bone – osteomyelitis of the temporal bone

It can readily spread to the base of skull leading to fatal complications( multiple cranial nv palsies) if it isnt adequately treated.

Facial Nv pasly common. Water exposure and irrigation of the auditory canal (usually for cerumen disimpaction) have been implicated as causative factors

Hx: Disproportionately severe pain esp at night

PE : On otoscopy, the external ear canal will typically have granulation tissue at the bony-cartilaginous junction

Ix : RBS, ESR, CT or MRI evidence of otitis externa with possible bone erosion and infiltration into infratemporal soft tissues

Rx : - high dose IV Antibiotic treatment

(antipseudomonal coverage (for six to eight weeks); quinolone is the drug of choice.

- Surgical debridement of devitalized tissue.

Foreign body in the ear Emergency when associated with vertigo, profound hearing loss and/ or facial parallysisDo not irrigate organic material or with a perforation

Methods of removal:

• Forceps removal• Syringing • Suction• Microscopic removal with specific instruments

small children - may put objects such as pips, beads and paper clips in their ears. Adults may get foreign bodies like toothpicks. Foreign bodies in ears are more often seen in the mentally disturbed

Isects should be killed first( olive oil)Then try syringing with warm water

Unskilled attempts at removal of FB may lacerate the meatal lining , damage tympanic membrane or the ossicles.

Acute Mastoditis

Aetilogy : accompanying

/ following ASOM Organism: B hemolytic streptococcus.

Pus canbreak through mastoid cortex – subperiosteal abcess–

burst in to surface – discharging fistula.

destruction and coalescence of mastoid air cells converting them

in to a single irregular cavity filled with pus.

production of pus under tensionHyperemic decalcification and orthoclastic resorption of bony

walls.

Pathology : Acute MastoditisInflamation of the mucosal

lining of antrum and mastoid air cell system.

When infection spreads beyond the mucosa – involving mastoid air cells and the bony mastoid cortex

Symptoms Fever with systemic sx Otorrhea – increasing Pain behind the ear

Signs Mastoid : Obliteration of retroauricular sulcus Postauricular swelling with erythema Mastoid tenderness Ear : Ear pushed forwards & downwards Ear discharge - pulsatile Sagging of post sup wall TM perforation

Investigation FBC- leucocytosis ESR – elavated X-ray Mastoid – clouding of air cells due to

the collection of exudate in them. Ear swab C/S

Complications•Subperiosteal abscess•Labyrinthitis •Facial paralysis•Petrositis •Extradural abscess•Subdural abscess•Meningitis•Brain abscess•Lat sinus thrombosis•Otitic hydrocephalus

Management•Medical – antibiotics( amoxicillin/ Ampicillin•Surgery•Myringotomy •Simple I&D•Cortical mastoidectomy

Sudden sensorineural hearing losssensorineural hearing loss of greater than 30 dB over 3 contiguous pure-tone frequencies occurring within 3 days' period.

Usually it presents as unilateral loss of hearing; bilateral involvement is rare

Pathophysiology

4 theoretical pathwaysLabyrinthine viral

infection Labyrinthine vascular

compromise Intracochlear

membrane ruptures Immune-mediated

inner ear disease.

Causes include:

•infections•trauma (e.g.head injury)•immunological (e.g.Cogan's syndrome)•toxins•ototoxic drugs•multiple sclerosis•Ménière's disease

Evaluation Rule out others conditionsNormal tmAudiometry test (pta, abr)Hrct, mri (tumor, multiple sclerosis)Vestibular test (prognosis)Blood ix. - esr, coagulation profiles, blood

sugar, serologic test - syphilis, ana etc.

management

Treatment has been controversial due to the lack of a definite causemany experience spontaneous recovery within the first 3 days.few recover gradually over a 1 or 2 weeks15 percent experience a gradually worsening hearing lossmany methods have been used• oral corticosteroid therapy

shown to be effective in few studies• hyperbaric oxygen• antivirals

herpes family viruses have been frequency associated with sudden hearing loss

• vasodilators

THANK YOU

REFERANCESDiseases of ear nose and throat PL Dhingrahttp://www.gpnotebook.co.uk

http://www.ispub.com/journal/the_internet_journal_of_otorhinolaryngology/volume_4_number_1_37

http://www.ncbi.nlm.nih.gov/pmc/articles