For ENT Infections (OM/OE/Mastoiditis), Refer to ID from Here.

Emergencies 🚨🚑

• This implies that the eardrum has perforated, the perforation has failed to heal and there is ongoing infection.
• Why it happens? 1- not adequate tx to AOM 2-Sepsis 3- general weak state
• Complications: invasive infection – cholesteotoma – permenant deafness
• Tx:
  • If bony → aural toilet (تنظف المكان)
• Dry perforation → nothing
• permenant perforation → Maryngoplasty → using temporalis fascia

• can be classified into: ear / cranial complications

• Acute mastoiditis
  • FEVER + pain  (over mastoid) + pus + swelling post-auricular
  • Tx:  IMMEDIATE IV ABx → Surgery (if abscess of slow response to ABx)
• CN7 Palsy
  • If w/ AOM → treat AOM
• if w/ choleostotoma → Surgery
• Cholesteotoma`
  • squamous epithelium within the middle ear. It results in accumulation of keratotic debris.
  • It expands and damages vital structures, such as dura, the facial nerve and the semicircular canals
  • Cholesteatoma is destructive and potentially lethal if untreated.
  • Tx: surgery (mastoidectomy)

• Because some fluid in the middle ear is normal for up to several weeks after an episode of AOM, the term OME requires that the fluid be persistent for at least 3 months.
• What are the indications or myringotomy and PE tube placement?

1. Persistent middle ear effusion over 3 months
2. Debilitated or immunocompromised patient
3. More than three episodes over 6 months (especially if bilateral)

• Complications:
  • Acute mastoiditis
    • perform CT scan of temporal bone.
    • myringotomy and IV antibiotics
  • Cholestotoma
    • tympanomastoid surgery

• Bony growth of stapes that causes CONDUCTIVE hearing loss
• Autosomal Dominant
• Px will be in 20s w/ hearing loss & +ve FHx
• Tx: hearing aids or surgery (romoval of stapes + putting prosthesis)

• Before 6 m → Brainstem response
• When 6 m → Visual reinforcement audiometry

1. Nose:

• What is it? pedunculated epithelial growth.
• Why it happens? Nobody knows exactly why, but in general, they are associated with: allergic rhinitis, asthma (aspirin), CF, and chronic sinusitis.
• Sx? obstruction sx (mouth breath, snoaring) & recurrent infections.
• Dx? Visualization (otoscope). CT can be done.
• Tx: Intranasal steroids → if steroid didn’t do the job, pt have multiple polyps or deformity → surgery (شيلهم وريح راسك)

• Causes: trauma (nose picking by kids), dryness (in winter),  COCAINE
• Tx: Compress and lean forward → drugs (topical: oxymetazonolone – phenylphrine) → Anterior nasal picking
• if bleeding site identified → Cautery.

• Unilateral + purulent maladorous mucus
• Tx: just remove it

• Management:

1. Educate pt about the condtition
2. Avoid triggers
3. Antihistamine
4. Local corticosteroids  (nansonex)
5. If severe → oral corticosteroids

• Juvenile nasopharyngeal angiofibroma (JNA) is a benign tumor that tends to bleed and occurs in the nasopharynx of prepubertal and adolescent males. Symptoms include Nasal obstruction (80-90%), epistaxis (45-60%) – mostly unilateral and recurrent, headache (25%).

6. Throat

• Tonsillitis
  • Sx: Sore throat + dysphagia (children will refuse to eat), +/- drooling
  • PEx: hyperemic tonsills + cervical LN
  • Dx:
  • Tx: ABx

1. Salivary gland
   • MC → Parotid (mostly benign) / Others (highly malignant)
   • Benign
     • Pleomorphic adenoma (mc tumor)
     • Warthin → associated w/ smoking + bilateral
     • Dx: FNA
     • Tx: Surgery (Gland excision w/ margin)
   • Malignant
     • Adenoid cystic carcinoma → pulmonary metastasis
   • Mucoepidermoid carcinoma (MC in children) → if epidermoid (poor prognosis) if mucoid (good prognosis)
   • Squ cell car → very aggressive (r/o metastasis to parotid LN)
   • Dx: FNA
   • Tx: 1* surgery → radiation
2. Thyroid
   • you know it: Papillary, Follicular, Medullary and anaplastic
   • papillary prognosis in thyroid is related to size
   • U/S most sensitive
   • FNA for all (except follicular)
   • Tx: Lobectomy if small (<1.5 papillary / <4 follicular) except with FAMILIAL MEDULLARY.
3. Oral cavity
   • High risk for malignancy
   • MCC → SCC
   • Dx: 1* line CT w/ contrast
   • Tx: SURGERY
     • +bone → chemo
4. Laryngeal (HPV16)
   • if arise from TRUE vocal cords → glottic → hoarseness
   • if arise from FALSE vocal cords → suppra-glottic → muffled sound
   • supraglottic: otolgia, dysphagia. hemoptysis

• laryngomalacia → improves when prone
• Laryngeal papilloma → true vocal cords → hoarseness
• conginertal subglottic stenosis
• Croup → barking cough (parainfluenza)
  • Tx: Adrenaline inhalation + steroids
  • steeple sign on x-ray
• Bacterial tracheitis
  • Sx: cough (barky) – stridor – sore throat – cold sx
  • PEx: Sick Sick – resp distress – FEVER
  • Dx: no response to recemic epinephrine (you thought it was croup) – GOLD STANDARD: Bronchoscopy
  • on x-ray: irregular trachea (membranes are formed)
  • Tx: 1) secure Airway (intubation may be needed) 2) Abx
• Retropharyngeal abscess:
  • Sx of sore throat
  • neck stiffness
  • Stridor
  • on Neck x-ray ➡️ increase paravertebral space
  • Tx Intravenous broad-spectrum antibiotic / O2 or intubation
• Grading:
  • 1: only inspiratory obstruction
  • 2: inspiratory + passive expiratory
  • 3: inspiratory + active expiratory + pulsus paradoxicus

• Rhinitis medicamentosa (RM), also known as rebound rhinitis, is a condition characterized by nasal congestion that is triggered by the overuse of topical vasoconstrictive medications, most notably intranasal decongestants.
• Quinsy Triad (Peritonsillar Abscess)

1. Trismus (due to irritation and reflex spasm of the medial pterygoid) is the most reliable indicator of peritonsillar abscess
2. Uvular deviation
3. Dysphonia (“hot potato voice”)

• lesion raised from fossa of Rosenmüller → nasopharyngeal carcinoma
• Juvenile nasopharyngeal angiofibroma (JNA) is a benign tumor that tends to bleed and occurs in the nasopharynx of prepubertal and adolescent males.
• In practice: Before biopsy → DO IMAGING FIRST
• Overall, prior nasal septal surgery (septoplasty) is the most common cause of septal perforations