Otolaryngologic

Rapid Review

• Background
  • Progressive inflammation of the epiglottitis and surrounding supraglottic structures, potentially leading to airway compromise
  • Typically occurs due to Haemophilus influenzae type B infection in unvaccinated children.
• Signs/Symptoms
  • Classically “3 D’s” (dysphagia, drooling, respiratory distress)
  • Other symptoms include fever, inspiratory stridor, cough
• Diagnosis
  • Lateral neck X-ray (will show “thumbprint” sign, indicating enlarged epiglottis)
• Treatment
  • Airway management (consider early intubation). Consult ENT
  • IV antibiotics (Ceftriaxone +/- MRSA coverage)

Pearls

Deep Dive

• Epiglottitis (Core EM)

Rapid Review

• Background
  • Nose bleeding; further divided into anterior epistaxis (most common) and posterior epistaxis (most serious). May cause life-threatening hemorrhage
  • Commonly caused by digital manipulation (nose-picking), dryness, cocaine, and hypertension.
• Signs/Symptoms
  • Mild-severe bleeding, nasal obstruction, respiratory distress
  • Posterior bleeds are more likely to drain from both nares
• Diagnosis
  • Clinical diagnosis
• Treatment
  • Direct pressure, lean forward, topical decongestants (oxymetazoline, phenylephrine)
  • Severe bleeds may require cautery, nasal packing, or balloon tamponade

Pearls

Deep Dive

• Epistaxis Management in the ED: A Helpful Mneumonic (ALiEM)

Rapid Review

• Background
  • Peritonsillar abscess is the accumulation of a purulent fluid collection in the tonsillar pillar. Typically a complication of strep pharyngitis.
• Signs/Symptoms
  • Painful swallowing, drooling, fever
  • “Hot potato voice”, (+) uvular deviation, (+) trismus. 
• Diagnosis
  • Clinical diagnosis
  • Ultrasound can help identify depth of abscess/neck vasculature
• Treatment
  • I&D or needle aspiration
  • Antibiotics (ex. amoxicillin, clindamycin)

Pearls

Deep Dive

• Peritonsillar Abscess (Core EM)

Rapid Review

• Background 
  • Infection and inflammation of the pharynx caused by group A streptococcus. 
  • Typically occurs in children 5-15 years of age
• Signs/Symptoms
  • Fever, sore throat, cervical lymphadenopathy, absence of cough, tonsillar exudates
• Diagnosis
  • Rapid strep test (if meet Centor criteria)
  • Gold standard is throat culture
• Treatment
  • Antibiotics (penicillin, amoxicillin, azithromycin)

Pearls

Deep Dive

• Streptococcal Pharyngitis (WikEM)

Rapid Review

• Background
  • Bacterial or viral infection of the middle ear, usually associated with an upper respiratory infection and/or eustachian tube dysfunction. If bacterial, S. pneumoniae is the most common cause.
  • Most common in children 6-36 months
• Signs/Symptoms
  • Otalgia +/- systemic symptoms (N/V, diarrhea, fever)
  • Significant erythema and/or bulging of TM
• Diagnosis
  • Clinical diagnosis based on otoscopy 
• Treatment
  • Antibiotics (ex. amoxicillin)
  • Recurrent ear infections may require tympanostomy or tympanocentesis

Pearls

Deep Dive

• Acute Otitis Media (Core EM)