Otolaryngologic

  • Epiglottitis
  • Epistaxis
  • Peritonsillar abscess
  • Strep Pharyngitis
  • Otitis Media

Epiglottitis

  • 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)
Video Credit: Armando Hasudungan

*Deep Dive: Epiglottitis (Core EM)



Epistaxis

  • 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
Video Credit: EM:RAP

*Deep Dive: Epistaxis Management in the ED: A Helpful Mneumonic (ALiEM)



Peritonsillar Abscess

  • 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)
Video Credit: Larry Mellick

*Deep Dive: Peritonsillar Abscess (Core EM)



Strep Pharyngitis

  • 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)
Video Credit: Armando Hasudungan

*Deep Dive: Streptococcal Pharyngitis (WikEM)



Otitis Media

  • 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
Video Credit: JJ Medicine

*Deep Dive: Acute Otitis Media (Core EM)



Brandon Simpson, PA-C
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