Otolaryngologic

  • Auricular Hematoma Evacuation
  • Cerumen Impaction Removal
  • Epistaxis Management
  • Nasal Foreign Body Removal
  • Peritonsillar Abscess Drainage

Auricular Hematoma Evacuation

  • Background
    • Complication from direct trauma to the anterior auricle; common in wrestlers. If left untreated, it may result in an auricular deformity known as “cauliflower ear”
  • Indications
    • Traumatic injury causing anterior auricular swelling
  • Contraindications
    • Hematomas older than 7 days (should be referred to a specialist)
  • Complications
    • Infection, scar formation, reaccumulation of hematoma, chondritis
Video Credit: HIPPO Education

*Deep Dive: Auricular Hematoma Management (REBEL EM)



Cerumen Impaction Removal

  • Background
    • Cerumen impaction is caused by a buildup of wax within the ear canal and can lead to pain, tinnitus, dizziness, or decreased hearing. Removal can be achieved by manual removal, irrigation, or cerumenolytic agents
  • Indications
    • Cerumen buildup with symptoms (pain, tinnitus, decreased hearing, etc.), inability to view the full tympanic membrane for diagnostic purposes.
  • Contraindications
    • Uncooperative patient, inability to visualize ear canal. Irrigation is contraindicated in the presence or history of perforated TM.
  • Complications
    • Short-term vertigo, lacerations to ear canal skin, worsening tinnitus.
Video Credit: Auburn Medical Group

*Deep Dive: Cures for Cerumen Impaction (The Procedural Pause)



Epistaxis Management

  • Background
    • Epistaxis is acute hemorrhage from the nostril, nasal cavity, or nasopharynx. 90% of bleeds occur from the anterior septum, with 10% in the posterior region. Management techniques include nasal packing vs commercial balloon tamponade devices
  • Indications
    • Uncontrolled bleeding despite conservative management.
  • Contraindications
    • Hemodynamically unstable; uncontrolled airway
  • Complications
    • Inadequate bleeding control, infection, sinusitis
Video Credit: EM:RAP

*Deep Dive: The Emergency Department Management of Posterior Epistaxis (emDocs)



Nasal Foreign Body Removal

  • Background
    • Typically occur in children; common foreign bodies include marbles, beans, nuts, beads, magnets, stones, etc. There are several removal techniques (Bulb syringe, manual removal with forceps, “Parent’s Kiss”, balloon catheter)
  • Indications
    • Known or suspected nasal foreign body (often present with unilateral purulent/bloody nasal discharge or unilateral sinusitis)
  • Contraindications
    • Inability to see foreign body, significant inflammation/edema, several failed attempts at removal.
  • Complications
    • Nasal mucosa injury, aspiration of foreign body, barotrauma (from “parent’s kiss” or BVM technique)
Video Credit: Larry Mellick

*Deep Dive: 20 Ways of Removing a Nasal Foreign Body in the Emergency Department (OAT)



Peritonsillar Abscess Drainage

  • Background
    • Peritonsillar abscesses are a complication of tonsillitis; it is the most common deep infection of the head and neck. Drainage is needed to prevent deep neck space infections, sepsis, and carotid artery erosion.
  • Indications
    • Cases of suspected peritonsillar abscess
  • Contraindications
    • Vascular malformations, malignancy, uncooperative patients.
  • Complications
    • Aspiration of abscess contents, bleeding.
Video Credit: Larry Mellick

*Deep Dive: Trick: Peritonsillar abscess drainage 3.0 (ALiEM)


Brandon Simpson, PA-S2
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