Otolaryngologic

Rapid Review

• Background
  • Airway foreign body emergencies are most common in children, but can also occur in the elderly and patients with sedative/alcohol use, impaired swallowing, or developmental delays.
  • Removal involves the use of laryngoscopy and forceps (Magill, Sponge stick, or Alligator). Suction may be sufficient as well. 
• Indications
  • Upper airway foreign body (above the glottis)
• Contraindications
  • Inability to visualize the foreign body
• Complications
  • Tissue damage, risk of pushing foreign body further down

Pearls

Deep Dive

• Upper Airway Foreign Bodies (emDocs)

Rapid Review

• 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

Pearls

Deep Dive

• Auricular Hematoma Management (REBEL EM)

Rapid Review

• 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.

Pearls

Deep Dive

• Cures for Cerumen Impaction (The Procedural Pause)

Rapid Review

• Background
  • Foreign bodies in the ear can include insects, food particles, organic material, and inorganic objects (toyes, beads, erasers).
  • Removal techniques include mechanical extraction, irrigation, and suction
• Indications
  • Ear foreign body (if well visualized)
• Contraindications
  • TM perforation, incomplete visualization
  • Button batteries require emergent ENT consultation (risk of liquefactive necrosis)
• Complications
  • Trauma to auditory canal, infection, retained foreign body particles

Pearls

Deep Dive

• PEM Pearls: Search & Rescue of Ear Foreign Bodies – Picking the Right Tool (ALiEM)

Rapid Review

• 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

Pearls

Deep Dive

• The Emergency Department Management of Posterior Epistaxis (emDocs)

Rapid Review

• 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)

Pearls

Deep Dive

• 20 Ways of Removing a Nasal Foreign Body in the Emergency Department (OAT)

Rapid Review

• 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.

Pearls

Deep Dive

• Trick: Peritonsillar abscess drainage 3.0 (ALiEM)