Otolaryngologic

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

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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

*Deep Dive: Auricular Hematoma Management (REBEL EM)

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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.

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

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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

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

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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)

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

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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.

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

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