Otolaryngologic

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

Airway Foreign Body Removal

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

Video Credit: The Gurney Room


Auricular Hematoma Evacuation

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

Video Credit: HIPPO Education


Cerumen Impaction Removal

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

Video Credit: Auburn Medical Group


Ear Foreign Body Removal

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

Video Credit: Don’t Forget The Bubbles


Epistaxis Management

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

Video Credit: EM:RAP


Nasal Foreign Body Removal

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

Video Credit: Larry Mellick


Peritonsillar Abscess Drainage

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

Video Credit: Larry Mellick

Brandon Simpson, PA-C
Latest posts by Brandon Simpson, PA-C (see all)