0071643192.pdf

HEAD, EYE, EAR, NOSE, AND THROAT

EMERGENCIES

LABYRINTHITIS

Infection or inflammation of labyrinth (viral mumps, measles, zoster, trauma,

allergic); see peripheral vertigo, hearing loss, tinnitus, nystagmus

ACOUSTICNEUROMA

Unilateral hearing loss, unilateral tinnitus, vertigo

OTOTOXICAGENTS

Tinnitus and hearing loss:

■ Loop diuretics

■ Salicylates (usually chronic toxicity)

■ NSAIDs

■ Quinine

■ Antibiotics (aminoglycosides, erythromycin, vancomycin)

■ Chemotherapeutics

NOSE

Epistaxis

Epistaxis is a common ED complaint. Most anterior bleeds can be treated

with packing and recheck in 48 hours. Posterior-bleed epistaxis and hyperten-

sion is debated, but it is reasonable to treat the BP of patients with very high

BP and persistent bleeding (see Figure 14.6).

CAUSES

■ Trauma (digital trauma, fractures)

■ Infection, inflammation (sinusitis, rhinitis)

■ Foreign body

■ Desiccation (cold, dry winter air)

■ Postsurgical bleeding.

■ Hypertension

■ Ischemia due to atherosclerois, insufflation (cocaine, meth)

■ Systemic disease (vasculitis, Osler-Weber-Rendu syndrome)

■ Bleeding disorders (hemophilia, von Willebrand, drug-induced coagulopathy)

■ Polyps

ANTERIOREPISTAXIS

SYMPTOMS/EXAM

■ Ninetypercent of all nosebleeds are anterior. Eightypercent are from

Kiesselbach plexus (also known as Little area), an anastomotic zone on the

anterior-inferior septal wall.

■ Site can be directly visualized.

■ Typically stops with pressure

■ Is more common in children

The most common cause of

unilateral hearing loss is

cerumen impaction.

The two tests for

hearing loss:

RinneRingsnext to the

ear.

Weber begins with W,

which has a center

point: Put the tuning

fork in the center of

the forehead.

Digital trauma is the most

common cause of epistaxis.