Emergency Medicine

Traumatic Conditions of the Nose

ENT emergencies 401

(b) trauma to the temporal bone or a facial laceration in the

parotid area

(c) tumours, such as an acoustic neuroma or parotid malignancy

(d) infection, such as acute otitis media, chronic otitis media

with cholesteatoma or geniculate herpes zoster, the Ramsay–

Hunt syndrome

(e) miscellaneous, including Guillain–Barré syndrome,

sarcoidosis, diabetes and hypertension.

2 Upper motor neurone paralysis
(i) There is weakness of the lower facial muscles sparing the
forehead, often associated with other neurological signs such as
hemiplegia.
(ii) The cause is usually a stroke.

3 Examine the external auditory canal, eardrum, parotid region and make a
full neurological assessment.

MANAGEMENT

1 Refer all acute cases with associated signs immediately to the medical, surgi-
cal or ENT team according to the likely aetiology.

2 Give prednisolone 50 mg orally once daily for 5 days, in a patient with Bell’s
pa lsy if seen wit hin 3 days of onset.
(i) The role of aciclovir 400 mg orally 5 times a day for 5 days is
inconclusive.
(ii) Add hypromellose artificial tears, tape or pad the eye closed at
night, and refer to the next ENT clinic.

Traumatic Conditions of the Face and Mouth EMERGENCIES

Fractured nose

DIAGNOSIS

1 This injury is usually obvious following a direct blow, causing swelling,
deformity and epistaxis.

2 Exclude a more serious facial bone fracture, e.g. with cerebrospinal f luid
rhinorrhoea from cribriform plate damage (see p. 31).

3 Look carefully for a septal haematoma which, if left, leads to necrosis of the
nasal cartilage and septal collapse.
(i) The nasal passage is blocked by a dull-red swelling replacing the
septum, associated with marked nasal obstruction.

4 Do not take a nasal X-ray as this does not alter the clinical management.