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.