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Emergencies in Otorhinolaryngology
GC Sahoo
CHAPTER 1:
Epistaxis
INTRODUCTION
VASCULAR ANATOMY
BLOOD SUPPLY
Blood Supply of Nasal Septum (Figure 1.1A)
Blood Supply of Lateral Wall of Nose (Figure 1.1B)
Sites of Epistaxis
EPIDEMIOLOGY
Causes of Epistaxis
Local
General
EVALUATION
Supplies and Equipment for the Evaluation and Treatment of Epistaxis in the Urgent Care Setting
Laboratory Studies
Imaging Studies
Treatment
Medical Management
Anterior Epistaxis
Posterior Epistaxis
Septoplasty
CHAPTER 2:
Stridor in Children
PHYSIOLOGY
PATHOPHYSIOLOGY
INITIAL HISTORY AND EVALUATION
CASES OF STRIDOR IN CHILDREN ACCORDING TO SITE OF OBSTRUCTION
Pharynx
Inflammatory
Larynx
Inflammatory
Miscellaneus
Vocal Cord Paralysis
Trauma
Neoplasm
ASSESSMENT
History
EXAMINATION
PRE-ENDOSCOPY INVESTIGATIONS
FLEXIBLE ENDOSCOPY IN THE OFFICE OR WARD
LARYNGOTRACHEOBRONCHOSCOPY
Anesthetic
Intubation
Jet Ventilation
Laryngeal Mask
Microlaryngoscopy
Bronchoscopy
DYNAMIC ASSESSMENT OF LARYNX ON RECOVERY FROM ANESTHESIA
TREATMENT OF ACUTE AIRWAY OBSTRUCTION
Medical
Management of the Difficult to Extubate Neonate
Cricoid Split
Single Stage Laryngeal Reconstruction
Recent Techniques to Avoid Tracheotomy
CHAPTER 3:
Deep Neck Space Infections
ANATOMY
DEEP NECK SPACES
Spaces Above the Level of the Hyoid Bone
Peritonsillar Space
Submandibular Space
Ludwig's Angina
Parapharyngeal Space
Masticator/Temporal Space
Buccal Space
Parotid Space
Spaces that Involve the Entire Length of the Neck
Retropharyngeal Space
Danger Space
Prevertebral Space
Carotid Space
Space Below the Level of the Hyoid Bone
Anterior Visceral Space
DIAGNOSING DEEP NECK INFECTION
Diagnostic Imaging
Airway Management
Microbiology
Empiric Antibiotic Coverage
Conservative Medical Management
Surgical Intervention
COMPLICATIONS
CHAPTER 4:
Tracheostomy
INTRODUCTION
HISTORICAL PERSPECTIVE
INDICATIONS
Upper Airway Obstruction
Pulmonary Toilet and Protection of Airway
Recent Indication
SURGICAL ANATOMY
TYPES OF TRACHEOSTOMY
According to Purpose
Temporary
Permanent
According to Timing of Surgery
Elective Tracheostomy
Urgent Tracheostomy (Awake)
Emergent Tracheostomy (or Slash Trash)
According to the Level of Procedure
EVALUATION
EFFECTS OF TRACHEOSTOMY
PROCEDURE
Anesthesia
Positioning
Method
POSTOPERATIVE CARE
Positioning
Monitoring
Suctioning
Home Care for Tracheostomy
Requirements
TYPES OF TRACHEOSTOMY TUBES
COMPLICATIONS OF TRACHEOSTOMY
General
Immediate (During the Procedure)
Intermediate (Up to One Week of Surgery)
Late (After One Week)
TRACHEOSTOMY IN THE PEDIATRIC PATIENTS
PERCUTANEOUS TRACHEOSTOMY
Ciaglia Technique
Contraindications
CRICOTHYROIDOTOMY
Contraindications
Complications
DECANNULATION
CONCLUSION
CHAPTER 5:
Vertigo
INTRODUCTION
FUNCTIONAL ANATOMY
ACUTE VERSUS CHRONIC VERTIGO
ETIOLOGY
PATHOPHYSIOLOGY
PRESENTATION
HISTORY AND EXAMINATION
Rotation Tests
CENTRAL VERSUS PERIPHERAL VERTIGO (TABLE 5.2)
DIAGNOSIS
INVESTIGATIONS
Electro-oculography (EOG), Electronystagmography (ENG) and Videonystagmography
VESTIBULAR INDEX
TREATMENT (FIGURE 5.12)
Principles
Conservative
Medical
Treatment of Acute Vertigo
Surgical
Types
Indications
Vestibular Rehabilitation Therapy (VRT)
Candidacy
Exercises
QUALITY OF LIFE
CONCLUSION
CHAPTER 6:
Diagnosis and Treatment of Headache and Facial Pain
INTRODUCTION
PATHOPHYSIOLOGY
CLASSIFICATION
Classification of Migraine (Group 1)
Diagnostic Criteria for Migraine
Diagnostic Criteria for Tension-type Headache
Diagnostic Features of Cluster Headache
Diagnostic Criteria or Temporal Arteritis (TA)
Causes of Secondary Headache over 50 Years of Age
Cranial Neuralgias and Headache with Craniovascular Disorders
Diagnostic Features of Pseudotumor Cerebri
Headache Associated with Sinonasal Disorders
Causes of Headache Associated with Papilledema
Causes of Chronic Progressive Headache in Children and Adolescents
Acute Severe New Onset Headache (First or Worst Headache)
Sentinel Headache (Warning Leak)
Headache Alarms (Red Flags)
Practice Guidelines or Indications for CT and MRI in Diagnosis
Diagnostic Roadmap of Headache
History in Case of Headache
INVESTIGATIONS
TREATMENT
Drugs Used for Migraine Prophylaxis
Acute Migraine Specific Drugs
Treatment of Acute Migraine in Children
Current Concept in Acute Migraine Treatment
Indications of Steroids in Headache Disorders
Indications of Functional Endoscopic Sinus Surgery (FESS) for Headache in Nose and PNS Disorders
Treatment of Trigeminal Neuralgia
Headache Attributed to Substance or its Withdrawal
Alternate Therapies for Headache
CHAPTER 7:
Anesthetic Considerations in ENT Emergencies
PROBLEMS ASSOCIATED WITH ENT EMERGENCIES
Certain Specific Anesthetic Techniques Used in ENT Emergencies
FOREIGN BODIES IN ENT PRACTICE
Foreign Bodies in the Airway
Objects Inhaled
Pathophysiology
Presentation
Partial Airway Obstruction
Complete Airway Obstruction
Maneuvers and Treatment Used for Foreign Body Airway Obstruction (FBAO)
Emergency Methods Used to Relieve Obstruction
Rigid Bronchoscopy
Flexible Bronchoscopy
Foreign Bodies in the Ear
Foreign Bodies in the Nose
INFECTIONS AFFECTING THE AIRWAY
TRAUMA EMERGENCIES IN ENT PRACTICE
Establishment of Airway in Trauma
Disrupted Airway Anatomy
Cervical Spine Injury
Shock
Chest Trauma
Traumatic Brain Injury
Assessment of Airway
Intubation
Points to Remember in Trauma Patients
Faciomaxillary Trauma
Implications for the Anesthesiologist
Nasal Fracture
Laryngeal Trauma
EPISTAXIS IN ENT PRACTICE
Anterior Epistaxis
Posterior Epistaxis
Anesthetic Considerations
Other Hemorrhagic Conditions in ENT Emergencies
Post-tonsillectomy Bleeding
Anesthetic Implications
SPECIFIC ANESTHETIC TECHNIQUES USED IN ENT EMERGENCIES
Cardiopulmonary Resuscitation
How Early CPR Helps
Foreign Body Airway Obstruction (FBAO)
Methods of Removal of Foreign Body
Advanced Cardiac Life Support (ACLS)
Prolonged Life Support
CRICOTHYROIDOTOMY
Technique
AWAKE INTUBATION
Awake Blind Nasotracheal Intubation
Awake Oral Intubation
Technique
FIBEROPTIC ENDOTRACHEAL INTUBATION
CHAPTER 8:
Pharyngeal and Esophageal Foreign Body
ETIOLOGY
Age
Esophageal Factor
Type of Food
Voluntary Swallowing
Altered Sensorium
TYPES OF FOREIGN BODIES
Sharp or Blunt
Battery Ingestion
Foreign Body can be Radiopaque or Radiolucent
SITES
CLINICAL FEATURES
Symptomatology
Evaluation (Examination) of Patient
Neck Examination
Radiological Examination
Management
Treatment
Coin in the Esophagus of a Child
A Sharp Foreign Body in the Esophagus
Meat and Soft Foreign Bodies
Safety-pin in the Esophagus
Denture in the Esophagus
Battery Ingestion
Medical Treatment
Flexible Endoscopy
Advantages of Rigid Endoscopy
External Operation for Removal of FB
Complications of FB
Caustic Ingestion
Evaluation of Patient
Role of Endoscopy
Grading of Injury
LATE COMPLICATIONS
CHAPTER 9:
Emergency in Maxillofacial Injuries
INTRODUCTION
ANATOMICAL CONSIDERATIONS
The Orbit
THE NERVES
Trigeminal Nerve
Facial Nerve
Greater Auricular Nerve
Other Cranial Nerves
BLOOD SUPPLY
INCIDENCE AND PREVALENCE
ETIOLOGY
PATHOPHYSIOLOGY
DIFFERENT FRACTURES
Upper Face
Midface
Upper Central
Lateral Midface
Lower Central Midface
Lower Face
Fractures of the Mandible
The incidence of fractures of mandible as far as the sites are concerned is given below (Figure 9.9)
Displacements in Different Types of Mandibular Fractures (Figures 9.10 and 9.11)
MANAGEMENT PROTOCOL OF THE FACIOMAXILLARY INJURIES
Primary Survey and Management
The Need for Airway
Control of Bleeding and Maintenance of Circulation
Assessment of Head Injury
Examination of Eyes
Examination of Nose
Examination of Ears
Examination of Tongue and Oral Cavity
Miscellaneous Approach
Medical Therapy
SECONDARY SURVEY AND CLINICAL FEATURES OF THE FACIOMAXILLARY INJURIES
CLINICAL FEATURES OF INDIVIDUAL FRACTURES
INVESTIGATIONS AND WORK UP
Laboratory Study
Imaging Study
DEFINITIVE TREATMENTS
Frontal Bone Fracture
Orbital Floor Fracture
Nasal Bone Fractures
Nasoethmoidal Fractures
Zygomatic Arch Fractures
Temporal Fossa Approach
Transcutaneous Approach
Zygomaticomaxillary Complex Fractures
Maxillary Fractures
Principle
Preoperative Preparation
Operative Plan and Procedures
LeFort I Fractures
LeFort II Fractures (Figure 9.20)
LeFort III Fractures
Mandibular Fractures (Figures 9.21A and B)
COMPLICATIONS IN SURGERY OF MAXILLOFACIAL INJURIES
CHAPTER 10:
Idiopathic Sudden Sensorineural Hearing Loss
DEFINITION
INCIDENCE
ETIOLOGY
EVALUATION
History Taking
Otolaryngological Examination
Audiometric Evaluation
MANAGEMENT
CHAPTER 11:
Quinsy
DEFINITION
TYPES
ETIOLOGY
BACTERIOLOGY
CLINICAL FEATURES
Symptoms
General
Local
Signs
DIFFERENTIAL DIAGNOSIS
COMPLICATIONS
DIAGNOSIS
TREATMENT
Conservative
Site of Incision and Drainage (Figure 11.6)
Tonsillectomy
Interval Tonsillectomy
Abscess Tonsillectomy or Hot Tonsillectomy or Quinsy Tonsillectomy
NOTABLE CASES
CHAPTER 12:
Malignant Otitis Externa with Skull Base Osteomyelitis
INTRODUCTION
ETIOPATHOLOGY
DIAGNOSIS
STAGING AND IMAGING
TREATMENT
COMPLICATIONS AND PROGNOSIS
SUMMARY AND CONCLUSION
CHAPTER 13:
Foreign Body Airway Obstruction
ETIOLOGY
PREDISPOSING FACTORS
INCIDENCE
NATURE OF FOREIGN BODIES
HISTORY
CLINICAL FEATURES
DIFFERENTIAL DIAGNOSIS FOR RESPIRATORY DISTRESS
WORK UP: IMAGING
Radiography
Fluoroscopy
CT Scanning
Management
PROCEDURE
Technique of Bronchoscopy
INDEX
TOC
Index
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