Otolaryngology

A

• Acute Mastoiditis - Pediatric and Adult Management

  Acute mastoiditis is a suppurative complication of otitis media characterized by inflammation of the mastoid air cells, often with postauricular swelling, tenderness, and auricular displacement. Management requires urgent ENT assessment, IV antibiotics, imaging when complications are suspected, and drainage or mastoid surgery when abscess or clinical failure occurs.
• Adult Epiglottitis — Airway First, Targeted Antibiotics, and Controlled Imaging

  Abrupt sore throat, dysphagia, muffled voice, and drooling with normal oropharyngeal exam suggests epiglottitis. Avoid agitating the airway; secure in a controlled setting if signs of obstruction. Start IV ceftriaxone + vancomycin (coverage varies) and obtain lateral neck radiograph or fiberoptic exam when safe.

B

• Benign Paroxysmal Positional Vertigo - Epley Maneuver

  Benign paroxysmal positional vertigo is diagnosed by characteristic brief position-triggered vertigo and positional nystagmus, most often with a positive Dix-Hallpike test for posterior canal disease. Treat posterior canal BPPV with a canalith repositioning maneuver such as Epley, avoid routine imaging and vestibular suppressants in classic cases, and investigate atypical neurologic features.
• Benign Paroxysmal Positional Vertigo — Diagnosis & Epley

  BPPV: brief positional vertigo from canalithiasis. Diagnose with Dix‑Hallpike (posterior canal) and supine roll (horizontal canal). Treat with canalith repositioning (Epley, BBQ roll); avoid prolonged vestibular suppressants.
• Button Battery in Nose - Emergency Removal

  A nasal button battery is a true ENT emergency because direct current, alkali generation, pressure, and leakage can cause rapid mucosal necrosis and septal perforation. Remove the battery immediately when safely possible, do not delay for routine imaging if directly visualized, avoid irrigation or neutralization attempts, and obtain ENT help for difficult removal or tissue injury.

C

• Cholesteatoma — Diagnosis & Surgery

  Keratinizing squamous epithelium in the middle ear/mastoid causing bone erosion. Diagnose by otoscopy and CT; treat with tympanomastoidectomy (canal wall up/down). Lifelong follow‑up to detect recurrence.

D

• Deep Neck Space Infection - Recognition and Management

  Deep neck space infection can progress rapidly to airway obstruction, sepsis, mediastinal spread, vascular complications, or intracranial infection. Recognize trismus, neck swelling, drooling, muffled voice, odynophagia, floor-of-mouth elevation, or toxic appearance; secure a threatened airway, obtain contrast CT when stable, start broad IV antibiotics, and obtain urgent ENT source control.

E

• Epiglottitis — Adult Airway and Antibiotics

  Adult epiglottitis is a potentially lethal supraglottic infection or inflammatory process that can cause abrupt upper-airway obstruction. Severe sore throat with odynophagia, dysphagia, muffled voice, drooling, stridor, or respiratory distress out of proportion to the visible oropharyngeal examination should trigger immediate airway-focused evaluation. Keep the patient calm and upright, involve anesthesia and otolaryngology early, secure a threatened airway in a controlled setting, and start IV antibiotics
• Epiglottitis (Adults) — Airway Strategy, Antibiotics, and ICU Monitoring

  Rapidly progressive sore throat, odynophagia, drooling, muffled voice, and stridor. Avoid agitation; secure the airway with awake fiberoptic technique when needed. Give broad IV antibiotics and steroids as adjunct; admit to ICU for monitoring.
• Epiglottitis in Adults — Recognition & Airway Plan

  Adult epiglottitis presents with severe sore throat, odynophagia, and muffled voice. Prioritize airway assessment; avoid agitation; secure airway early if stridor/respiratory distress; give IV antibiotics and steroids.
• Epistaxis - Acute Management and Packing

  Most bleeds are anterior. Apply firm compression, topical vasoconstrictor, cautery for visible source, and pack if bleeding persists. Treat posterior bleeds with urgent specialty involvement.
• Epistaxis — Anterior and Posterior Management

  Control bleeding with firm compression, topical vasoconstrictor and anesthetic, cautery for visible anterior source, and packing when needed; manage posterior bleeds with packing and specialty support.
• Epistaxis — Initial and Definitive Management

  Most epistaxis is anterior and responds to correct compression, topical vasoconstrictor, and targeted cautery or packing. Management begins with airway and hemodynamic assessment in severe bleeding, followed by firm continuous compression of the soft nasal alae. Persistent or posterior bleeding requires packing, ENT involvement, and sometimes endoscopic arterial control or embolization.

F

• Foreign Body Ingestion — Button Batteries & Magnets

  Button batteries and multiple magnets are GI emergencies. Immediate imaging; urgent endoscopic removal for esophageal button batteries and for ≥2 magnets. Observe single small magnets if distal and asymptomatic with close follow‑up.

H

• Hoarseness — Evaluation & Red Flags

  Persistent hoarseness >2–4 weeks warrants laryngoscopy. Identify red flags (stridor, airway compromise, hemoptysis, weight loss) and risk factors (smoking).

L

• Laryngopharyngeal Reflux — Diagnosis & Treatment

  LPR presents with throat clearing, cough, and dysphonia. Diagnosis is clinical with laryngoscopy support; initial management is lifestyle + empiric therapy; consider reflux testing if refractory.
• Ludwig Angina — Airway First & Antibiotics

  Ludwig angina is a rapidly progressive cellulitis of the bilateral submandibular, sublingual, and submental spaces that can elevate and posteriorly displace the tongue and cause sudden airway obstruction. Airway assessment and early involvement of anesthesia and otolaryngology or oral-maxillofacial surgery take priority over imaging. Start broad IV antibiotics covering oral streptococci and anaerobes, obtain source control for odontogenic infection, and drain any organized abscess or necrotic focus when pre
• Ludwig’s Angina — Airway Strategy, Broad Antibiotics, and Early Drainage

  Rapidly progressive cellulitis of the submandibular space with tongue elevation and trismus. Prioritize a secure airway (often awake fiberoptic), start broad‑spectrum IV antibiotics covering oral anaerobes and streptococci, and obtain early surgical drainage when abscess/collection suspected.

N

• Necrotizing Otitis Externa - High Risk Ear Infection

  Necrotizing otitis externa is an invasive infection of the external auditory canal and skull base, usually caused by Pseudomonas in older adults with diabetes or immunocompromise. Severe persistent otalgia, granulation tissue, and cranial neuropathy are red flags requiring urgent ENT evaluation, culture, imaging, prolonged systemic antipseudomonal therapy, and control of host risk factors.

O

• Obstructive Sleep Apnea — Surgical Options & Selection

  Surgery is for patients intolerant of CPAP or with anatomic obstruction amenable to correction. Selection based on BMI, DISE findings, and site of collapse; outcomes vary by procedure.
• Orbital Cellulitis — Imaging and IV Antibiotics

  Orbital cellulitis is a postseptal infection of the orbital tissues that can cause optic neuropathy, subperiosteal or orbital abscess, cavernous sinus thrombosis, intracranial infection, and vision loss. Suspect it when eyelid swelling is accompanied by pain with eye movements, ophthalmoplegia, proptosis, decreased vision, afferent pupillary defect, or systemic toxicity. Obtain urgent contrast-enhanced orbital and sinus imaging, start broad IV antibiotics, and involve ophthalmology and ENT early. Abscess, o
• Otitis Media with Effusion in Adults — Evaluation & Treatment

  Adult OME requires search for eustachian tube dysfunction and nasopharyngeal pathology. Avoid routine antibiotics; use watchful waiting, nasal steroids if allergic, autoinflation; refer for nasopharyngoscopy with unilateral/recurrent effusions.

P

• Peritonsillar Abscess — Drainage and Antibiotics

  Peritonsillar abscess is a collection between the tonsillar capsule and pharyngeal muscles, usually following tonsillitis, and presents with severe unilateral sore throat, muffled voice, trismus, drooling, uvular deviation, and asymmetric tonsillar swelling. Assess the airway first, provide analgesia and hydration, drain a mature abscess by needle aspiration or incision and drainage when appropriate, and give antibiotics covering group A streptococci and oral anaerobes. ENT consultation is needed for airway
• Peritonsillar Abscess — Drainage, Antibiotics, and Airway Precautions

  Severe unilateral sore throat with trismus, muffled ‘hot potato’ voice, and uvular deviation. Secure airway if threatened, drain (needle aspiration/incision and drainage), and start antibiotics covering streptococci and oral anaerobes; steroids can reduce pain/edema.
• Post Tonsillectomy Hemorrhage - ED Management

  Post-tonsillectomy hemorrhage is an airway and bleeding emergency. Even apparently modest bleeding can represent a larger swallowed blood loss. Keep the patient upright with suction available, establish IV access, obtain CBC and blood-bank testing, involve ENT immediately, resuscitate as needed, and prepare for operative hemostasis when bleeding is active or clinically significant.

S

• Severe Epistaxis — Resuscitation, TXA, and Posterior Packing

  Manage airway and hemodynamics first. Apply topical vasoconstrictor/anesthetic, direct pressure, and cautery for anterior bleeds; use tranexamic acid–soaked pledgets as adjunct. Posterior packing and ENT consultation for uncontrolled or posterior sources.
• Sudden Olfactory Loss — Differential & Workup

  Acute anosmia/hyposmia differential includes post‑viral olfactory dysfunction, sinonasal disease, head trauma, toxins, neurodegenerative disease. Early olfactory training improves recovery; consider short steroid course for inflammatory rhinitis/sinusitis.
• Sudden Sensorineural Hearing Loss - Steroid Therapy

  Sudden sensorineural hearing loss is an otologic urgency, classically defined as a rapid loss of at least 30 dB across three contiguous frequencies within 72 hours. Confirm sensorineural rather than conductive loss promptly, obtain audiometry, evaluate for retrocochlear disease, and consider corticosteroid therapy within two weeks, with intratympanic steroids for incomplete recovery.

T

• Tonsillectomy — Indications & Perioperative Care

  Indications include recurrent tonsillitis (Paradise criteria), obstructive sleep‑disordered breathing, peritonsillar abscess history, and suspicion for malignancy. Manage perioperative pain and hemorrhage risk.