Most of us don’t know when to take a situation seriously and seek medical attention, and when to deal with it ourselves at home. To this end, I have compiled a list of emergencies related to ear, nose, throat, head and neck that should be dealt with on priority and the appropriate protocols to be followed at this time.
If you face issues related to the ear, nose and throat repeatedly, this article should help ease your worries regarding seeking treatment. And for my fellow medical professionals, I hope these practical tips will help serve their patients better.
Nose bleed
- Pinched nostrils, proper positioning and patience are the initial steps.
- Avoid forceful blowing of the nose to clear blood clots
- Apply local decongestants soaked cotton pledgets
- Chemical cauterisation, if necessary (avoid electro cautery)
- Elderly patients and patients with brisk bleeds that cannot be directly visualised require treatment in a hospital setting. Temporary nasal packing with inflatable balloons is preferred.
- Apply ice to the palate to reduce nasal blood flow by up to 25%
- If all these measures fail, attempt endoscopic control with full PPE.
Nasal, ear and throat blockage
Tips for nasal foreign bodies
- Look directly and remove
- Next option is to sniff out the foreign body, closing the other nostril
- Final option is removal under general anaesthesia as per COVID-19 protocol
Tips for ear foreign bodies
- Look and remove without use of suction apparatus
- Syringing to remove small, non-wedged objects
- Tissue adhesive may be used for objects that are difficult to grasp, but avoid adhering to the ear canal. Apply glue to the end of a cotton swab stick and hold on the foreign body for 20 to 30 seconds, then remove.
- Impacted foreign bodies that may swell should be attended to urgently
Tips for throat foreign bodies
- X-ray will give clues to where it is lodged
- It should be treated as an emergency and utmost precautions taken as these are aerosol generating procedures.
(Button batteries and magnets as foreign bodies should be treated as absolute emergencies for removal) Any planned surgical procedures and establishing tissue diagnosis for treatment planning is regarded as a priority.
All such patients in the follow up period, exhibiting sudden signs or complications like bleeding,airway distress etc should be treated urgently.
Sudden hearing loss
- Acute onset of one-sided hearing loss occurs over hours. Patients may present with vertigo and a few will have permanent hearing loss.
- After a quick clinical assessment, appropriate therapeutic measures are put in place, including imaging and audiometric testing.
- Although, unsure of literature during COVID-19 times, it is better to start steroids and antivirals. Steroid injections inside the ear drum are a viable option to attempt reversal of the damage caused.
Ludwig’s angina and acute epiglottitis
Both these clinical conditions warrant close monitoring as life-threatening airway obstructions can manifest in a short time. COVID-19 airway protocol is to secure the airway along with a course of third generation cephalosporins and an attempt to aspirate rather than incision and drainage.
Surgical airway readiness is the need of the hour with proper PPE in place. The “golden hour” concept of treatment is important in preventing mortality and morbidity.