• Clinical science

Miscellaneous ear, nose, and throat disorders

Summary

This learning card provides an overview of ear, nose, and throat conditions not discussed elsewhere, including common ones (e.g., deviated nasal septum) as well as uncommon ones (e.g., decompression sickness, ear barotrauma, auricular hematoma).

For an overview of differential diagnoses for hearing loss, see the corresponding learning card.

Deviated nasal septum

  • Definition: significant deviation of the nasal septum from midline; which often leads to obstruction of nasal breathing.
  • Etiology
  • Clinical findings
    • Difficulty breathing (typically in only one nostril)
    • Nasal congestion
    • Snoring or noisy breathing during sleep
    • Headaches or facial pain
    • Epistaxis (nosebleeds)
  • Diagnostics
    • Anterior rhinoscopy: A nasal speculum and external light source are used to visualize the septum.
    • Nasal endoscopy
    • CT scan
  • Treatment
    • Septoplasty to correct the deviation is indicated if there are significant symptoms.
  • Complication of surgery
    • Nasal septum perforation
      • Etiology: sequela of septal hematoma (e.g., due to nasal fracture, septoplasty, or rhinoplasty)
      • Clinical features: nasal whistling sound with breathing
      • Diagnostics
        • Anterior rhinoscopy: to directly visualize abnormalities of the anterior to middle part of the septum
        • Posterior rhinoscopy: to directly visualize abnormalities of the middle to posterior part of the septum (via endoscopy)
        • CT: for more detailed evaluation of the nasal septum (and adjacent structures)
      • Treatment: : surgical restoration of physiologic configuration/structure (septoplasty)

References:[1][2][3]

Temporomandibular joint dysfunction

Symptoms resolve spontaneously in approx. 40% of patients!

References:[4][5][6]

Decompression sickness

  • Definition: formation of air embolisms as a result of a rapid decline of barometric pressure within the body
  • Etiology
  • Pathophysiology (in diving)
    • The pressure increases as the diver dives deeper → more oxygen and nitrogen are dissolved in the blood.
    • During normal ascent → pressure decreases and the tension of gas in the blood exceeds the surrounding pressure → dissolved nitrogen changes back into its gaseous form → the gas is exchanged with the lungs and breathed out.
    • In rapid ascent → formation of nitrogen gas bubbles within the blood vessels → insufficient time for the gas to be released via the lungs → gas bubbles remain in circulation and obstruct proper blood flow air embolism
  • Clinical features
  • Treatment
    • Hyperbaric, 100% oxygen
    • Hydration
    • Positioning maneuvers (left lateral decubitus and lowering the head zone of the bed)
  • Prevention
    • Avoid situations with rapid decline of barometric pressure
    • Follow diving safety guidelines

References:[7][8][9]

Ear barotrauma (barotitis media, aerotitis media)

References:[8][10]

Auricular hematoma

  • Definition: hematoma of the auricle
  • Etiology: trauma to the ear
    • Blunt: blow/s to the ear (e.g., in boxers/wrestlers)
    • Penetrating: lacerations of the ear (less common)
  • Clinical features
    • Sudden tense, tender, fluctuant swelling of the pinna and loss of normal anatomy/landmarks of the anterosuperior aspect pinna
    • Overlying skin is ecchymotic
  • Treatment
    • Small auricular hematomas: needle aspiration
    • Large auricular hematomas: incision, drainage, placement of a draining wick
    • Post-procedure formed pressure packing of the pinna
    • Re-assess in 48 hours to check for re-accumulation
  • Complications

Surgical drainage is always indicated!

References:[11][11][12][13]