What basic ear, nose, and throat (ENT) cases should be expected in a casualty department, considering various patient demographics and medical histories?

Basic ENT Cases Expected in Casualty

Epistaxis (nosebleed), foreign bodies in the ear/nose/throat, acute otitis externa, acute otitis media, and upper respiratory tract infections represent the most common ENT emergencies presenting to casualty departments, with epistaxis and foreign bodies being particularly prevalent across all age groups. 1, 2

Most Common ENT Emergencies by Anatomical Region

Ear-Related Emergencies (46% of ENT casualties)

• Foreign bodies in the ear are the most common pediatric ear emergency, typically involving plastic toys, beads, and small objects inserted by children 2, 3
• Acute otitis externa presents as one of the most common otological emergencies requiring immediate assessment and topical treatment 4
• Acute otitis media (AOM) requires antibiotic treatment only in specific circumstances: children under 2 years with purulent AOM, or complicated/symptomatic forms in older children 5
• Mastoiditis represents a severe ear infection requiring hospitalization and intravenous antibiotics as a therapeutic emergency 5

Nose-Related Emergencies (34% of ENT casualties)

• Epistaxis is the single most common ENT emergency presenting to casualty departments, with nearly 60% of the population experiencing at least one episode, and 10% seeking medical intervention 1, 2
• Epistaxis shows a bimodal age distribution: peak frequency in children under 10 years (mean age 7.5 years, 57.4% male) and elderly patients, with those aged 85+ being 3.24 times more likely to present than those under 65 1
• Anterior epistaxis (93.5% of pediatric cases) originates from Kiesselbach's plexus and responds to simple compression and limited cautery 1
• Posterior epistaxis (5-10% of cases) occurs more commonly in elderly patients, is more difficult to control, and carries a 3.4% 30-day mortality rate 1
• Nasal foreign bodies are common in children and require prompt removal using suction catheters, syringing, or instrumentation 3, 6

Throat, Neck, and Airway Emergencies (19.5% of ENT casualties)

• Stridor is the most common ENT emergency in the geriatric age group and requires immediate airway assessment 2
• Foreign bodies in the throat and aerodigestive tract can present as life-threatening airway emergencies, particularly in pediatric patients 2, 3
• Oesophageal food bolus obstruction in adults may require combined medical and surgical intervention 3
• Severe throat infections including epiglottitis, retro- and parapharyngeal abscesses require hospitalization and intravenous antibiotics as therapeutic emergencies 5
• Laryngitis in pediatric patients requires careful airway assessment with observation for estridor, use of accessory muscles, and signs of respiratory distress 7

Key Patient Demographics and Risk Factors

Pediatric Presentations

• Foreign bodies dominate pediatric ENT emergencies across all anatomical sites (ear, nose, throat, aerodigestive tract) 2
• Three out of four children experience at least one episode of epistaxis, with procedures required in only 6.9% of cases 1
• Upper respiratory tract infections are the most common infections in children and leading cause of antibiotic prescriptions, though most are viral and self-limiting 5

Geriatric Presentations

• Stridor is the predominant emergency in elderly patients 2
• Posterior epistaxis is significantly more common with advancing age and more difficult to control 1
• Among epistaxis patients presenting to emergency departments: 15% are on long-term anticoagulation, 33% have hypertension, and 0.9% have underlying coagulation disorders 1

Initial Management Priorities

Epistaxis Management Algorithm

• First-line treatment: Position patient sitting upright with head tilted slightly forward; apply firm sustained compression to soft lower third of nose for full 10-15 minutes without interruption 8
• If bleeding continues: Apply topical vasoconstrictors, perform nasal cautery (chemical or electrocautery), or place nasal packing 1
• Admit immediately if hemodynamic instability present (tachycardia, orthostatic hypotension, signs of hypovolemia) 8
• Posterior epistaxis may require endoscopic arterial ligation or interventional radiology embolization procedures (>90% success rate) 1

Foreign Body Removal

• Most foreign bodies can be removed by skilled practitioners using suction catheters, syringing, or instrumentation with minimal complications 3
• Diagnosis is often delayed as insertion is usually not witnessed 3
• Airway foreign bodies require immediate assessment for life-threatening obstruction 3

Upper Respiratory Tract Infections

• Refrain from prescribing antibiotics for: common cold, most sore throats, laryngitis, congestive otitis, and otitis media with effusion 5
• Treat sore throats with antibiotics only when Group A Streptococcus rapid antigen test is positive 5
• Amoxicillin is first-line treatment for ambulatory ENT infections justifying antibiotics 9, 5

Critical Pitfalls to Avoid

• Do not assume hypertension causes epistaxis - the causal relationship is not well established despite common assumption 1
• Do not overlook posterior epistaxis in elderly patients, as it carries significant mortality risk and requires more aggressive management 1
• Do not delay airway assessment in patients with stridor or suspected foreign body aspiration 7, 2
• Avoid unnecessary antibiotic prescriptions for viral upper respiratory infections, which represent the majority of cases 5
• Ensure waveform capnography is immediately available for any pediatric airway emergency to improve safety of airway management 1, 7