ENT

EAR TRAUMA

HAEMATOMAS Consider aspirating haematomas to avoid cauliflower

ear may need formal drainage
LACERATIONS Especially those into the cartilage will need oral
antibiotic cover (flucloxacillin). If laceration is large and
involves cartilage such that the ear is unstable will
need referral to ENT or Facio max.

PEFORATED DRUM Need oral antibiotic cover ( amoxicillin). The patient

must avoid getting water in the ear. Most will heal up by
themselves Perforations due to trauma need follow up
in ENT clinic, perforations due to infection can be
followed up by the GP.
FOREIGN BODY See guideline

EARACHE PLUS OR MINUS DISCHARGE

OTITIS MEDIA Pain, discharge, red ear drum bulging, pyrexia

( remember childrens ear drums can look red just
due to temp and or crying)
Treatment Under fives Amoxycillin
Over fives Penicillin & Analgesics. If concerned about
Hearing once infection cleared, see GP.
Some studies suggest that antibiotics are not required
if the child is well

OTITS EXTERNA (infection in the ear canal)

Very painful, may see debris in the ear canal, ear canal
may be swollen.
Treatment if not too severe
Gentimycin HC drops tds
NSAID are a good analgesic.
Avoid water in the ear
If severe ie very swollen or a lot of debris will need to
be referred for aural toilet to ENT clinic. May even need
acute referral if ear canal is completely closed so ENT
can place a wick into canal to allow antibiotic drops to
get to where they need to be

IMPACTED WAX Can be very painful .Advise warm olive oil for several
days before syringing at GP
MASTOIDITIS NEED ACUTE REFERRAL FOR IV ANTIBIOTICS
SWELLING AND TENDER OVER MASTOID
PATIENT UNWELL AND PYREXIAL.

REMEMBER REFERRED PAIN FROM THROAT, TONGUE, NECK, TMP JOINT.

Updated Aug 2005

NOSE TRAUMA

HAEMATOMAS Dont X-ray

Look for SEPTAL HAEMATOMA if present refer asap
ENT clinic referral if deformity , blocked airway at 5-7
Days

LACERATIONS cover with antibiotics( flucloxacillin ), particularly if

involving cartilage . Note also danger area of face ,at
risk of cavernous sinus thrombosis.

FOREIGN BODY
Make sure you have a nurse or mother willing and able
to hold the child very still. Make sure you have a good
light and a blunt hook. Have one go at removing the
FB. If unsuccessful refer to oncall ENT
Think of foreign body if history of unilateral nasal
discharge..

EPISTAXSIS See Guideline

If sent home with a pack bring back 24-48hrs later to
have the pack removed. Observe for a period of time
before sending them home.
REMEMBER TO GIVE OUT EPISTAXSIS LEAFLET.

THROAT

STRIDOR
First remember A B C
Try not to distress the child any more than you have to.
Get Senior Anaesthetic, Paediatric,ENT help
DO not attempt to look at throat
Some possible causes include FB , acute epiglottitis,
croup,laryngitis

SORE THROAT
You are unable to tell from looking whether or not it is viral or
bacterial. If you decide to give an antibiotic use a penicillin as vast
majority are Strep. Advice a regular mouth gargle and regular
paracetamol
If you think it is a Quinsy (Tonsillar abscess, swelling and bulging
one side) refer

HAEMORRHAGE.

Most commonly after tonsillectomy. IV access and fluids.

Secondary haemorrhage can occur several days later, usually
caused by infection.

FOREIGN BODY See guideline

Updated Aug 2005

Updated Aug 2005