HEENT

Life-Threatening Infections

• Ludwig’s Angina – Severe soft tissue cellulitis affecting the floor of the mouth and neck; high risk of airway obstruction.
• Peritonsillar Abscess & Epiglottitis – Can lead to respiratory distress if untreated.
• Orbital Cellulitis – Infection can rapidly spread to the brain, requiring urgent intervention.

Ophthalmologic Emergencies

• Closed-Angle Glaucoma – Sudden increase in intraocular pressure, requiring immediate treatment.
• Central Retinal Artery Occlusion – Painless, but an emergency, as it can cause permanent vision loss.
• Hyphema – Blood pooling in the eye → increased pressure → risk of glaucoma and irreversible blindness.

Dental Trauma – Tooth Avulsion & Fracture Classification

• Ellis I: Minor, involves enamel only, minimal discomfort.
• Ellis II: Extends into dentin, more painful, higher infection risk → requires dental referral.
• Ellis III: Deep pulp exposure, high risk of infection/ischemia → immediate consult needed.

Head Trauma

• Le Fort Fractures – Serious facial fractures; see Trauma Section for details.

Ear Conditions

Otitis Externa

• Location: Ear canal
• Causes: “Swimmer’s ear,” trauma, fungal infections
• Findings: Normal tympanic membranes, not linked to upper respiratory infections

Ménière’s Disease (Chronic, Episodic)

• Triggers: Post-infection, trauma
• Symptoms: Occur at rest
• Signs: Vertigo, tinnitus, unilateral sensorineural hearing loss
• Treatment: Symptom management, meclizine, steroids, low-sodium diet

Labyrinthitis (Acute)

• Symptoms: Triggered by head movements
• Cause: Inflammatory response in the middle ear, sudden onset

Eye Conditions

• OD (Right Eye): “Won’t OD on the RIGHT dose”
• OU (Both Eyes): “yOU see with both eyes”
• OS (Left Eye): “The only one LEFT is OS”
• Normal Eye pH: 7.0–7.4

Uveitis/Iritis

• Affects: Uveal tract (iris, ciliary body, choroid)
• Symptoms: Pain, redness, tearing, typically unilateral
• Diagnostic Test: Shining light into the unaffected eye causes pain in the inflamed eye due to ciliary body inflammation
• Findings: Inflammatory cells in the anterior chamber on slit lamp exam; may progress to glaucoma
• Treatment: Dark environment, warm compresses, cycloplegic drops
• Follow-up: Ophthalmology referral

Glaucoma – Elevated Intraocular Pressure (IOP)

• Normal IOP: 12–22 mmHg (measured with a tonometer)
• Aqueous Humor Flow Pathway:
  1. Produced by the ciliary epithelium in the posterior chamber of the anterior segment
  2. Flows forward around the ciliary process into the anterior chamber, where it drains via the trabecular meshwork
• Glaucoma Types:
  • Open-Angle: Chronic, gradual onset
  • Closed-Angle (Emergency!):
    • Symptoms: Halos around lights, sudden photophobia, headache
    • Definitive Treatment: Laser iridotomy to relieve pressure
    • Other Treatments: IV acetazolamide (Diamox), timolol eye drops

Central Retinal Artery Occlusion (CRAO)

• Presentation: Sudden, painless, unilateral vision loss due to an embolism
• Warning Sign: May be preceded by amaurosis fugax

Amaurosis Fugax

• Description: Temporary, unilateral vision loss lasting minutes, self-resolving
• Analogy: Like a mini-stroke (TIA) of the retinal artery
• Potential Causes:
  • Retinal artery stenosis or embolism
  • Optic nerve inflammation
  • Giant Cell Arteritis (especially in older adults)

Retinal & Nasal Conditions

Retinal Detachment

• Progression: Gradual onset, described as a curtain or veil descending over vision
• Symptoms: Floaters, flashes of light
• Management:
  • Shield the eye to limit movement
  • Bed rest
  • Urgent ophthalmology consultation

Diabetic Retinopathy

• Cause: Diabetes-induced retinal vascular changes
  • Increased vascular permeability & occlusions → ischemia → VEGF production → abnormal blood vessel formation
• Symptoms: Often asymptomatic in early stages; later signs include:
  • Floaters, scattered lights, blurry/cloudy vision
  • Photopsias (flashes of light), scotomas (blind spots)
• Treatment: Prevention is key
  • VEGF inhibitors (e.g., Votrient/pazopanib)
  • Laser coagulation for leaky vessels

Age-Related Macular Degeneration (AMD)

• Major Risk Factors: Smoking, hypertension
• Symptoms:
  • Progressive central vision loss
  • Worse at night, fluctuating severity
• Diagnosis: Fundoscopic exam
  • Drusen: Yellowish subretinal deposits in the macula

Nasal Conditions

Epistaxis (Nosebleed)

Posterior: Requires ENT consultation due to risk of significant bleeding

Types:

Anterior: More common, treated with direct pressure, silver nitrate, nasal tampon, etc.