Emergencies in Otorhinolaryngology: Diagnostic Evaluation, Assessment of Urgency, and Treatment

Emergencies in otorhinolaryngology are common: According to a Spanish study, approximately 12% of patients in a general emergency room have symptoms relating to the ear, nose, or throat (ENT). Such situations range in severity from minimal to lifethreatening and affect persons of all ages. These patients may pre - sent first to a general practitioner or to an emergency room without specialized ENT coverage. In this article, we discuss the assessment of clinical urgency based on symptoms, and the ensuing treatments.

This narrative review is based on pertinent publications retrieved by a literature search. Common and typical ENT emergencies are discussed, including the necessary diagnostic evaluation, time management, and treatment. For each clinical entity, "red flags" are defined, i.e., warning signs indicating the need for urgent, specialized care.

Treatment by a specialist in otorhinolaryngology (usually surgical and in-hospital, and often as part of an interdisciplinary collaboration) is needed, in particular, for clinical entities that may be life-threatening, such as otogenic or sinugenic complications, neck abscesses, angioedema, posterior epistaxis, tumor hemorrhages, and foreign bodies in the respiratory tract, as well as inner ear diseases that cause severe vertigo and vomiting.

The rising number of patients presenting to emergency rooms presents a challenge to all affected areas of the health care system. The physician in the emergency room has the task of recognizing the risk of serious complications in certain clinical situations with nonspecific symptoms that may seem harmless, and of obtaining specialized care for these patients in a timely manner. The "red flags" presented in this article can serve as an initial guide to ENT emergencies.