Trauma in Otolaryngology

190 Pages·2018·3.848 MB·English

by  Jayita Das (auth.)

Jayita Das
Trauma in
Otolaryngology
123
Trauma in Otolaryngology
Jayita Das
Trauma in Otolaryngology
Jayita Das
Department of Otolaryngology
Pondicherry Institute of Medical Science
Kalapet
Pondicherry
India
ISBN 978-981-10-6360-2 ISBN 978-981-10-6361-9 (eBook)
https://doi.org/10.1007/978-981-10-6361-9
Library of Congress Control Number: 2017958869
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Foreword
Trauma in ENT practice is fairly common, but its severity varies from trivial to a
life-threatening emergency such as airway obstruction. The general practitioner is
taught the basics of treating minor trauma and the initial lifesaving skills in dealing
with major trauma before transferring the patient/casualty to the appropriate center
for specialized care. The ENT surgeon, on the other hand, is expected to manage
any ENT emergency regardless of whether he or she is practicing in a standalone
clinic or a tertiary referral hospital. However, the emergency surgical skills are not
learned fully during the training phase, due to many reasons, one being paucity of
time and the second being exposure to real emergencies.
This practical textbook written by Dr Jayita Das—associate professor,
Department of ENT, Head & Neck Surgery, Pondicherry Institute of Medical
Sciences—gives a detailed description of all kinds of trauma that an ENT or casu-
alty medical officer may have to face. The pathophysiology, management princi-
ples, techniques, as well as prognosis have been described along with function
restoration. I compliment the author for taking up a topic which is applicable and
useful, for both a GP and the ENT doctor. The topics have been dealt with system-
atically and covered in depth with good illustrations. The quiz at the end attempts to
test the reader in assessing his/her level of competence after reading this excellent
book. This book is recommended for all medical practitioners and especially ENT
doctors. I congratulate the author for her excellent overview of the subject and clar-
ity in expression. I wish her the very best for the success of this maiden attempt and
wish her more success in future publications.
A. Ravikumar, MS, DNB, DLORCS (England), FAMS,
Department of ENT, Head & Neck Surgery,
Sri Ramachandra Medical College & Research Institute,
Chennai, India
v
Preface
If only the human body could handle trauma as well as biotechnology stocks do.
Spy novelist Alex Berenson was perhaps ignorant of the truth about the human
body, and its ability to handle trauma, better and more efficiently than one could
imagine.
But there is a caveat here. It does matter which part of the human body suffers
the trauma and what is the magnitude of the injury.
Trauma can range from major to miniscule, physical to psychological, and emo-
tional to electrical. Major trauma to the major organ systems—the cranial cavity,
airway, chest and lungs, abdomen, and pelvis and long bones—is usually fatal or at
least accompanied by a very high level of morbidity. Minor trauma, on the other
hand, may often go unnoticed and unremembered. Physical trauma may be exter-
nally obvious, but psychological trauma may fester for long periods of time and do
even more serious damage to the sufferer. Emotional trauma could stop the heart in
its tracks, literally, as could an electric shock running through the body.
It now becomes clear that it is almost impossible to predict or preempt trauma
and, further still, to formulate treatment policies that might apply to trauma in gen-
eral. Each type of trauma, and the body part it affects, must be considered as a sepa-
rate entity, and suitable management protocols devised.
Most of the literature on trauma describes the issues or problems surrounding the
wound and perhaps some host factors such as health, nutritional status, and immu-
nity. It would therefore be interesting to look at how numerous other factors, mainly
social and economic, directly or indirectly impact the outcomes arising out of
trauma or its treatment.
For example, much trauma or injurious insult results from urbanization of societ-
ies and the occurrence of motor vehicle accidents. Also, increased life spans, artifi-
cial life support, and assisted reproduction have added their peculiar imprint upon
the evolution of trauma in many parts of the globe. All these, coupled with the
monetary and educational standards of the population, and the health infrastructure
of that region, play an important role. They also define how a particular kind of
trauma might be dealt with using a particular level of expertise and thereby the final
consequence of the particular event.
There are some unique characteristics of trauma in ENT practice. Spanning the
entire gamut of major and minor trauma, there are also factors which should take
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viii Preface
into consideration demographic profiles and medicolegal aspects, besides the actual
business of management of the said trauma. For example, variations among differ-
ent age groups, rural and urban populations, and healthcare facilities available could
impact the way trauma is treated. Outcomes would also vary accordingly. It is
imperative to follow sound clinical practices, evidence-based medicine, and, of
course, a gut instinct in order to ensure that the best outcomes result from the treat-
ment of trauma.
Because trauma is sudden and unpredictable, the outcomes of managing it have
a telling impact upon the quality of life of the patient and reflect on the quality of
healthcare facility in general and the doctor in particular. This book therefore
endeavors to remind all practitioners of ENT the core principles of management of
trauma in this specialty. The chapters describing trauma in each region in the head
and neck are presented in a simple and comprehensive manner, with a background
or introduction about the relevant anatomy and pathophysiology, the body or main
text dealing with the clinical implications, and finally rounding off with a section on
prognosis, best practice, future directions, and/or practical applications. A brief and
gentle reminder of the embryological development of the ear and nose would hope-
fully serve to sensitize the reader to the implications of trauma to these organs of
special sense. The book follows an easy storytelling style instead of a bullet-point
handbook format, specifically with the aim to suit the casual reader, slow reader,
methodical reader, or even the reader who has no time to read!
The first three chapters deal with the history of trauma care and general princi-
ples in trauma, while the next three specifically discuss trauma in the ear, nose, and
throat regions. Chapter 7 describes eye trauma in the context of the ENT surgeon,
while Chap. 8 is devoted to foreign bodies, which may be considered to form a par-
ticular type of trauma or external insult. Controversies regarding trauma in various
regions of the head and neck are discussed in the respective chapters. Chapter 9
challenges trainees and practitioners alike with case scenarios taken from both insti-
tutional and independent settings. The last section provides a quick review in the
form of a quiz.
It is hoped that this book shall be able to provide everything the ENT practitioner
wanted to know about trauma in this specialty and that the management of trauma
will turn out to be a gratifying experience for both patient and doctor, in spite of the
daunting implications it carries for most individuals.
Kalapet, Pondicherry, India Jayita Das
Acknowledgment
The author wishes to convey her heartfelt gratitude to the following:
Professor Ravikumar—mentor and role model—for writing the Foreword of this
book.
Patients, resident doctors, peers, and superiors at the Pondicherry Institute of
Medical Sciences for the opportunity and purpose to take up this enterprise.
My colleagues in the Department of Radiology—Dr Linu Kuruvilla and
Dr Sreshtha Hegde—have helped me immensely with the sourcing of the images.
A special word of thanks goes to my residents Paresh Pramod Naik and Roshan
Marie Thomas for being friends, critics, and sounding boards.
And my family without whose love, patience, and support this would not have
been possible.
Photo credits for the images of outer ear trauma also go to Dr Paresh Naik.
Springer publishers for the valuable guidance and encouragement.
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About the Author
Jayita Das is an ENT specialist with more than 20 years of operative experience in

all areas of general otolaryngology practice, in both the private sector and institu-
tional settings dealing with postgraduate training. She is a firm believer in the phi-
losophy of patient-centered, evidence-based practice and an active educator at both
the undergraduate and postgraduate levels.
Her published works include more than 15 articles in indexed journals, in addi-
tion to textbook chapters in the Medscape (eMedicine) Online References. She is a
reviewer/editorial board member for several indexed national and international
journals. She authored the book Optimizing Medicine Residency Training Programs,
published by IGI Global in October 2015, and contributed a chapter on medical
errors in another publication by IGI Global.
She is also an avid mother, homemaker, trekker, travel writer, photographer and
amateur musician, and is currently engaged in academic practice at a tertiary care
facility in Pondicherry.
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Contents
Part: I Principles of Trauma Management in ENT, Head and Neck
1 Introduction and Historical Backdrop . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.1 The Background Is the Battleground . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.2 The Battleground in the Backyard . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
1.3 The Daily Battle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
1.4 The Battle Begins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
1.5 The Rules of the Battle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
1.5.1 Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
1.5.2 Classification and Types of Trauma . . . . . . . . . . . . . . . . . . . . 9
1.6 Winning the Battle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
2 General Considerations in Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
2.1 General Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
2.1.1 Time of Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
2.1.2 Place of Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
2.1.3 Nature of Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
2.1.4 Coverage of Costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
2.1.5 Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
2.1.6 In Cases of Polytrauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
2.2 Management Protocol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
2.3 Medicolegal Aspects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
2.4 Practical Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
2.4.1 Complications of Transfusion . . . . . . . . . . . . . . . . . . . . . . . . 24
2.4.2 Documentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
2.4.3 Communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
2.4.4 Antibiotic Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
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