耳鼻咽喉科救急患者への対応 Management of Otorhinolaryngologic Emergent Diseases
Otorhinolaryngologic emergent diseases are sometimes life-threatening involving airway problems such as acute epiglottitis, peritonsillar abscess, deep neck infections and foreign bodies in the trachea and bronchus.<br>With regard to acute epiglottitis, this disease occurs mainly in adults in Japan, while it is common among children in European countries and North America.<br>Recently, however, an increased incidence of this disease has been reported both in Japan and abroad. The mortality rate was about 1.3% in our series.<br>Peritonsillar abscess is one of the most common emergent diseases in otorhinolaryngologic practice. The male: female ratio is about 3 to 1 and it is seen more often in males.<br>The peak incidence is the third decade. Anaerobic bacteria were detected in 62% of the patients.<br>As complications, deep neck infection, laryngeal edema and mediastinal abscess were found in 1.0%, 0.6%, and 0.3% of patients, respectively.<br>Deep neck infection is also a life-threatening disease when it extends to the mediastinum.<br>Basically, abscess in the neck should be excised and drained outward as soon as possible. However, early abscess or small abscess could be initially treated by intravenous administration of high-dose antibiotics. The indication for antibiotics for neck abscess has not yet been clearly demonstrated. Foreign bodies in the trachea and bronchus are decreasing in Japan in recent years. This may be due to increased education and awareness of public health in our society.<br>Since fiberoptic bronchoscopy has become common in our medical practice, foreign bodies have been removed by chest physicians using fiberoptic bronchoscopes more often than by otorhinolaryngologists using rigid bronchoscopes. Therefore, the role of otorhinolaryngologists in removing foreign bodies is now showing an annual reduction. However, foreign bodies in the trachea and bronchus of children should still be removed by rigid ventilating bronchoscopes, becuase fiberoptic bronchoscopes are not available for children.<br>Otorhinolaryngologists are still responsible for treating this condition.
耳鼻咽喉科臨床 95(3), 213-220, 2002-03-01