Wilderness and Rescue Medicine 7th Edition Jeffrey Isaac, PA-C and David E. Johnson, MD

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Section VI: Backcountry Medicine

or a local allergic reaction to something in the environment. Decongestants and antihistamines may offer some relief. Antibiotics are not helpful or necessary.

symptoms develop, there is no emergency. Avoid swimming and diving and see a medical practi- tioner when possible.

Middle Ear and Sinus Infection Anticipate: • Pain • Spread of infection Treatment: • OTC decongestants • Inhaled steam • Saline irrigation • Antibiotics if symptoms persist “… the situation can be improved with drainage.” Middle ear Eustachian tube Inner ear Serious: • Persistent fever • Severe pain • Swelling • Altered mental status • Ataxia • Vomiting Middle Ear and Sinus Infection

General Principles

General Principles

Middle Ear and Sinus Infection

Tympanic Membrane

Inner Ear

Eustachian Tube

Middle Ear

Mechanisms: • Obstruction to infection • Water infiltration

Nasal Sinuses

“Problems begin when the tube becomes obstructed and mucous accumulates.”

©2018WMA

©2018WMA

A more serious bacterial infection will cause severe pain, fever, and a bloody green nasal dis- charge. Involvement of the maxillary sinus in the face can feel like a dental infection in the upper teeth, but you won’t find one specific tooth that is tender to percussion. Serious middle ear and sinus infection carries the anticipated problem of spread to adjacent structures like the skull, inner ear, and brain. As with any obstructed organ, the situation can be improved with drainage. Try to reduce the swell- ing and obstruction of the eustachian tube and sinus passages with decongestant nasal spray or by having the patient breathe steam from a pot of hot water. Keeping your patient well hydrated is important. This will keep mucous from drying and becoming too thick to drain. Antibiotics are sometimes necessary for com- plete treatment of more serious middle ear and sinus infections if the patient is not responding to decongestion and hydration. A middle ear infection may ultimately perforate the eardrum and drain spontaneously through the external ear canal. Pain is almost immediately relieved as the pressure is released, but hearing may be temporarily impaired. If no fever or other adverse Treatment of Middle Ear Infection and Sinusitis

General Principles

“Red flags for ear and sinus infection reflect the anticipated problem inner ear involvement and systemic infection.”

©2018WMA

Treating infection of the other sinus cavities is similar, except that there is no safety valve like the eardrum for perforation and drainage if neces- sary. Aggressive decongestion and hydration to promote drainage through the sinus passages may improve symptoms and cure the infection. Sinus infection not responding to field treatment is best evacuated to medical care, especially if moderate pain or fever is present. Steroid nasal sprays may be prescribed to reduce inflammation and swell- ing. Antibiotic therapy, sometimes for several weeks, is indicated in resistant cases. Sore Throat Most sore throats are caused by viral infection and occur as part of a constellation of symptoms related to a cold or flu. These are self-limiting and require only treatment to relieve symptoms.