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Danger Signs in Otolaryngology
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In any branch of medicine, there are certain conditions which should always be kept in back of the mind so as not to miss them as a diagnosis. In the field of ear nose and throat surgery too a few golden rules are applicable. The following are a few which I think are of paramount importance, not only to the specialist in ha field, but also to any clinician or even the layman.
Hoarseness
"The croaky voice"
If a person gets a hoarse voice that is not responding to treatment after a reasonable time, it is compulsory to have a look at the vocal cords. A reasonable length of time would be 2 weeks in my opinion.
Why?
Because the diagnosis not to miss is a carcinoma of the vocal cords
Dysphagia
"The Swallow which doesn't Swallow"
If a person develops dysphagia for which a definite diagnosis has not been attributed, it compulsory to investigate in full with endoscopic and radiological studies.
Why?
Because the diagnosis not to miss is a carcinoma of the oesophagus
Unilateral Deafness
"The ear which can't hear"
If a person develops deafness on one side, which maybe sensory neural deafness or, conductive deafness, it has to be investigated fully.
Why?
Because the diagnoses not to miss are either an acoustic neuroma or a naso pharyngeal carcinoma respectively.
Enlarging Maxilla
"The teeth becomes loose, and the denture doesn't fit"
If a person notices that the teeth are becoming loose or the spaces between them are widening or, that the denture becomes difficult to insert, it is vital to look for a possibility of a maxillary pathology.
Why?
Because a carcinoma of the maxilla is one reason for these symptoms to appear, and must be diagnosed early as possible.
Nasal Bleeding
"A little bit of blood with mucus"
A blood stained nasal discharge, specially in an elderly person should indicate a complete nasal and sinus evaluation. The bleeding maybe mild as compared to epistaxis, but should be considered an important clinical feature.
Why?
Because the diagnosis not to be missed is a carcinoma of the nose or sinuses
Complicated Ottitis Media
"Whether acute or chronic, can complicate"
If a person with acute or chronic suppurative ottitis media develops symptoms such as headache, vomiting, fever, pain. vertigo or a facial nerve palsy, it must be considered with grave concern.
Why?
Because such symptoms could be the result of intracranial extension of the disease. This may or may not be associated with a cholesteatoma.
Acute Epiglottitis
"The hot potato in the mouth voice"
If a child develops fever and difficulty in swallowing, which progresses rapidly over a short period of time, and the child starts to drool and is quite ill, appropriate medical attention is needed without a seconds delay.
Why?
Because the diagnosis of acute epiglottitis is staring in your face, and every minute delayed, makes it that bit more worse with the possibility of fatal consequences.
Aspirated Foreign Body
"A child should not have access to small items which maybe inhaled"
If a child is brought with a history of developing an unusual episode of coughing, with or without evidence of respiratory obstruction and cyanosis, and the child is quite normal at the time seen by the doctor, it is vital to examine the child carefully without concluding that everything is O.K.
Why?
More than one foreign body aspirations into the lung have been missed due to the apparent normal appearance of the child.
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Authors note - this list is continually being modified. Please feel free to send me any other clinical situations which you feel should be included in this page
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