SurgSpace / Specialties / Otolaryngology, Head & Neck
Otolaryngology, Head & Neck
Ear, nose, throat and the neck's compartments: the airway always first, the thyroid and the nerves that decide the voice, and the high-volume operations, tonsils, grommets, septum, whose small complication lists are learned precisely because the operations are so common.
After, and when it goes wrong
Post-op & Emergencies
The expected course, the ward reads, and the calls that cannot wait.
The expected course and the ward reads, then the complications and the calls that cannot wait.
On the ward
Three boards, three reads
POD 0 · total thyroidectomy
Voice slightly husky
Neck soft, drain 25 mL
Calcium due 06:00
Tingling around lips reported at 05:30
Which of these lines matters most?
The read
The tingling: perioral and fingertip paraesthesia is early hypocalcaemia announcing itself before the 06:00 blood test does, and it earns a calcium check now with replacement per protocol. The husky voice is documented and followed; the soft neck is reassuring but re-examined, since the haematoma drill is only useful before it is needed.
Day 3 · new tracheostomy
Sudden distress and noisy effort
Sats falling
Suction catheter will not pass
Inner cannula in situ
What is the drill?
The read
The blocked-tracheostomy sequence, in order and out loud: call for help, remove the inner cannula, attempt suction, deflate the cuff so air can pass around the tube, and if obstruction persists remove the tracheostomy tube entirely, in a patient with a patent upper airway, and manage from the face while help arrives. The drill is printed at the bedhead precisely so that nobody has to invent it at 3 a.m.
Evening · child admitted after herald bleed
No further bleeding for 6 hours
Swallowing frequently in sleep
HR creeping 96 to 118
Parents asking about discharge
What is the swallowing telling you?
The read
Possibly that the bleeding has restarted where it cannot be seen: frequent swallowing in a sleeping post-tonsillectomy child is blood being swallowed until proven otherwise, and the creeping heart rate seconds the concern. Wake and examine the fossae, recheck observations against age-based norms, keep the child fasted, and escalate early: children compensate silently and then abruptly stop.
Emergencies
The calls that cannot wait
Acute stridor
Recognise: Noisy inspiration with voice change, drooling or fatigue: an upper airway narrowing on a trajectory.
First move: Do not lie them flat, do not instrument the mouth, do call senior anaesthesia and ENT to the bedside now: the plan is made before the crisis, in the room.
Post-tonsillectomy haemorrhage
Recognise: Any bleeding after tonsillectomy, classically day 5 to 10: herald bleeds rehearse bigger ones, and children hide their losses by swallowing.
First move: Every one comes in: assess the fossae, gain access, group and save, and escalate the active bleed to theatre early, with induction planned around a stomach full of blood.
The expanding neck haematoma
Recognise: Tense swelling, anxiety, voice change or stridor after thyroid, parathyroid or carotid surgery: pressure building millimetres from the airway.
First move: Open the wound at the bedside if the airway is threatened, clips out, layers released, and call anaesthesia and the surgeon in the same breath: saturation is the last number to fall, not the first.
Uncontrolled epistaxis
Recognise: Bleeding through correct pressure and packing, or posterior trickle behind an anterior pack, often on anticoagulation.
First move: Resuscitate like any haemorrhage, climb the ladder without lingering, and involve ENT early for posterior packing, ligation or embolisation, with the anticoagulation decision run in parallel.
Hub shaped by the Surgical Specialties Lead with the ENT reviewer (open seat). Images and videos carry their source; educational use for supervised learning, not clinical guidance.