شعار تجمع حفر الباطن الصحي
بوابة أطباء الرعاية الصحية الأولية
تجمع حفر الباطن الصحي — Hafr AlBatin Health Cluster

تجمع حفر الباطن الصحي

Ear, Nose and Throat (ENT)

Otitis Externa

Routine — روتيني
  • Recurrent otitis externa (≥3 in 12 months) despite appropriate therapy.
  • Significant canal stenosis preventing effective topical treatment.
  • Eczema/psoriasis/dermatologic conditions of the canal complicating treatment.
  • Chronic otitis externa (>3 months).
Urgent (<5 days) — عاجل (< 5 أيام)
  • Persistent symptoms despite appropriate therapy.
  • Granulation tissue or persistent otorrhea in diabetic/immunocompromised → early MOE concern.
  • Severe unrelenting otalgia disproportionate to exam in high-risk patients.
Immediate (ER referral) — فوري (طوارئ)
  • Suspected malignant (necrotizing) otitis externa with cranial nerve involvement.
  • Systemic toxicity (high fever, altered mental status, sepsis).

Cerumen Impaction

Routine — روتيني
  • Refractory after failed PHC removal attempts.
  • Anatomical abnormalities making safe removal difficult.
  • Recurrent symptomatic impaction requiring frequent removal.
  • Surgically altered ears (e.g., mastoid cavity).
Urgent (<5 days) — عاجل (< 5 أيام)
  • Persistent otorrhea or foul discharge after removal.
  • Severe pain after removal — canal injury or TM perforation.
  • Sudden SNHL mistakenly attributed to cerumen.
Immediate (ER referral) — فوري (طوارئ)
  • Significant bleeding post-removal with active arterial bleeding.

Dizziness

Routine — روتيني
  • Persistent/recurrent vertigo not responsive to initial treatment.
  • Suspected Ménière's, vestibular migraine, or other central/inner-ear causes.
  • Progressive hearing loss with vertigo (vestibular schwannoma).
  • Multifactorial dizziness with falls in elderly.
Urgent (<5 days) — عاجل (< 5 أيام)
  • Dizziness with non-acute neurological signs (diplopia, dysarthria, ataxia, unilateral weakness).
  • Persistent imbalance increasing fall risk in older adults.
Immediate (ER referral) — فوري (طوارئ)
  • Signs of stroke / posterior circulation TIA.
  • Acute vestibular syndrome with red flags (vertical/direction-changing nystagmus, skew deviation, new hearing loss).
  • Severe dehydration from protracted vomiting.

Hearing Loss

Routine — روتيني
  • Persistent unilateral or bilateral hearing loss >4 weeks without reversible cause.
  • Asymmetric SNHL (confirmed) — retrocochlear pathology workup.
  • Progressive hearing loss impacting QoL (esp. children with speech delay).
  • Recurrent/chronic OM with hearing loss → tympanostomy.
Urgent (<5 days) — عاجل (< 5 أيام)
  • Sudden SNHL — rapid onset over <72h → treat within 14 days (steroids).
  • Hearing loss with severe vertigo, facial weakness, persistent severe tinnitus.
Immediate (ER referral) — فوري (طوارئ)
  • Hearing loss with central neuro signs (confusion, weakness, vision changes).
  • Acute hearing loss after head trauma (± CSF otorrhea).
  • Meningitis signs after ear infection or surgery.

Allergic & Chronic Rhinitis

Routine — روتيني
  • Persistent/severe symptoms unresponsive to optimal pharmacotherapy + environmental control for ≥3 months.
  • Consideration of allergen-specific immunotherapy.
  • Diagnostic uncertainty (unilateral symptoms, purulent drainage >10 days, suspected polyps).
  • Associated comorbidities (asthma, recurrent sinusitis, OME).
Urgent (<5 days) — عاجل (< 5 أيام)
  • Severe nasal obstruction causing sleep-disordered breathing or suspected OSA — esp. pediatric (adenotonsillar hypertrophy).
Immediate (ER referral) — فوري (طوارئ)
  • Orbital or intracranial complications of sinusitis (proptosis, vision changes, ophthalmoplegia, AMS).
  • Anaphylaxis triggered by allergen exposure.

Adenotonsillar Hypertrophy

Routine — روتيني
  • Persistent nasal obstruction, mouth breathing, hyponasal speech.
  • Suspected OSA.
  • Recurrent tonsillitis — ≥7/yr, or ≥5/yr × 2 yrs, or ≥3/yr × 3 yrs.
  • Chronic halitosis, dysphagia, or voice change.
Urgent (<5 days) — عاجل (< 5 أيام)
  • Persistent OME or recurrent AOM with enlarged adenoids.
  • Failure to thrive related to sleep-disordered breathing.
Immediate (ER referral) — فوري (طوارئ)
  • Airway obstruction: severe stridor, significant retractions, cyanosis.
  • Peritonsillar or retropharyngeal abscess.

Epistaxis

Routine — روتيني
  • Recurrent mild anterior epistaxis despite conservative measures.
  • Suspected underlying cause needing ENT workup.
Urgent (<5 days) — عاجل (< 5 أيام)
  • Frequent epistaxis with anemia or requiring repeated packing.
  • Epistaxis on anticoagulation / bleeding disorder, currently controlled.
Immediate (ER referral) — فوري (طوارئ)
  • Profuse bleeding not controlled with anterior packing.
  • Posterior epistaxis (blood in oropharynx) — airway risk.
  • Hemodynamic instability.

Chronic Rhinosinusitis / Nasal Polyposis

Routine — روتيني
  • Symptoms >12 weeks despite maximal medical therapy.
  • Nasal obstruction / anosmia affecting QoL.
  • Suspected nasal polyps needing endoscopic assessment.
Urgent (<5 days) — عاجل (< 5 أيام)
  • Unilateral persistent obstruction ± purulent/bloody discharge (rule out tumor).
  • Recurrent acute sinusitis ≥4/year.
Immediate (ER referral) — فوري (طوارئ)
  • Orbital / intracranial complications.

Hoarseness

Urgent (<5 days) — عاجل (< 5 أيام)
  • ≥2 weeks despite treatment OR red flags: weight loss, neck mass/lymphadenopathy, dysphagia/odynophagia, hemoptysis.
  • New-onset hoarseness in professional voice users.
Immediate (ER referral) — فوري (طوارئ)
  • Hoarseness with stridor or airway obstruction (severe distress, angioedema, epiglottitis).
Initial PHC treatment: voice rest, hydration, avoid irritants, limit throat clearing, PPI trial if GERD suspected.

Neck Masses / Lymphadenopathy

Routine — روتيني
  • Persistent neck mass >2–3 weeks without infection history.
  • Suspicion of benign lesions (lipoma, branchial cleft cyst) needing excision.
Urgent (<5 days) — عاجل (< 5 أيام)
  • Suspicious mass (firm, fixed, >2 cm, >3 weeks) or with hoarseness/dysphagia/otalgia.
  • Asymmetric tonsillar enlargement or firm fixed cervical node.
Immediate (ER referral) — فوري (طوارئ)
  • Rapidly enlarging painful mass with airway compromise (Ludwig’s angina, peritonsillar / deep neck abscess).
  • Systemic toxicity (fever, sepsis).

Other ENT indications

Routine — روتيني
  • Mild facial or nasal trauma without airway compromise.
  • Benign oral lesions or small painless neck swellings.
  • Stable chronic ear conditions.
  • Chronic sialadenitis without pain.
Urgent (<5 days) — عاجل (< 5 أيام)
  • Unilateral nasal obstruction / persistent unilateral epistaxis (tumor suspicion).
  • Facial nerve palsy with chronic ear infection (cholesteatoma risk).
  • Persistent oral ulcers >2–3 weeks.
  • Progressive dysphagia.
Immediate (ER referral) — فوري (طوارئ)
  • Airway compromise from any ENT cause.
  • Foreign body with respiratory distress.
  • Peritonsillar abscess with trismus.
  • Septal hematoma after nasal trauma (drain within 48 h).
  • Deep neck infection.