ABSTRACT
The comatosed patient is a disabled subject. The defense reflexes [e.g. sneezing and coughing] are impaired. Most of the care is directed towards the vital signs, blood gases monitoring and care of chest. The aim of this study is to detect the possible hazards that affect the upper respiratory tracts of comatosed ICU patients to reach useful conclusions for the E.N.T. care needed for them to avoid these hazards. Our study was done upon 34 comatosed ICU patients. We found that sinusitis, mainly caused by Gram-ve bacteria and anaerobes, was a common complication [50%], mostly the maxillary sinus. Tympanogram type B, indicating M.E.E, was a common finding [24%]. Nasal intubation increased the incidence of sinusitis and MEE markedly, and was mostly on the ipsilateral side. Laryngotracheal complications were found in 12 [35%] cases, and the most frequent complication was tracheal stenosis then vocal cord granuloma and immobility. All cases with laryngotracheal complications were having endotracheal intubation [nasal or oral] especially when two intubations [gastric and endotracheal] were present in the same patient. The incidence of sinusitis, MEE,and laryngotracheal complications were significantly correlated with the duration of intubation, nasal and/or throat colonization on admission, pneumonia and association of general diseases. This study showed that daily E.N. T. examination is mandatory for ICU patients for the early detection of complications. The sinusitis and pneumonia were mostly caused by Gram-ve bacilli and anaerobes and this must be met with the proper antibiotics. CT scan on the nose and paranasal sinuses is mandatory on admission and serially thereafter for the early detection and treatment of hidden sinusitis. Oral intubation is preferred nasal intubation, avoid high-pressure cuff, avoid endotracheal reintubation if possible, the intubation must be as shorter as possible and avoid double intubation in the same patient [endotracheal and gastric]. Tracheostomy is preferred [in the first 7 days], tympanometry are mandatory to detect Eustachian tube obstruction, MEE or infection. Serial PH monitoring of the pharynx, for early detection of gastro-esophageal reflux, is essential and the ICU staff must be aware of the occult E.N.T. hazards of coma