URIs are the most common ENT complaints usually presenting as nasal copious watery nasal discharge, nasal congestion, sore throat and malaise. Viral infections predominate, but bacterial infections like Streptococcus can complicate URIs.

Symptomatic treatment (rest, fluids, analgesia) is often sufficient for viral infections as they tend to be self-limiting between 7-10daysAntibiotics should be reserved for bacterial complications, such as sinusitis or bacterial tonsillitis. These are generally determined by throat swabs and usually are broad-spectrum. Most commonly, penicillin-based antibiotics are considered as first-line. Educate the public about the rational use of antibiotics to reduce resistance.

Acute Otitis Media (is prevalent in Children across many parts of the world. It is often self-limiting and results from confluent infections of the upper respiratory tract which is most commonly viral in origin with possible bacterial superimposition

Initial treatment usually comprises adequate hydration and pain control with dose-appropriate paracetamol or ibuprofen. Antibiotics are indicated if symptoms persist after 3-5 days or worsen rapidly within a shorter period, or in the presence of complications at presentation such as mastoiditis, meningitis, facial paralysis etc. Address contributing factors such as overcrowding, malnutrition, exposure to indoor smoke, and upper respiratory tract infections.

Hearing loss is common in Sub-Saharan Africa, often due to untreated ear infections, ototoxic drugs, or noise exposure.

Early screening of neonates for congenital hearing loss and routine hearing screening in children can help in early detection and prevent associated speech delays with its potentially catastrophic effects on their overall development, social integration and literacy Initial assessment should include an otoscopy to identify readily reversible causes such as wax impaction, external and middle ear infections and foreign bodies. Ototoxicity (drug-induced hearing loss) is a major cause of irreversible hearing impairment. Carefully consider the risk-benefit ratio of prescribing implicated drugs (such as aminoglycosides and loop diuretics etc), especially in patients with pre-existing ear symptoms such as tinnitus, vertigo, and hearing loss. Encourage safe work environments among industrial workers, and safe listening practices especially with insert ear phones, to prevent noise-induced hearing loss. Promote public health initiatives for education on ear hygiene and prevention of infections.

Rhinosinusitis is classified as acute or chronic depending on whether it has lasted for up to 12 weeks or not. While acute rhinosinusitis is mostly infective in origin (viral or bacterial), chronic rhinosinusitis may be aetiologically infective or allergic.

Management of Acute rhinosinusitis includes saline nasal irrigation, nasal decongestants and topical corticosteroids, oral NSAIDS/ Paracetamol and treating allergies, if present, with antihistamines. Antibiotics are indicated if symptoms persist beyond 10 days, or there is a worsening of purulent nasal discharge, cough and fever after an initial period of improvement. Chronic or recurrent acute rhinosinusitis require evaluation by an ENT surgeon and may warrant surgical intervention.

Acute tonsillitis is common in Children but could occur at any age, and can manifest with severely painful swallowing, consequent reduced oral intake, dehydration and sepsis. Other complications include obstructive sleep apnoea, Acute glomerular nephritis and rheumatic heart disease. This infection is frequently viral or bacterial, but could be fungal or parasitic in origin

Viral tonsillitis is invariably self-limiting. Symptom control can be gained with oral paracetamol, NSAIDS, warm saline gargles and adequate hydration. Antibiotics are indicated if symptoms persist beyond 5 days or if they are severe ab initio such as being associated with follicular or membranous exudates on the surface of the tonsil. Penicillin-based antibiotics, clarithromycin and erythromycin are considered first-line and are given along with other medications as per viral tonsillitis. i. A Tonsillectomy is considered for patients with recurrent episodes of acute tonsillitis of 7 or more in a 12 month period, or at least 5 episodes in each year for 2 consecutive years, or 3 or more episodes in each year for 3 consecutive years. A Tonsillectomy may also be considered for other reasons such as tonsillar hypertrophy associated with obstruction to swallowing or sleep-disordered breathing. Ensure proper perioperative care and management of potential bleeding.

Epistaxis usually results from trauma which could be self-inflicted during nose-picking, particularly in children, or following external trauma from road traffic accidents, assault or contact sports. Other causes include drug-induced events from the use of blood thinners, antiplatelets and NSAIDS, bleeding diathesis, nasal infections and tumours. Hypertension significantly aggravates epistaxis and is also considered a predisposing factor.

Initial management largely depends on the severity of the nosebleed, especially in polytraumatized patients following severe accidents. Always follow the Advanced Trauma Life Support protocol of the American College of Surgeons in the resuscitation of all such cases. First-line treatment for haemorrhage control involves, where feasible, positioning the Patient in Trotters position: Sitting up, leaning slightly forward, pinching the soft part of the nose tightly together with the mouth open for 10 minutes. This measure could be augmented by having an assistant place an icepack on the forehead or the bridge of the nose. Also consider giving dose appropriate IV Tranexamic acid. If this measure fails to stop the nosebleed, consider cauterization if a point bleed is identified and the skill set for the procedure is available. If not, consider gentle packing of the nasal cavities with gauze generously lubricated with KY-Gel, and urgent referral to an ENT surgeon. Check blood pressure in adults, as uncontrolled hypertension is a frequent contributor. The management of epistaxis is not complete until the primary cause is identified and treated. Educate the public on preventive measures such as open mouth sneezing, and avoidance of nose-picking particularly during the dry seasons of the year.

The most common sites are the oropharynx, nasopharynx, larynx and the nose/paranasal sinuses. Other sites of head and neck cancer include the salivary glands, oral cavity, hypopharynx, upper oesophagus, and the thyroid gland. Major identified risk factors include viruses such as Human Papilloma virus, Epstein-Barr virus and the Human Immunodeficiency Virus, tobacco use either by smoking or chewing, alcohol intake and malnutrition, specifically vitamin D and micronutrient deficiency.

Late-stage presentation is common, making management more challenging.

Emphasize early detection through screening and public awareness campaigns. Red-flag symptoms such as hoarseness lasting for than 2 weeks, inexplicable epistaxis, persistent nasal congestion, recent-onset snoring and anosmia, persistent painful or difficult swallowing, particularly in a known smoker should warrant an urgent ENT referral. Tobacco and alcohol consumption as well as unsafe sexual practices such as orogenital sex with multiple partners are common risk factors that should be addressed through education. Definitive management would depend on the primary site, extent and the physiologic reserve of the patient. Advanced disease may require comprehensive palliative care to ameliorate the morbidity that results from the profound affectation of basic physiologic functions such as breathing, swallowing and talking. Palliative care services should be established and available for patients with terminal illness.

Children often present with foreign bodies in the ear, nose, or throat.

Urgent removal is required, especially if the airway is compromised or the foreign body is considered a considerable hazard such as with button batteries. With all foreign bodies in the ears, nose and oropharynx, especially in Children, your first chance of removal is your best chance of removal. It is important that this initial attempt be maximized by using appropriate instruments and proper illumination such as a bright headlight. In the absence of these, it is safer to urgently refer to a skilled physician or an ENT surgeon. Keep in mind that measures such as the Heimlich manoeuvre in adults and the paediatric foreign body airway obstruction protocol of the Resuscitation council UK remain first-line for aspirated foreign bodies. Educate parents about the dangers of small objects around children and timely presentation to an adequately skilled healthcare provider. Preventive measures in adults include avoiding the use of cotton buds and other foreign bodies to “clean” the ears, avoiding holding foreign bodies between the teeth such as sewing needles, office pins and toothpicks, removing temporary dentures before eating, careful and thorough chewing of food before swallowing.

Facial trauma, including fractures of the nose and mandible, are common due to road traffic accidents and violence. The nose is the most prominent feature of the midface, and therefore its most commonly traumatized part.

Where necessary, resuscitation must proceed according to the Advanced Trauma Life Support protocol. Immediate stabilization of the airway, breathing, and circulation (ABC) is crucial. closed reduction of simple nasal fractures can often be performed in a primary healthcare setting. These are usually done to correct functional problems associated with breathing and overt cosmetic deformities, and should be carried out either within the first few hours after trauma or attempted after associated oedema has resolved. More complex nasal fractures, or delayed presentation would generally require surgery (septorhinoplasty) Referral to specialized centers for more complex maxillofacial injuries is necessary.