Ear, Nose, and Throat Complaints in Urgent Care: A Practical Approach to Otalgia, Sore Throat, Sinus Symptoms, Epistaxis, and ENT Emergencies

Why ENT complaints require disciplined examination

ENT symptoms account for a large share of urgent-care visits. Most are uncomplicated and self-limited, but their familiarity creates a risk: the clinician may stop reasoning after recognizing a common symptom pattern. “Ear infection” may actually be otitis externa, middle-ear effusion, referred dental pain, temporomandibular disease, mastoiditis, or sudden sensorineural hearing loss. “Sore throat” may be viral pharyngitis, group A streptococcal infection, peritonsillar abscess, retropharyngeal infection, epiglottitis, or an evolving airway emergency.

The urgent-care task is not simply to select an antibiotic. It is to localize the affected structure, determine whether the disease is uncomplicated or invasive, identify threats to airway, vision, hearing, neurologic function, or circulation, and choose a safe disposition.

Start with airway and physiologic stability

Before focusing on an ear or throat, assess general appearance and obtain a complete set of vital signs. Observe whether the patient can speak normally, manage secretions, drink, and breathe comfortably. Do not force an agitated child with suspected upper-airway obstruction into a position that worsens distress.

Emergency evaluation is generally indicated for:

• Stridor, respiratory distress, cyanosis, tripod positioning, drooling with inability to swallow, rapidly progressive voice change, or suspected epiglottitis
• Expanding floor-of-mouth or neck swelling, tongue elevation, trismus with toxicity, or concern for Ludwig angina or deep-neck infection
• Unilateral pharyngeal swelling with airway symptoms, severe dehydration, sepsis, or extension beyond a straightforward peritonsillar process
• Neck stiffness or swelling, torticollis, toxic appearance, or neurologic symptoms concerning for retropharyngeal or parapharyngeal infection
• Sudden facial weakness, focal neurologic deficit, severe headache, meningismus, altered mental status, or intracranial complication
• Proptosis, ophthalmoplegia, pain with eye movement, reduced vision, afferent pupillary defect, or severe orbital symptoms
• Postauricular swelling or erythema with auricular displacement, systemic illness, or suspected mastoiditis
• Sudden hearing loss that may be sensorineural, particularly with neurologic findings
• Uncontrolled epistaxis, hemodynamic instability, major blood loss, airway compromise, or posterior bleeding
• Button battery in the nose or ear, penetrating trauma, caustic exposure, or airway foreign body
• Severe otalgia in a patient with diabetes or immunocompromise when invasive external-ear infection is possible

Normal oxygen saturation does not exclude a threatened upper airway. Likewise, absence of fever does not exclude a serious infection in an older or immunocompromised patient.

Localize the complaint before naming the disease

ENT evaluation becomes more reliable when the clinician asks which anatomic compartment is involved.

• External ear: Auricle, tragus, canal, and surrounding soft tissue
• Middle ear: Tympanic membrane and air-containing middle-ear cleft
• Inner ear or auditory nerve: Cochlear and vestibular structures; sensorineural function
• Nose and sinuses: Anterior nasal cavity, septum, turbinates, and paranasal sinuses
• Oropharynx: Tonsils, soft palate, uvula, posterior pharynx, and tongue base
• Deep neck: Peritonsillar, retropharyngeal, parapharyngeal, and submandibular spaces
• Referred sources: Teeth, temporomandibular joint, cervical spine, salivary glands, larynx, and head or neck tumors

A symptom label should never substitute for direct visualization when visualization is feasible and safe.

Focused history

Onset and trajectory

Determine whether symptoms began suddenly or gradually and whether they are improving, stable, or rapidly worsening. Sudden hearing change over hours is different from chronic cerumen-related fullness. “Sinus pressure” for three days is different from persistent symptoms beyond ten days or improvement followed by a second deterioration.

Ear-specific questions

Ask about laterality, hearing change, tinnitus, vertigo, drainage, water exposure, instrumentation, trauma, air travel, recent upper-respiratory infection, previous perforation, tubes, surgery, hearing devices, and severe nocturnal pain. Clarify whether pain is triggered by chewing or jaw movement. Diabetes and immunocompromise increase concern for invasive infection.

Nose and sinus questions

Ask about obstruction, discharge, facial pain or pressure, smell change, fever, dental pain, allergy symptoms, epistaxis, trauma, intranasal medication or drug use, anticoagulants, and recurrent unilateral symptoms. Determine duration and whether there was “double worsening” after initial improvement.

Throat and neck questions

Ask about cough, rhinorrhea, hoarseness, conjunctivitis, oral ulcers, fever, odynophagia, dysphagia, drooling, voice change, trismus, neck pain or stiffness, unilateral symptoms, rash, sexual exposure, recent antibiotics, immunization status, and contact with group A streptococcal infection. Clarify whether the patient can swallow liquids and secretions.

Host and medication factors

Review age, pregnancy, allergies and their reaction phenotype, renal or hepatic disease, diabetes, immune status, anticoagulant or antiplatelet use, tobacco and alcohol exposure, prior resistant organisms, recurrent infections, recent hospitalization, and previous ENT procedures.

Focused examination

General and airway examination

Record appearance, work of breathing, voice, secretion control, hydration, and ability to open the mouth. Inspect and palpate the neck for swelling, tenderness, asymmetry, fluctuance, crepitus, lymphadenopathy, and range of motion. Do not aggressively depress the tongue or examine the throat in a way that delays airway management when epiglottitis is suspected.

Ear examination

Inspect the auricle, mastoid, tragus, and canal before viewing the tympanic membrane. Document canal edema, erythema, debris, discharge, foreign body, vesicles, and tenderness with tragal pressure or auricular manipulation.

For the tympanic membrane, document:

• Degree of bulging or retraction
• Opacity, translucency, and landmarks
• Perforation or tube status
• Effusion and air-fluid level when visible
• Mobility with pneumatic otoscopy when available and appropriate
• Otorrhea and its likely source

A tympanic membrane can appear erythematous from crying, fever, or canal irritation. In children, the AAP recommends diagnosing acute otitis media when there is moderate-to-severe tympanic-membrane bulging or new otorrhea not caused by otitis externa; mild bulging requires recent otalgia or intense erythema. Middle-ear effusion should be present.[1]

When hearing loss is reported, perform and document a basic hearing assessment. A whispered voice or finger rub can screen gross asymmetry. Weber and Rinne testing can help distinguish conductive from sensorineural loss, but imperfect technique or equivocal results should not create false reassurance.

Nasal and sinus examination

Inspect the anterior septum, mucosa, turbinates, discharge, visible bleeding site, foreign body, and septal swelling. Bilateral boggy or pale turbinates may support allergic rhinitis, but color alone is not diagnostic. Facial tenderness is nonspecific and should not be used alone to diagnose bacterial sinusitis.

After nasal trauma, specifically assess for a septal hematoma: soft, fluctuant, often bilateral septal swelling that can obstruct the airway and does not shrink with topical vasoconstrictor. This requires urgent drainage by a clinician with appropriate expertise because delayed treatment can cause cartilage necrosis and deformity.

Mouth, throat, and neck examination

Use adequate light. Inspect lips, dentition, gingiva, tongue, floor of mouth, buccal mucosa, tonsils, pillars, uvula, soft palate, posterior pharynx, and visible lesions. Note exudate, petechiae, ulcers, asymmetry, palatal bulging, uvular deviation, drooling, muffled voice, trismus, tongue elevation, dental infection, and neck mobility.

The classic “hot-potato” voice or uvular deviation may support peritonsillar abscess, but neither is universally present. A patient with marked trismus, unilateral swelling, toxic appearance, airway concerns, or uncertain anatomy may require imaging, drainage capability, specialty consultation, or emergency transfer.

Ear complaints: pattern-based approach

Acute otitis media

Acute otitis media is an inflammatory middle-ear process with acute symptoms and objective effusion. Bulging—not redness alone—is the central otoscopic finding. Distinguish AOM from otitis media with effusion, in which fluid is present without acute middle-ear inflammation; antibiotics do not treat uncomplicated residual effusion.

Pain control is part of management regardless of whether antibiotics are prescribed. In children, the decision between immediate antibiotics and observation depends on age, diagnostic certainty, severity, otorrhea, laterality, reliable follow-up, and shared decision-making. Severe symptoms include moderate-to-severe otalgia, otalgia for at least 48 hours, or temperature at or above 39°C in the AAP framework.[1]

When antibiotics are indicated, amoxicillin is commonly first-line for appropriate uncomplicated pediatric patients. Recent amoxicillin exposure, purulent conjunctivitis, treatment failure, allergy phenotype, recurrent disease, or complicating factors may change selection. Verify current dosing and duration based on age, weight, severity, renal function, and local guidance.

Expected pain and fever improvement usually begins within 48–72 hours. Persistent or worsening symptoms warrant reassessment of the diagnosis, adherence, drug selection, resistant pathogens, perforation, mastoiditis, or another pain source.

Acute otitis externa

Diffuse acute otitis externa typically causes canal inflammation, otalgia, and tenderness with tragal pressure or pinna movement. Canal edema or debris may prevent full tympanic-membrane visualization. Topical therapy is preferred for uncomplicated diffuse disease; systemic antibiotics are not initial therapy unless infection extends beyond the canal or important host factors alter management. Adequate analgesia is essential.[2]

Select non-ototoxic drops when the tympanic membrane is perforated, a tube is present, or membrane integrity is uncertain. A wick may improve drug delivery through a markedly edematous canal when performed competently. Counsel the patient to keep the ear dry, avoid instrumentation, and administer drops correctly. Reassess nonresponse within 48–72 hours.

Severe deep pain, granulation tissue, cranial neuropathy, or disease in a patient with diabetes or major immune compromise raises concern for necrotizing otitis externa and requires urgent specialty or hospital evaluation.

Cerumen impaction and foreign body

Cerumen is “impacted” when it causes symptoms or prevents a necessary examination—not merely because wax is visible. Before irrigation, consider tympanic-membrane perforation, tubes, prior ear surgery, canal stenosis, active infection, anticoagulation, immunocompromise, and whether the object can swell or cause trauma.

Do not irrigate a button battery, sharp object, or vegetable matter that may expand. Stop after failed or traumatic attempts; repeated instrumentation increases edema, bleeding, perforation risk, and pushes the object deeper. Early referral is appropriate for a tightly wedged object, poor visualization, proximity to the membrane, uncooperative patient, prior failed attempts, or lack of safe equipment.

Sudden hearing loss

Sudden sensorineural hearing loss can be mistaken for cerumen, congestion, or eustachian-tube dysfunction. Ask exactly when the change occurred and whether tinnitus, vertigo, neurologic symptoms, or unilateral fullness accompanied it. Examine the canal and membrane, then use bedside hearing tests when possible to separate conductive from sensorineural loss.

Suspected sudden sensorineural hearing loss requires urgent audiometry and ENT-directed treatment. The AAO-HNS guideline emphasizes prompt differentiation from conductive loss and timely evaluation; corticosteroid therapy may be offered within two weeks of symptom onset, while treatment decisions require individualized contraindication review.[3] Focal neurologic findings, severe headache, or stroke concern require emergency evaluation rather than routine referral.

Nose and sinus complaints

Viral rhinosinusitis versus acute bacterial rhinosinusitis

Most acute nasal and sinus symptoms are viral. Purulent-colored discharge alone does not establish bacterial infection. Clinical patterns supporting acute bacterial rhinosinusitis include:

• Persistent compatible symptoms for at least ten days without improvement
• Severe onset with high fever and purulent discharge or facial pain for several consecutive days
• Worsening symptoms after initial improvement—the “double-sickening” pattern

These patterns are reflected in IDSA guidance.[4] Evaluate orbital and neurologic findings before choosing outpatient care. Antibiotic selection should follow current guidance and incorporate age, allergy, pregnancy, renal function, recent antibiotics, local resistance, and disease severity.

Supportive treatment may include hydration, saline irrigation with properly treated water, analgesics, and intranasal corticosteroid when appropriate, especially with allergic inflammation. Explain that many cases improve without antibiotics and that cough or congestion can persist after the peak illness.

Unilateral foul discharge in a child suggests a nasal foreign body. Persistent unilateral symptoms in an adult should prompt consideration of dental disease, structural obstruction, fungal disease, or neoplasm.

Epistaxis

Initial care begins with positioning the patient upright and leaning forward, clearing large clots when appropriate, and firmly compressing the soft cartilaginous portion of the nose continuously. Pinching the nasal bones or repeatedly releasing pressure is ineffective. Topical vasoconstrictor may help when not contraindicated.

Once bleeding slows, inspect for an anterior source. Treatment may include targeted cautery or packing based on visualization, equipment, clinician skill, anticoagulation, and bleeding severity. Cauterize only the identified site and avoid indiscriminate bilateral septal cautery because of perforation risk. Document packing type, removal plan, medication considerations, and explicit return precautions. AAO-HNS guidance supports structured compression, site identification, appropriate packing, and referral for recurrent or difficult-to-control bleeding.[5]

Recurrent unilateral epistaxis, recurrent bleeding despite prior packing or cautery, suspected posterior bleeding, hereditary hemorrhagic telangiectasia features, anemia, tumor concern, or anticoagulation complexity warrants further evaluation. Do not reflexively stop prescribed anticoagulants without weighing thrombotic risk and coordinating care.

Sore throat and neck complaints

Viral versus group A streptococcal pharyngitis

Viruses cause most pharyngitis. Cough, rhinorrhea, hoarseness, oral ulcers, and conjunctivitis strongly support a viral cause. In the absence of clear viral features, examination alone cannot reliably separate viral from group A streptococcal pharyngitis.[6]

Use a validated clinical decision framework to guide testing rather than prescribing from tonsillar exudate alone. A positive rapid antigen test, nucleic-acid amplification test where used, or culture confirms group A streptococcal infection. For symptomatic children aged three years or older, CDC guidance recommends a backup throat culture after a negative rapid antigen test; routine backup culture is not generally indicated for adults.[6]

Treat confirmed group A streptococcal pharyngitis. Penicillin or amoxicillin remains first-line when appropriate. Clarify whether a reported penicillin allergy was an immediate hypersensitivity reaction, a severe delayed reaction, or an intolerance because this changes alternatives. Macrolide and clindamycin resistance varies geographically, whereas group A streptococcal resistance to penicillin has not been reported.[6]

Antibiotics are not indicated for viral pharyngitis. Provide analgesia, hydration guidance, transmission precautions, and reassessment instructions. A patient treated for uncomplicated pharyngitis who develops worsening unilateral pain, trismus, voice change, neck swelling, or inability to swallow needs reevaluation for a suppurative complication.

Peritonsillar abscess and deep-neck infection

Peritonsillar abscess often presents with progressive unilateral throat pain, muffled voice, trismus, drooling, ipsilateral otalgia, palatal swelling, and possible uvular deviation. Cellulitis can look similar. Drainage plus antimicrobial therapy is generally required for a drainable abscess, but the safest setting depends on airway stability, anatomy, clinician competence, patient cooperation, bleeding risk, hydration, and access to follow-up.

Retropharyngeal or parapharyngeal infection may produce fever, neck stiffness, torticollis, drooling, muffled voice, dysphagia, swelling, or toxicity. Younger children may present nonspecifically. These infections can compromise the airway or spread to the mediastinum, vascular structures, or intracranial space. Arrange emergency imaging, ENT consultation, intravenous therapy, and airway-capable care rather than treating as simple pharyngitis.

Ludwig angina, epiglottitis, and dental sources

Ludwig angina is a rapidly progressive cellulitis of the submandibular and sublingual spaces, commonly arising from dental infection. Floor-of-mouth induration, tongue elevation, drooling, dysphagia, voice change, and neck swelling are ominous. Airway deterioration can be abrupt; prioritize emergency airway-capable transfer and avoid delaying for routine outpatient testing.

Epiglottitis may present with severe throat pain, odynophagia, drooling, muffled voice, stridor, or symptoms disproportionate to routine oropharyngeal findings. Vaccination has changed its epidemiology but has not eliminated it. Keep the patient calm, minimize unnecessary manipulation, and activate emergency airway management.

Dental abscesses and temporomandibular disorders commonly refer pain to the ear or throat. Inspect the teeth and floor of mouth. Antibiotics do not replace definitive dental drainage or extraction when required.

Diagnostic testing: answer a specific question

• Rapid antigen testing, NAAT, or throat culture: Confirms group A streptococcal infection in the appropriate clinical context.
• Pneumatic otoscopy or tympanometry: Supports identification of middle-ear effusion when available and performed correctly.
• Audiometry: Urgently confirms and quantifies suspected sudden sensorineural hearing loss.
• Point-of-care ultrasound: May support assessment of selected superficial abscesses or peritonsillar processes in trained hands, but it does not replace airway judgment.
• CT with contrast: Often required in emergency or hospital settings for suspected deep-neck, orbital, intracranial, complicated sinus, or invasive infectious processes. Transfer should not be delayed when the airway or physiology is threatened.
• CBC, metabolic testing, cultures, or coagulation studies: Reserve for systemic illness, significant bleeding, immune compromise, complications, or results likely to change management.

Avoid shotgun respiratory testing or imaging when results will not alter treatment. Conversely, do not allow a negative rapid test to override an examination suggesting a deep-space or airway emergency.

Medication and procedure safeguards

Antibiotics

State the anatomic diagnosis and why bacterial disease is likely. Verify allergy phenotype, recent antimicrobial use, pregnancy, kidney and liver function, interactions, weight-based pediatric calculations, and local resistance. Provide expected response and a defined failure threshold. Antibiotics do not drain pus, remove a foreign body, correct septal hematoma, or restore hearing from every cause.

Corticosteroids

Corticosteroids may have a defined role in selected conditions, including specialist-directed sudden sensorineural hearing loss, but they should not be used as a nonspecific injection for every sore throat, sinus complaint, or ear symptom. Consider diabetes, infection, pregnancy, psychiatric effects, gastrointestinal risk, immunosuppression, and masking of progression. Steroids do not secure an airway or replace drainage.

Decongestants and topical vasoconstrictors

Review hypertension, cardiovascular disease, pregnancy, glaucoma, urinary retention risk, interactions, and age restrictions. Prolonged use of topical nasal decongestants can cause rebound congestion. Intranasal corticosteroids require correct direction away from the septum and regular use; they do not provide immediate relief like a vasoconstrictor.

Procedures

Procedures such as cerumen removal, ear-wick placement, nasal cautery, packing, foreign-body removal, or peritonsillar drainage require correct equipment, visualization, consent, patient cooperation, and rescue planning. Stop when anatomy is uncertain, bleeding obscures the field, repeated attempts are causing trauma, or the required skill exceeds the setting.

Disposition and follow-up

Discharge is appropriate only when the patient is stable, can maintain hydration and medication, has no threat to airway, vision, hearing, neurologic function, or deep structures, and has realistic follow-up.

Provide condition-specific expectations:

• Viral upper-respiratory and throat symptoms often peak over several days and then gradually improve; cough and congestion may linger.
• AOM pain and fever should generally begin improving within 48–72 hours of appropriate management.
• Otitis externa should show meaningful improvement within 48–72 hours after effective drop delivery.
• Bacterial sinusitis should be reassessed when symptoms worsen or fail to improve within the expected interval after treatment.
• Epistaxis may recur if the mucosa is traumatized or dry; explain pressure technique and packing instructions.

Immediate emergency precautions should include difficulty breathing, stridor, drooling, inability to swallow, rapidly increasing neck or tongue swelling, severe dehydration, confusion, severe headache, stiff neck, facial weakness, eye pain or vision change, postauricular swelling, uncontrolled bleeding, or sudden/worsening hearing loss.

Documentation that demonstrates clinical reasoning

Include:

• Symptom onset, progression, laterality, exposures, associated features, and prior treatment
• Vital signs, appearance, airway status, voice, secretion control, and hydration
• Ear canal, mastoid, tympanic-membrane, hearing, nasal, oral, dental, pharyngeal, and neck findings relevant to the complaint
• Important negatives such as no trismus, drooling, uvular deviation, floor-of-mouth elevation, postauricular swelling, pain with eye movement, neurologic deficit, or respiratory distress—only when actually assessed
• Tests performed and how they changed management
• Working diagnosis and dangerous alternatives considered
• Medication selection, allergy assessment, pediatric weight, and dose verification
• Procedure consent, technique, findings, complications, and aftercare
• Follow-up interval, referral urgency, and specific return precautions

Example medical-decision-making language

Patient is clinically stable, managing secretions, and tolerating oral intake without stridor, respiratory distress, drooling, trismus, muffled voice, uvular deviation, floor-of-mouth swelling, neck rigidity, or toxic appearance. Oropharyngeal findings and testing support uncomplicated pharyngitis at this time. Peritonsillar abscess, deep-neck infection, epiglottitis, and Ludwig angina were considered but are not supported by the current examination. Outpatient management is reasonable with close follow-up and immediate emergency precautions for airway symptoms, inability to swallow, progressive unilateral swelling, voice change, neck stiffness, or clinical deterioration.

Adapt the language to the actual patient. Do not import normal findings that were not examined.

Coding considerations

Common ICD-10-CM examples include:

• H66.90 — Otitis media, unspecified, unspecified ear
• H60.90 — Unspecified otitis externa, unspecified ear
• H61.20 — Impacted cerumen, unspecified ear
• H91.20 — Sudden idiopathic hearing loss, unspecified ear
• J02.9 — Acute pharyngitis, unspecified
• J02.0 — Streptococcal pharyngitis
• J01.90 — Acute sinusitis, unspecified
• R04.0 — Epistaxis
• J36 — Peritonsillar abscess

Use greater specificity for laterality, acuity, recurrence, perforation, organism, complication, and encounter details when supported. Verify the current code set.

Procedure-code families may include removal of impacted cerumen, removal of an ear or nasal foreign body, control of anterior or posterior nasal hemorrhage, and drainage of a peritonsillar abscess. Coding depends on technique, complexity, laterality, anesthesia, separate evaluation-and-management work, bundling rules, and documentation. Do not choose a procedure code merely because an attempt was made; verify the current CPT descriptor and payer policy.

Clinical pearls

• A red tympanic membrane is not synonymous with AOM; look for bulging and effusion.
• Tragal or pinna tenderness localizes disease toward the external canal.
• Ear pain with a normal ear examination should trigger a search for referred pain.
• Treat pain even when observation rather than antibiotics is appropriate.
• Use non-ototoxic ear drops when membrane integrity is uncertain.
• Sudden unilateral hearing loss is time-sensitive until sensorineural loss is excluded.
• Colored nasal discharge alone does not diagnose bacterial sinusitis.
• Do not miss a septal hematoma after nasal trauma.
• Exudate alone cannot distinguish viral from streptococcal pharyngitis.
• A normal-looking anterior throat does not exclude epiglottitis or deep-neck disease.
• Trismus, drooling, voice change, tongue elevation, and neck stiffness are escalation clues.
• Firm pressure on the soft nose—not the nasal bones—is first-line epistaxis care.
• Repeated foreign-body attempts often make the eventual removal harder and riskier.
• When airway or deep-space infection is possible, disposition matters more than a polished outpatient diagnosis.

Conclusion

A safe urgent-care ENT assessment follows a consistent sequence: stabilize the airway and physiology, localize the involved structure, obtain direct visualization when safe, distinguish uncomplicated disease from invasive or function-threatening pathology, and match treatment to the anatomy.

The most important habits are simple but consequential: diagnose AOM by bulging and effusion rather than redness, separate external from middle-ear disease, treat sudden sensorineural hearing loss as time-sensitive, use duration and trajectory to assess sinus symptoms, test selectively for streptococcal pharyngitis, and actively search for deep-neck and airway warnings. When the patient may lose an airway, vision, hearing, neurologic function, or substantial blood volume, timely escalation is the definitive urgent-care intervention.

References

1. Lieberthal AS, Carroll AE, Chonmaitree T, Ganiats TG, Hoberman A, Jackson MA, et al. The diagnosis and management of acute otitis media. Pediatrics. 2013;131(3). doi:10.1542/peds.2012-3488. Available from: https://publications.aap.org/pediatrics/article/131/3/e964/30912/The-Diagnosis-and-Management-of-Acute-Otitis-Media
2. Rosenfeld RM, Schwartz SR, Cannon CR, Roland PS, Simon GR, Kumar KA, et al. Clinical practice guideline: acute otitis externa. Otolaryngol Head Neck Surg. 2014;150(1 Suppl). doi:10.1177/0194599813517083. Available from: https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/aoe/
3. Chandrasekhar SS, Tsai Do BS, Schwartz SR, Bontempo LJ, Faucett EA, Finestone SA, et al. Clinical practice guideline: sudden hearing loss (update). Otolaryngol Head Neck Surg. 2019;161(1 Suppl). doi:10.1177/0194599819859885. Available from: https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/sudden-hearing-loss-update/
4. Chow AW, Benninger MS, Brook I, Brozek JL, Goldstein EJC, Hicks LA, et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis. 2012;54(8). doi:10.1093/cid/cis370. Available from: https://www.idsociety.org/practice-guideline/rhinosinusitis/
5. Tunkel DE, Anne S, Payne SC, Ishman SL, Rosenfeld RM, Abramson PJ, et al. Clinical practice guideline: nosebleed (epistaxis). Otolaryngol Head Neck Surg. 2020;162(1 Suppl). doi:10.1177/0194599819890327. Available from: https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/nosebleed-epistaxis/
6. Centers for Disease Control and Prevention. Clinical guidance for group A streptococcal pharyngitis [Internet]. Atlanta: CDC; 2025 Nov 18 [cited 2026 Aug 14]. Available from: https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html