3. Paeds [ENT & Opthalmology] Flashcards
Acquired causes of permanent deafness, split into pre, peri and postnatal:
Prenatal - CMV, rubella, toxoplasma
Perinatal - aminoglycoside abx, sbcu e.g. hypoxia, jaundice causing kernicterus
Postnatal - meningitis, head injury, ototoxic drugs e.g. cisplatin
2/3 of congenital deafness is non-syndromic; what is the most common cause in this category?
Autosomal recessive to mutations in gap junction protein
Most common cause of acute stridor?
Croup
Most common cause of chronic stridor?
Laryngomalacia
From birth, within first 2 weeks
Describe the screening programme for newborn infants for hearing loss.
Automated otoacoustic emissions - 2 attempts.
If they do not pass this, refer for:
Automated ABR (auditory brainstem response)
Check for risk factors e.g. FHx, CMV, NICU admission
Describe what happens in the cochlea to produce hearing impulse.
Outer hair cells amplify sound through vibrations.
Inner hair cells detect this and transduce it into a nerve signal.
Which parts of hearing apparatus does automated otoacoustic emission test?
Everything from the pinna to the outer hair cells; does not test the inner hair cells / cochlea etc.
Give some conditions associated with otitis media (6).
Cleft palate (Eustachian tube dysfunction due to soft palate abnormality)
Trisomy 21
Primary ciliary dyskinesia (Kartagener’s)
CF
Craniofacial abnormalities
Adenoids (?due to biofilm)
Microtia describes smaller / absent outer ear that can be associated with cochlear dysplasia. What types of hearing loss can be present with microtia?
Conductive, SN or mixed depending on the severity
What does an air / bone gap on an audiogram indicate?
Conductive hearing loss
Describe the severity of hearing loss in terms of decibels.
Up to 20 = normal
20-40 = mild
40-70 = moderate
70-90 = severe
>90 = profound
What is the correct term for hearing loss?
Raised thresholds
What type of hearing loss are bone conduction hearing aids used for?
Conductive
Why is a pinna haematoma an emergency?
The cartilage has no blood supply and gets its supply from the perichondrium.
In the case of a haematoma, the cartilage is separated from the perichondrium and can lead to hypoxic necrosis of the cartilage = cauliflower ear.
Criteria for abx in AOM:
High fever not controlled with paracetamol
Complications e.g. meningitis, mastoiditis, brain abscess and facial nerve paralysis
Ongoing for 4 or more days with no improvement
Children under 2 with bilateral OM
OM with ear discharge
Systemically unwell
Why is a swallowed button battery an emergency?
Button batteries contain lithium which is alkaline and can lead to an alkaline burn.
Furthermore, the battery generates an electrical circuit with the tissues and saliva and causes dissociation of water, resulting in production of HCO3 and causing further severe alkaline burns.
Stridor often indicates airway obstruction. The timing of it can be used to identify where the likely level of obstruction is. Discuss this.
Inspiratory = above the vocal cords e.g. epiglottis
Expiratory = below the cord e.g. trachea
Biphasic = at level of the cords
Most common cause of croup in children?
Parainfluenza viruses
Give 4 causes of stridor in children:
Acute Epiglottitis
Croup
Inhaled foreign body
Laryngomalacia
Most common organism to cause acute epiglottitis in children, and peak age of incidence?
Haemophilus influenzae type B
2-6 years old
Give 3 congenital causes of hearing loss.
Maternal rubella or CMV during pregnancy
Genetic - AD or AR, risk factors are siblings with hearing loss
Syndromic e.g. Down’s
Give 2 perinatal and 4 post natal causes of hearing loss in children.
Hypoxia during or after birth
Prematurity
Jaundice
Meningitis / encephalitits
Otitis media / glue ear
Chemo
Give 4 behavioural traits that could indicate hearing problems.
Ignoring calls / sounds
Frustrating or bad behaviour
Poor speech and language development
Poor school performance
Which condition nearly always precedes periorbital cellulitis in children?
Sinusitis
