Childhood hearing loss

Question 1

Causes of childhood hearing loss?

Answer 1

Otitis media with effusion
Downs syndrome
Lead toxicity
Rubella

Question 2

RF for otitis media with effusion?

Answer 2

Male
Siblings with glue ear
Higher incidence in spring and winter
Bottle feeding
Day care attendance
Parental smoking

Question 3

Features of otitis media with effusion?

Answer 3

Peaks at 2 y/o
hearing loss is the presenting feature
secondary problems-> speech and language delay, behavioural or balance problems

Question 4

Management of otitis media with effusion?

Answer 4

Grommet insertion- stop functioning after about 10 months
Adenoidectomy

Question 5

What do grommets do?

Answer 5

Allow air to pass through into the middle ear and hence do the job normally done by Eustachian tube

Question 6

What is down’s syndrome?

Answer 6

Genetic condition- trisomy 21

Question 7

What are the physical features of Down’s syndrome?

Answer 7

Brachycephaly with flat occiput
Epicanthal folds and up slanting palpebral fissures
Brushfield spots in the iris
Low nasal bridge
Low set ears
Broad neck
Small hands with transverse crease

Question 8

What are the symptoms of Down’s syndrome?

Answer 8

Hypotonia
Congential heart disease
gross motor delay
language delay
hearing loss
language delay

Question 9

Why do patients with Down’s syndrome have chronic/recurrent ear infections?

Answer 9

Likely to get more URTIs so predisposes to chronic ear infections

Have stenotic or narrow ear canals

Question 10

What is acute otitis media?

Answer 10

Middle ear infection

Question 11

Features of acute otitis media?

Answer 11

Otalgia

+/- fever
hearing loss
recent viral URTI symptoms (e.g. coryza)
ear discharge may occur if tympanic membrane perforates

Question 12

Otoscopy findings in acute otitis media?

Answer 12

Bulging tympanic membrane–> loss of light reflex
Opacification or erythema of the tympanic membrane
perforation with purulent otorrhoea
decreased mobility if using a pneumatic otoscope

Question 13

How do you diagnose otitis media?

Answer 13

Acute onset of symptoms–> otalgia or ear tugging

Presence of middle ear effusion–> building of the tympanic membrane, or otorrhoea or decreased mobility on pneumatic otoscopy

Inflammation of the tympanic membrane–> erythema

Question 14

Management of acute otitis media?

Answer 14

Mostly self- resolving
Advise if no improvement/worsening in 3 days, seek medical help.

In some cases, prescribe immediately

Question 15

When should you immediately prescribe abx in acute otitis media?

Answer 15

Abx prescribed if:
Symptoms lasting more than 4 days or not improving
Systermically unwell but not requiring admission
Immunocompromised or high risk of complications secondary to significant heart, lung, kidney, liver or NM disease
Younger than 2 years with bilateral otitis media
Otitis media with perforation and/or discharge

Question 16

First line abx used for acute otitis media?

Answer 16

5-7 day course of amoxicillin
Penicillin allergy-erythromycin or clarithromycin

Question 17

Complications of otitis media?

Answer 17

NICE guidlines:
Persistent otitis media with effusion.
Recurrence of infection.
Hearing loss (usually conductive and temporary).
Tympanic membrane perforation.
Labyrinthitis.
Rarely, mastoiditis, meningitis, intracranial abscess, sinus thrombosis, and facial nerve paralysis.

Passmed/QM:
Mastoiditis
Meningitis
Brain abscess
Facial nerve paralysis

Question 18

Sequelae of otitis media?

Answer 18

Perforation of the tympanic membrane
Hearing loss
Labyrinthitis