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Pediatrics > Ear, Nose, Sinus > Flashcards

Ear, Nose, Sinus Flashcards

1
Q

Describe the etiology/risk factors for otitis media

A

Acute: middle ear effusion leading to infection of middle ear space
Chronic: untreated 6+ weeks leading to TM retraction, perforation, cholesteatoma, mastoiditis
- common in kids <5, M>F
- mostly viral, also bacterial (strep pneumo, M. cat, H. flu)
- RF: smoke, allergies, craniofacial abnormalities

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2
Q

Describe the clinical presentation of otitis media

A
  • pain, hearing loss, crackling, popping, fever, URI, drainage
  • bulging, red TM with pus in middle ear, fluid, perforation and drainage
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3
Q

Describe the diagnostic testing for otitis media

A
  • pneumatic otoscopy: limited mobility of TM
  • criteria: bulging of TM, new onset otorrhea
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4
Q

Describe the treatment for otitis media

A
  • refer to ent for PE tubes if 3+ mos hearing loss
  • 1st line: amoxicillin 90mg/kg/day divided in 2 doses x10 days
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5
Q

Describe the etiology/risk factors for mastoiditis

A
  • suppurative infection & inflammation of mastoid air cells that **starts in the ear
  • untreated acute otitis media, s pneumo, h flu**
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6
Q

Describe the clinical presentation of mastoiditis

A

**- pain in & behind the ear
- hearing loss
- fever
- bulging, red TM
- purulent middle ear
- post-auricular warmth, erythema, edema, fluctuance
- +/- protrusion of auricle
- +/- cranial nerve palsy

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7
Q

Describe the diagnostic testing for mastoiditis

A
  • CT temporal bone w/o contrast shows mastoid effusion, loss of trabecular bone
  • elevated CBC, ESR, CRP
  • do lactate, blood cultures, LP if toxic
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8
Q

Describe the treatment of mastoiditis

A
  • IV abx +/- myringotomy
  • IV abx + mastoidectomy if abscess develops/does not improve
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9
Q

Describe the etiology/risk factors of otitis externa

A

aka swimmer’s ear
- infection of external auditory canal d/t excess moisture, trauma, bacterial/fungal infection
- Bacteria: pseudomonas aeruginosa, s. epi, s. aureus
- Fungal: candida, aspergillus

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10
Q

Describe the clinical presentation of otitis externa

A
  • **plugging/fullness
  • hearing loss**
  • drainage
  • pain
  • itching (fingal)
  • wet, edematous canal with debris, redness, flaking
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11
Q

Describe the diagnostic criteria of otitis externa

A
  • rapid onset (<48 hr) canal inflammation w/wo otorrhea, regional adenopathy, erythematous TM, cellulitis
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12
Q

Describe the 3 components of otitis externa treatment

A
  • strict dry ear
  • abx/antifungal drops +/- wick (fluoroquinolones with steroid, neomycin, hydrocortisone, polymixin b, clotrimazole, acetic acid)
  • removal of debris
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13
Q

Describe the etiology/risk factors of necrotizing otitis externa

A

secondary to untreated otitis externa (usually pseudomonas) leading to osteomyelitis of temporal bone
- RF: elderly, diabetic, immunocompromised

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14
Q

Describe the clinical presentation of necrotizing OE

A
  • +/- exposed bone
  • tissue granulation
  • CN7 palsy
  • sepsis with altered mental status
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15
Q

Describe the treatment for necrotizing OE

A
  • hospital admit with IV abx, +/- glucose control or surgery
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16
Q

Describe the etiology/risk factors for tympanic membrane perforation

A
  • hole in eardrum
  • M>F
  • RF: recurrent AOM, flying/diving with ETD, multiple ear surgeries, barotrauma, q-tip use, water irrigation, myringotomies, non-healing PE tube sites
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17
Q

Describe the clinical presentation of tympanic membrane perforations

A
  • asymptomatic if small/chronic
  • sudden pop +/- drainage/blood
  • hearing loss
  • tinnitus
  • vertigo
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18
Q

Describe the diagnostic testing for tympanic membrane perforation

A
  • insufflation: no movement
  • otoscopy: describe size, shape, quadrant
  • tympanometry: flat with large vol
  • audiogram: +/- conductive hearing loss
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19
Q

Describe the treatment for tympanic membrane perforation

A
  • spontaneously healing in 2 mos
  • avoid irrigation
  • abx drops if concerned for infection
  • refer to ENT if not healed in 2 mos, suspect ossicle injury, >40 dB hearing loss, vestibular sx
  • paper patching, tympanoplasty, ossicular chain reconstruction
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20
Q

Describe the etiology/risk factors for vertigo

A
  • 80% peripheral, 20% central
  • MC benign paroxysmal positional vertigo (BPPV): **calcium carbonate crystals (otoliths) become loose/misplaced in semicircular canal
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21
Q

Describe the clinical presentation of BPPV

A
  • room spinning
  • triggered by positional movement
  • +/- n/v
  • residual imbalance after
  • periodic recurrence for weeks/mos
  • otoliths can displace posteriorly, unilateral/bilateral
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22
Q

Describe the diagnostic testing for BPPV

A

-Normal audiogram, MRI, videonystagmography

Criteria: dix-hallpike maneuver
- nystagmus/vertigo appear within seconds and last 30 sec
- Nystagmus has predictable trajectory
- Nystagmus recurs in opposite direction after sitting up
- Intensity and duration diminishes with repeat

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23
Q

Describe the treatment for BPPV

A
  • Epley maneuver
  • Semont maneuver
  • antihistamines, antiemetics, benzos
24
Q

Describe the etiology/risk factors for labyrinthitis & vestibular neuritis

A

Labyrinthitis: with SNHL
Vestibular neuritis: w/o SNHL

  • viral/postviral (HSV) inflammatory disorder affecting a portion of CN8
25
Q

Describe the clinical presentation of labyrinthitis & vestibular neuritis

A
  • intense spinning vertigo for a few days followed by imbalance for a few months
  • room spinning, n/v, gait instability toward affected side
  • spontaneous nystagmus suppressed with visual fixation
26
Q

Describe the diagnostic testing and PE for labyrinthitis & vestibular neuritis

A
  • MRI shows findings 29% of the time: inflammation
  • positive head thrust test
  • audiogram: asymmetric SNHL in labyrinthitis
27
Q

Describe the treatment for labyrinthitis & vestibular neuritis

A
  • **high dose steroids
  • TTI**
  • +/- antivirals
  • antihistamines
  • antiemetics
  • vestibular rehab
  • 2% recurrence but 15% develop BPPV/panic disorder
28
Q

Describe the etiology/risk factors for hematoma of the ear

A

auricular perichondrium separates from underlying cartilage and space fills with blood causing swelling/cauliflower ear
- RF: wrestlers, M>F, limited mobility

29
Q

Describe the clinical presentation of cauliflower ear

A
  • tense, fluctuant pinnae
  • +/- pain
  • +/- erythema/ecchymosis
30
Q

Describe the treatment for hematoma of the ear

A
  • drainage & reapposition of periochondrial layer asap before clotting
  • I&D + bolster placement
  • cephalexin x1 week, no trauma x2 weeks
31
Q

Describe the etiology/risk factors for foreign bodies in the ear/nose

A

object lodged in small cavity of ear/nose
- mostly pediatric (nose MC)

32
Q

Describe the clinical presentation of ear vs nose foreign bodies

A

Ear: commonly asymptomatic, +/- HL, pain, drainage/bleeding

Nose: unilateral foul nasal drainage/bleeding, congestion, +/- pain

33
Q

Describe the treatment for foreign body of the nose & ear

A
  • “mother kiss”
  • forcep, suction, swab + adhesive, flushing, lidocaine/oil
  • RED FLAGS for ENT: button battery, magnets, sharp objects
34
Q

Describe the complications of a button battery foreign body

A

can erode/ulcerate in 2 hrs, perforate in 8hrs

35
Q

Describe the etiology/risk factors of epistaxis

A
  • dry weather, anticoags, clotting disorders, HTN, trauma, intranasal drug use, etoh, neoplasm
  • **anterior (90%): Kesselbach’s plexus (minor)
  • posterior: Woodruff’s plexus (more concerning)**
36
Q

Describe the clinical presentation of epistaxis

A
  • recurrent blood from nostrils/oropharynx
  • active bleeding/stigmata of recent bleeding, obvious vessel on septum, blood in oropharynx
37
Q

Describe the diagnostic testing for epistaxis

A

may consider CBC, INR, coag studies

38
Q

Describe the treatment of epistaxis

A
  • cotton ball soaked in Afrin + pressure for 15 mins
  • pack & observe 30 mins, cephalexin, refer to ENT for rhino balloon pack or spongy foam pack
  • emergent ENT page for OR intervention if persistent (cautery, silver nitrate)
39
Q

Describe the etiology/risk factors of nasal septal hematoma

A

blood pooling in nasal septum, can lead to infection, necrosis, deformity
- RF: recent surgery, nasal trauma

40
Q

Describe the clinical presentation of nasal septal hematoma

A

sudden onset of nasal congestion, change in nose shape, painful swelling of septum
- red fluctuant mass

41
Q

Describe the treatment of nasal septal hematoma

A

emergent ENT referral: drainage, sterile packing, prophylactic abx

42
Q

Describe the etiology/risk factors for sinusitis

A

acute v chronic inflammation of paranasal sinuses and nasal cavity
- RF: allergy, polyps, age, smoking, air travel, dental disease, immunodeficiency
- viral: rhino, flu, adeno, parainfluenza
- bacterial: s. pneumo, m. cat, h. flu)

43
Q

Describe the stages/types of sinusitis

A
  • acute: <4 weeks
  • subacute: 4-12 weeks
  • chronic: >12 weeks
  • recurrent: 4+ occurrences per year with complete resolution between episodes
44
Q

Describe the clinical presentation of sinusitis

A

- nasal congestion
- pressure/pain
- purulence
- hyposmia
- foul smell
- fever
- fatigue
- cough
- ETD
- sinuses TTP
- hyponasal voice

45
Q

Describe the diagnostic criteria and treatment of acute viral sinusitis

A

<10d
- purulent drainage
- severe obstruction
- facial pain/pressure

saline irrigation 2-3x/day, nasal steroids (flonase)

46
Q

Describe the diagnostic criteria and treatment of acute bacterial sinusitis

A

+10d
- purulent drainage
- severe obstruction
- facial pain/pressure
- double worsening

7+ days amox+clav, cephalexin, doxy

47
Q

Describe the diagnostic criteria and treatment of chronic bacterial sinusitis

A

12+ weeks of inflammation and 2 of:
- mucopurulent drainage
- obstruction
- facial pressure/pain
- loss of smell

21+ days abx and 10+ days oral steroid taper

48
Q

What are these HINTS test results indicative of?

Nystagmus: positive
Test of Skew: positive
Head Impulse: negative

A

central vertigo
- single episode lasting 24+ hrs
- CNS etiology: acoustic neuroma, TIA posterior circulation, cerebellar hemorrhage

49
Q

What does the HINTS exam stand for

A

Head Impulse, Nystagmus, Test of Skew

50
Q

What is a positive head impulse on HINTS testing indicative of?

A

peripheral vertigo
- vestibular neuritis/labyrinthitis

51
Q

What is the etiology and timeframe of Meniere’s disease symptoms

A

Intermittent vertigo d/t an excess of endolymph fluid in the inner ear
- +/- permanent hearing loss seen on audiometry
- triggered by stress, work, fatigue, pressure change
- vertigo lasting several minutes but less than an hour

52
Q

What is the maneuver that elicits nystagmus in BPPV

A

Dix-Halpike maneuver

53
Q

Describe what may be indicated in a positive and negative refixation/catch of saccade

A

Positive: peripheral, nerve problem
Negative: central, brain problem

54
Q

Describe a positive test of skew

A

Ask pt to maintain gaze on providers nose. A positive result will be the deviation of one eye while it is being covered, followed by correction after uncovering it. (positive = ominous for central, move to head impulse test)

55
Q

Describe the dix-halpike maneuver

A
  • elicits nystagmus in BPPV
  • repetitive beating of eyes with dizziness (horizontal or rotational)
  • (nystagmus diagnostic for BPPV, no nystagmus may be indicative of uncommon BPPV)
  • can continue into treatment if positive with the Epply
56
Q

Describe what the Epply’s Maneuver does

A

dislodges crystals from the semicircular canals and brings them back to the utricle to relieve vertigo

Pediatrics (22 decks)

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