ENT Flashcards
What are the indications for tonsillectomy?
Recurrent tonsillitis
- At least 7 episodes in the previous year
- At least 5 episodes in each of the previous 2 years
- At least 3 episodes in each of the previous 3 years
OSA
Modifying factors
- Hospitalizations due to severe symptoms
- Multiple antibiotic allergies making therapy difficult
- Recurrent peritonsillar abscess
- PFAPA
- Lemierre’s syndrome (internal jugular vein thrombosis) due to tonsillitis
- Rheumatic heart disease
What is Gradenigo syndrome and a Bezold abscess?
Complications of mastoiditis
Gradenigo syndrome = triad of suppurative OM, paralysis or external rectus muscle + pain in ipsilateral orbit
Bezold abscess → complication resulting in neck abscess
What is the treatment for mastoiditis?
- Myringotomy + parenteral antibiotics +/- mastoidectomy if osteitis
- Antibiotics → Ampicillin or Cefazolin or Cefuroxime
What are the indications for supraglottoplasty in children with laryngomalacia?
- Progressive respiratory distress
- Cyanosis
- Cor pulmonale
- FTT
What test should be done in an older child presenting with vocal cord paralysis?
MRI Brain!
Example CNS lesions: chiari malformation, myelomeningocele, hydrocephalus, birth trauma
What are the typical organisms responsible for retropharyngeal abscess?
Typically polymicrobial - most common:
- Gram +: GAS, Streptococcus pyrogens, Staphylococcus aureus
- Resp anaerobes: Fusobacterium, Bacteroides, Peptostreptococcus
- Rare: Gram neg (e.g. Haemophilus), TB, Bartonella hensalae
What percentage of children with asymptomatic congenital CMV develop neurological consequences?
5-15%
What investigations do you order when congenital CMV is suspected?
- CBC, bili, AST/ALT, CSF + CMV PCR on CSF, HUS and MRI if abnormal or neurologic symptoms, hearing screen, ophtho
What are genetic causes of SNHL loss?
Genetic causes make up 50% of SNHL causes
- SNHL often seen with ear/eye abnormalities, metabolic, MSK, renal and CNS
- Autosomal dominant: accounts for 10%
- Most common Waardenburg (type I and II) & brachiootorenal syndromes
- Autosomal recessive: accounts for 80%
- Most common: Usher (associated with blindness), Pendred syndrome and the Jervell and Lange-Nielsen syndrome
What are the clinical features suggestive of bacterial sinusitis?
- Persistent URTI (nasal discharge, cough) >10d without improvement
- OR Severe respiratory sx (w/ T>39) + purulent nasal discharge 3-4 days
What the major symptoms in bacterial sinusitis?
- Purulent anterior nasal discharge
- Purulent or discoloured posterior nasal discharge
- Nasal congestion or obstruction
- Facial congestion or fullness
- Facial pain or pressure
- Hyposmia or anosmia
- Fever (for acute sinusitis only)
“Classic presentation”: prolonged nasal congestion/discharge after URI without improvement for > 10 days OR sudden onset of fever and purulent nasal discharge for > 3 days
What are the common pathogens for cervical adenitis?
- Staph aureus (#1)
- GAS
- Anaerobic
- Nontuberculous mycobacteria
- Tuberculosis
- Bartonella
- Toxoplasmosis
- Histoplasmosis
- EBV
What are risk factors for hearing loss in the newborn period?
ABCD’s
A = affected family member
B = bilirubin
C = congenital intrauterine infections
D = defects of the ear, nose and throat
S = small at birth (< 1500g), low apgar, NICU
What are findings on lateral soft tissue neck x-ray that is suggestive of RPA?
- Thickening of prevertebral tissues (greater than half the width of the C2 vertebral body, or >7-mm diameter at C2, or >14-mm diameter at C6)
- Locules of gas within the prevertebral tissues
What is the clinical features of acute otitis externa?
Rapid onset (within 48h) in past 3wk
- AND
- Symptoms of ear canal inflammation, including
- Otalgia (often severe), itching or fullness
- WITH or WITHOUT hearing loss or jaw pain
- AND
- Signs of ear canal inflammation, including
- Tenderness of the tragus, pinna or both
- OR
- Diffuse ear canal edema, erythema, or both
- WITH to WITHOUT otorrhea, regional lymphadenitis, tympanic membrane erythema, or cellulitis of the pinna and adjacent skin
- Tenderness of the tragus, pinna or both