ENT Flashcards
Patient with noisy breathing, seems hungry but has difficulty feeding because it seems hard to breath. Sats 92% in RA and RR 46. Physician unable to pass 6F NG via either nare. Dx?
Congenital nasal pyriform aperture stenosis
Dx made with CT scan where pyriform aperture is <11mm. If <5.7mm need surgery.
First line tx conservative: nasal saline, humidification, topical decongestants, nasal corticosteroids, Oral airway, nasal stenting or gavage feeding. If fails then endoscopic surgery via sublabial approach (transnasal approach is for choanal atresia).
Differentiates from choanal atresia in absence of cyanosis (in bilateral) and blockage in anterior rather than posterior aperture but bony or membranous septum.
** Assoc’d with midline dev abnormalities (holoprosencephaly)
Normal palatal index
0.3
Asymmetric crying facies is hypoplasia or agenesis of
Depressor anguli oris muscle
Best method to evaluate vocal cord motion ?
Flexible fiberoptic endoscopy
Can also use direct laryngoscopy
Presenting symptom of vocal cord paralysis
High pitched stridor
What is the interval for next exam for a pt with low stage rop in zone I?
1 week or less
What type of inheritance pattern can be seen in pts with increased risk of hearing loss with amino glycoside use?
Mitochondrial mutation in m.1555A>G
Nasal cavity forms from invagination of nasal placodes between which weeks?
3-6 weeks
Nostrils contain an epithelial plug until 24 weeks when resorption occurs
What is the embryology of nose development?
Formation of neural tube from ectoderm (3 rd week gestation)
——> Develops into Neural crest cells
-—-> Then Migration of neural crest cells into mesenchyme
Skeletal elements of craniofacial region are derived primarily from cranial ___________
Neural crest cells
Muscle from cranial mesoderm and somites
Which is the most common nasal mass in neonate?
Nasal dermoid cyst
Manifest was external midline nasal masses with no effect on nasal breathing
External put on nasal dorsum will drain ous or debris
Which nasal maldevelopment most likely to be associated with holoprosencephaly?
Pyriform aperture stenosis
Remember if central incisior and this finding think holoprosencephaly
What is the threshold of an abnormal newborn hearing screen (ABR and OAE)?
> 35 decibels
What does AABR hearing screen measure?
What types of hearing loss are detected?
Detects electric signals from the brain via scalp electrodes when baby is exposed to sound
Conductive
Sensorineural
Neural
What does OAE hearing screen measure?
What type of hearing loss is detected?
Measures acoustic ‘feedback’ from cochlear outer hair cells through the ossicles to the tympanic membrane and ear canal
Conductive
Less effective with sensorineural
Conductive vs sensorineural hearing loss
Conductive
-Blockage of conduction in the outer or middle ear —> transient (assoc’d with fluid debris) or permanent (anatomical abnormality) conductive hearing loss.
Bone conduction»_space; Air conduction
Sensorineural
- Abnormal dev or damage to cochlear hair cells
- Decreased bone and air conduction
Syndromes assoc’d with hearing loss
Alport syndrome Pierre Robin sequence Waardenburg syndrome Treacher Collins CHARGE Klippel Feil T8 T21 Stickler syndrome
Where are dermoid cysts derived from?
Include derivatives from ectoderm (hair follicles and sebaceous/ eccrine glands) fron neural crest mesectoderm
What findings lead to diagnosis if Stickler Syndrome ?
Micrognathia
Ocular abnormalities (cataracts)
What is the only muscle innervated by thé cervical branch of the facial nerve ?
Platysma muscle
Most common cause of bilateral vocal cord paralysis
Idiopathic vocal cord adductor muscle hyperreactivity
Most common cause of unilateral vocal cord paralysis
Cardiac surgery
Factor that is incorporated in the algorithm to predict threshold ROP
Insulin like growth factor 1
Most common cause of vascular ring in neonate?
Doible aortic arch
