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Y5 Paeds > ENT > Flashcards

ENT Flashcards

1
Q

Describe a normal tympanic membrane

A

Thin, transluminal membrane with a cone of light

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2
Q

What is otitis externa?

A

Infection of the skin of the external auditory canal

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3
Q

Sx of otitis externa?

A

Irritable child
Worsening otalgia (ear pain)
Otorrhoea (discharge)
Itchiness
Ear fullness / hearing loss
Tinnitus

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4
Q

What is the prevalence of otitis externa?

A

1% of children

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5
Q

List 8 risk factors of otitis externa

A

Younger children
Females
Frequent water contact
Obstruction of ear canal
Ear trauma
Foreign body in ear
Skin conditions: eczema, psoriasis
Immunocompromised patients

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6
Q

List otoscopic features of bacterial otitis externa

A

Narrow, swollen & red ear canal
Tympanic membrane not visible
Yellow / white crusted discharge

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7
Q

List otoscopic features of fungal otitis externa

A

Narrow, swollen & red ear canal
Tympanic membrane not visible
Thick white / grey spores

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8
Q

What is the difference in fungal / bacterial otitis externa Tx?

A

Fungal Tx is used for 6 weeks but bacterial Tx is used less

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9
Q

What pathogens cause otitis externa ?

A

Pseudomonas aeruginosa (40%)
S. epidermis
S. aureus
Anaerobes
Fungal infection eso aspergillus

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10
Q

List otitis externa Mx?

A

Patient education - no cotton buds, keep ear moisturised
Take a swab
Ear microsuction
Ear drops - antibiotic / steroid / antifungals

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11
Q

What is otitis media ?

A

Acute inflammation of the middle ear cavity

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12
Q

What is the prevalence of otitis media ?

A

30% of age 3s

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13
Q

What is peak incidence of otitis media ?

A

6 to 15 months

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14
Q

List risk factors of otitis media ?

A

Young children - nursery age
Male
Passive smoking
Bottle feeding
Cleft palate / Downs - craniofacial abnormalities
Large adenoids

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15
Q

List common organisms causing otitis media

A

Respiratory syncytial virus and rhinovirus
Step pneumoniae (40%)
Hameophillius influenza (25%)

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16
Q

Why are kids more likely to get otitis media vs adults?

A

Thinner, flatter eustachian tube is more prone to blockage

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17
Q

Outline the course of otitis media ?

A

Child has URTI / cold
Becomes irritable
EITHER:
- tympanic membrane perforation
- mastoiditis

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18
Q

List Sx of otitis media

A

Irritable child
Otalgia
Ear fullness
Fever
Unilateral hearing loss

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19
Q

List Sx of tympanic membrane perforation

A

Purulent ear discharge
Child becomes happier (relieved fullness of otitis media)
Unilateral hearing loss

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20
Q

List Sx of mastoiditis?

A

Bulging, opaque tympanic membrane (red/yellow/pink) with evidence of effusion posteriorly
Unwell child
Protruding ear with red, hot, tender mass over mastoid

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21
Q

Describe Mx of mastoiditis?

A

ENT EMERGENCY
IV antibiotics

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22
Q

List Mx of otitis media

A

80% self limiting - resolves in 3 days
Oral Abx if systemically unwell

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23
Q

List complications of otitis media

A

Tympanic membrane perforation
Otitis media with effusion (glue ear)
Intracranial complications eg meningitis / abscess

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24
Q

List causes of tympanic membrane perforation

A

Loud sounds
Head trauma
Infection
Foreign body in ear
Iatrogenic
Cholesteatoma

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25
Q

List Sx of tympanic membrane perforation

A

Sudden unilateral hearing loss
Tinnitus
Otalgia
Otorrhoea

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26
Q

List Mx of tympanic membrane perforation

A

Depends on cause:
- small perforations: watch & wait
- treat infection
- cholesteatoma: urgent ENT referral
- chronic large perforation: refer for surgical repair if affecting QoL

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27
Q

What is cholesteatoma?

A

Migration of middle ear mucosa to outer ear causing gradual erosion

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28
Q

What is glue ear?
- time period diagnosis for glue ear

A

Otitis media with effusion
Presence of fluid in middle ear for 3 months or more

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29
Q

What is the prevalence of glue ear?

A

80% children have it before age of 10

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30
Q

What is peak age incidence of glue ear?

A

2-5 years

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31
Q

When is glue ear more common?

A

Winter

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32
Q

What causes glue ear?

A

Chronic eustachian tube dysfunction leading to difficulty ventilating middle ear

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33
Q

List complications of glue ear

A

Hearing loss
Delay in speech development
Poor performance in school

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34
Q

List risk factors of glue ear

A

Male
Under 7
Immunocompromised
Bottle fed
Passive smoking
Downs / Cleft palette
CF

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35
Q

List Sx glue ear

A

Mainly asymptomatic
Unilateral hearing loss - behaviour issues, poor attention and speech
Mild otalgia

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36
Q

Describe Ix of glue ear

A

Examination of ear
Otoscopy
Hearing test
Tympanogram

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37
Q

What will tympanic membrane look like in glue ear?

A

Dull or opaque
Fluid bubbles behind drum

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38
Q

List tympanogram findings of glue ear

A

Type B - flat trace with normal volume
Type C - negative peak (eustachian tube dysfunction)

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39
Q

List Mx of glue ear

A

Active monitoring - self resolving in 3 months
+/- Rhinitis Tx / otovent balloon
+/- Hearing aids
+/- Grommets

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40
Q

What are the types of hearing loss?

A

Conductive and sensorineural

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41
Q

What is conductive hearing loss?

A

Damage to outer and middle ear causing interference with sound travelling

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42
Q

What is sensorineural hearing loss?

A

Interference with AP conduction in inner ear

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43
Q

Is glue ear conductive or sensorineural?

A

Conductive - prevents tympanic membrane movement

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44
Q

What is mastoiditis?

A

Infection of mastoid air cells spreading from ear

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45
Q

List risk factors of mastoiditis

A

<2 years old
Immunocompromised
Pre existing cholesteatoma
Communication difficulties - can’t vocalise the pain

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46
Q

List Sx of acute mastoiditis

A

Acute / recurrent otitis media
Otalgia
Fever
Irritable child
Muffled hearing

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47
Q

List signs of acute mastoiditis

A

VERY UNWELL
red, tender swelling over mastoid
protrusion of external ear forward
bulging and erythematous tympanic membrane

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48
Q

List Sx of chronic mastoiditis

A

recurrent otitis media, headaches, otalgia

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49
Q

List signs of chronic mastoiditis

A

no perimastoid inflammation
+/- tympanic membrane affected

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50
Q

Ix of mastoiditis?

A

EARLY & PROMPT
FBC, U&E, CRP, blood cultures
Ear swab
+/- CT petrous bone / brain - complications

51
Q

Mx of mastoiditis?

A

IV Abx
topical Abx ear drops
+/- cortical mastoidectomy
+/- grommet

52
Q

What is a cholesteatoma?

A

Squamous epitheleium (skin) migrates in the middle ear and gradually erodes the bone / soft tissues

53
Q

Sx of cholesteatoma?

A

persistent smelly discharge
progressive / severe hearing loss
dizziness
acute mastoiditis
facial palsy

54
Q

Ix & Mx of cholesteatoma

A

Diffusion weighted MRI aids diagnosis
Surgery - mastoidectomy

55
Q

List risks of cholesteatoma

A

Permenant hearing loss
Spread of infection into brain / facial nerve

56
Q

Mx of foreign body in ear?

A

Diagnosis = Hx & evidence on otoscopy
EXAMINE BOTH EARS
1st attempt is best attempt to remove it
If unsuccessful - use GA

57
Q

What foreign bodies need to be removed straight away?

A

Corrosive materials or evidence of infections

58
Q

What foreign bodies need to be removed same day?

A

Organic material - food or bugs

59
Q

What foreign bodies need to be removed at the next appt?

A

Inorganic material - eg beads / cotton buds

60
Q

Sx of pinna haematoma?

A

Boggy, blueish swelling of pinna
(cauliflower ear - chronic)

61
Q

Causes of pinna haematoma?

A

blunt ear injury
infection - secondary to piercing

62
Q

Mx of pinna haematoma?

A

Urgent drainage under GA
Pressure dressing
Abx

63
Q

Describe the new born hearing screening

A

Usually during first few weeks, before 3 months
AOAE - Automated otoacoustic emission test
- clicking sound in ear, with echo measured by microphone
ABR - auditory brainstem response test
- electrodes on head detects brain waves in response to clicking sound

64
Q

Describe prevalence of epistaxis

A

60% population have them
Less common under 2
6% need admission

65
Q

Risk factors for epistaxis?

A

Male
Winter months
Nasal allergies
Previous episodes
Coagulation disorders
Nasal trauma

66
Q

Where is the most common place for a nose bleed and why?

A

Kiesselbach’s plexus / Little’s area
where major arteries in the nose anastamose

67
Q

What is Mx of epistaxis?

A

ABCDE
A - lean child forward and pinch nose for 15 minutes (prevent congealing of blood at back of nose)
–> 90% resolve at this point
Topical lidocaine / tranexamic acid / adrenaline
Cauterisation with silver nitrate stick
Packing if a posterior bleed eg with Foley’s catheter or rapid rhino or naseptin cream

68
Q

Why is adenoidal hypertrophy a problem?

A

Persistent mouth breathing
Hyponasal speech
OSA
Glue ear

69
Q

When are adnenoids the biggest?

A

5-7 years old, then regress

70
Q

Indications for adenoidectomy?

A

Airway obstruction eg OSA
Glue ear

71
Q

What must be done post adenoidectomy for best results?

A

Good analgesia
Start eating / drinking ASAP

72
Q

What type of allergy is allergic rhinitis?

A

Type 1 sensitivity

73
Q

List allergens causing allergic rhinitis

A

Hay, pollen, dust, animal hair, mold spores

74
Q

What causes T1HR?

A

Lack of exposure to siblings / animals

75
Q

Sx of allergic rhinitis?

A

Related to excess fluid in facial tissues
- sneezing
- red itchy swollen eyes
- nasal congestion
- affects concentration / sleep / attendance

76
Q

How is allergic rhinitis diagnosed?

A

Skin prick test or patch test

77
Q

Mx of allergic rhinitis?

A

Avoid allergen
Antihistamines eg cetirizine
Nasal toileting - flush water up and down nose
Desensitisation if very severe - gradual exposure to allergen

78
Q

What is rhinosinusitis?

A

Acute inflammation of nose and paranasal sinuses from viral infection and inadequate drainage of paranasal sinuses

79
Q

Causes of rhinosinusitis?

A

Rhino virus or coronavirus
2% strep

80
Q

Risk factors of rhinosinusitis?

A

Air pollution, damp housing, winter months, smoke

81
Q

Sx of rhinosinusitis?

A

Headache
Hyposmia
Nasal obstruction
Rhinorrhoea & post nasal drip
Facial pain
fever

82
Q

Mx of rhinosinusitis?

A

Resolve spontaneously in 7 days
Abx if fever or prolonged Sx
Nasal steroids
CT sinus is persistent

83
Q

What is periorbital cellulitis?

A

ENT EMERGENCY
Infection from nasal sinuses, eyes or skin extend to surround eyes

84
Q

List categories of periorbital cellulitis

A

Pre-septal - infection from conjunctiva / lids
Post-septal - infection from frontal / ethmoid sinuses

85
Q

Mx of periorbital cellulitis

A

Keep monitoring eye movements of child
Nasal decongestants
IV Abx
+/- surgical drainage

86
Q

Sx of periorbital cellulitis

A

Prodrome of URTI
Acute swelling of eye
Proptosis
Restricted eye movements

87
Q

Complications of periorbital cellulitis

A

Cavernous sinus thrombosis
Erosion into orbital bones
Brain abcess
Meningitis

88
Q

What is the peak age of nasal foreign bodies?

A

1-4 years old

89
Q

Sx of nasal foreign bodies

A

Unilateral nasal discharge
Offensive smelling discharge
Excoriation around nostril with foreign body

90
Q

Mx of nasal foreign bodies

A

Check BOTH nostrils
Remove object on SAME DAY - risk of inhalation to lungs
- can be done under GA
Ways to remove:
- positive pressure technique “magic kiss”: close empty nostril, ask parent to blow air through mouth and hopefully will dislodge object
Jobson Horn / St Barts Wax Hook / Foley Catheter - hook or drag it out
Crocodile forceps - pinch and pull it out

91
Q

Name 3 parts of the throat and their boundaries

A

Nasopharynx - end of inferior turbinate to end of soft pallate
Oropharynx - end of soft pallate to laryngeal vestibule
Laryngopharynx - laryngeal vestibule to division of trachea/oesophagus

92
Q

List Sx of tonsillitis

A

Sore throat
Odynophagia
Fever
Malaise
Enlarged red tonsils +/- exudate
Cervical lymphadenopathy

93
Q

What is the duration of tonsillitis?

A

3-7 days

94
Q

List responsible organisms of tonsillitis?

A

Resp viruses
Haemophilius influenza
Pneumococcus
Haemolytic strep

95
Q

DDx of tonsilitis?

A

Mono
Agranulocytosis
Scarlet fever
Diptheria

96
Q

Ix of tonsilitis?

A

FBC
U&E
Glandular fever screen - mono spot / EBV serology

97
Q

Mx of tonsilitis

A

Pain killers
Fluids & keep eating
Abx if no improvement after 5 days

98
Q

When would you refer tonsilitis to ENT?

A

Recurrent debilitating tonsilitis
Asymmetrical tonsils / unilateral enlargement
Sleep disordered breathing in children

99
Q

Complications of acute tonsilitis

A

Quinsy
Retropharangeal abcess if under 5 years old or parapharyngeal abcess
Rheumatic fever
Glomerulonephritis
Septicaemia

100
Q

What causes pharyngitis?

A

Viral disease - flu / measles
EBV
Scarlet fever
Thyphoid fever
Coxsackie infection
Diptheria

101
Q

What does EBV pharyngitis look like?

A

White membrane

102
Q

What does diptheria pharyngitis look like?

A

Gray film

103
Q

Complications of pharyngitis?

A

Peritonsilar abcess
Uvulitis

104
Q

Sx of pharyngitis

A

Sore throat
Malaise
Fever
Erythema

105
Q

Mx of pharyngitis

A

90% resolve spontaneously in 7 days
Good analgesia - difflam mouthwash, ibuprofen etc
Only give ABx if FeverPain score appropriate

106
Q

Mx of post tonsillectomy bleed

A

ENT EMERGENCY
Majority are self limiting but must admit as they have sudden severe harmorrhage risk
ABCDE
A- lean head forward
Stop bleeding - hydrogen peroxide gargles, NBM, tranexamic acid, silver nitrate cautery sticks

107
Q

Sx of foreign body inhalation

A

Short, sudden episode of respiratory distress, cyanosis, coughing and gagging
Then the child will appear well
Stridor
Unilateral wheeze
Persistent recurrent cough

108
Q

Mx of foreign body inhalation

A

AIRWAY EMERGENCY
Removal must be same day

109
Q

Complications of foreign body inhalation

A

Airway obstruction
Cardiac arrest
Choking
Lung abcess
Fistula

110
Q

What is the difference between stridor or stertor?

A

Stridor = upper airway obstruction sound
Stertor = doesn’t mean airway is at risk, is just a snoring nose. Much longer duration

111
Q

How are stridor and stertor similar?

A

Both inspiratory sounds

112
Q

When do you hear wheeze?

A

Expiratory sound

113
Q

What is laryngomalacia?

A

When a child’s larynx is soft / floppy / malformed

114
Q

What is the main clinical sign of laryngomalacia?

A

Stridor - the most common cause for stridor

115
Q

When is laryngomalacia present?

A

Birth or 1st month of life

116
Q

Mx of laryngomalacia?

A

90% cases resolve by 20 months
Mx of GORD
Surgery

117
Q

Sx of laryngomalacia?

A

Stridor - worse when laying on back or crying
Struggling to breathe
Poor oral intake / choking when eating
Failure to thrive

118
Q

When do you refer laryngomalacia

A

Life threatening apnea
Significant cyanosis episode
failure to thrive
Chest / neck retractions
secondary heart or lung disease

119
Q

When do you get cervical lymphadenitis?

A

URTI viral infection
Bacterial infections
Cancer
Immunological response

120
Q

What is cervical lymphadenitis linked with?

A

Eczema

121
Q

Mx of cervical lymphadenitis?

A

ABx
USS neck
Surgery for drainage collection

122
Q

Sx of cervical lymphadenitis?

A

Tired child, off their food and not sleeping well
Enlarging neck lump
Tender, red, hot lump

123
Q

What does a fluctuant cervical lymphadenitis lump indicate?

A

Abscess formed

Y5 Paeds (13 decks)

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