ENT Flashcards
Define chronic otitis media
Chronic inflammation of the middle ear and mastoid cavity, which presents with recurrent otorrhoea through a tympanic perforation
Who is most frequently affected by chronic OM
Children <5
When does acute OM become chronic OM
After at least 2 weeks of discharge
Who is most affected by chronic OM
List some other risk factors
Children <5
Other risk factors include: recurrent OM, history of allergy/atopy, smoking household, social deprivation
Organisms which cause chronic OM
Pseudomonas aeruginosa (most common)
Staph aureus
Proteus
Aspergillus
Candida albicans
Most common organism to cause chronic OM
Pseudomonas aeruginosa
Management of chronic OM
Insertion of grommets
Long term Abx rarely useful
Audiology assessment if suspected hearing loss
When a grommets usually extruded spontaneously?
6-9 months
Can children with grommets go swimming?
Yes - studies have shown swimming is not considered harmful however they should avoid diving
Why is Pen-V recommended over Amoxicillin for those with suspected bacterial throat infection?
Risk of widespread rash / misdiagnosed penicillin allergy with Amoxicillin if the underlying infection is EBV/glandular fever
Which children are more likely to benefit from Abx in OM?
Children <2 with bilateral OM or those with OM and otorrhoea
First line Abx for acute OM
Amoxicillin
Best hearing test for those aged 2-5?
Play audiometry
Best hearing test for those aged 8 months - 1 year
Distraction testing (requires the child to sit unsupported)
Best hearing test for those aged >5
Pure tone audiometry
Best hearing tests for babies (<6mths)
Automated auditory brainstem response (AABR) / Brain stem evoked potentials
Oto acoustic test (100% sensitivity for moderate - profound sensorineural hearing loss). THIS IS THE INITIAL NEWBORN SCREENING TEST IN THE UK.
Most common cause of conductive hearing loss
Chronic OM
Most common cause of sensorineural hearing loss
Genetic (e.g. Klinefelter syndrome, Turner syndrome)
Which is more common: conductive or sensorineural hearing loss
Conductive
Causes of sensorineural hearing loss
Genetic (e.g. Klinefelter syndrome, Turner syndrome)
TORCH infections
Maternal drugs (alcohol, cocaine)
Encephalitis
Meningitis
Prematurity
Hypoxic injury at birth
Severe hyperbilirubinaemia
Rinne and Weber findings in conductive hearing loss
Preservation of bone conduction and diminished air conduction
Rinne and Weber findings in sensorineural hearing loss
Equal impairment of both air and bone conduction
What is the most common embryological aetiology of cleft lip?
Failure of fusion of the medial nasal and maxillary processes.
This occurs in the 5-6th week of gestation.
Which type of hearing loss has a greater prevalance of tinnitus?
Conductive hearing loss
Also mild hearing loss
