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Phase 3a > ENT > Flashcards

ENT Flashcards

1
Q

Otitis media

A

Infection of ear metween tympanic membrane + cochlea/vestibular apparatus.

Common site of infection in children as bacteria from back of throat can enter through eustachian tube.

Oft preceeded by viral URTI.

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2
Q

Bacterial causes of otitis media

A

STREP PNEUMONIA = most common (commonly causes rhino-sinusitis, tonsillitis)

Others:

  • Haem influenza
  • Moraxella catarrhalis
  • Staph aureus
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3
Q

Otitis media presentation

A
  • EAR PAIN + REDUCED HEARING (usually unilateral)

Fever, cough, coryza, sore throat, malaise
- very non-specific Sx esp in young kids

Can cause BALANCE ISSUES + VERTIGO if affecting vestibular system

If typanic membrane perforates - may get DISCHARGE

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4
Q

Examination findings from otoscopy in healthy ear

A

Tympanic membrane - ‘Pearly-grey’, translucent + slightly shiny
- cone of reflected light
- should be able to see malleus through membrane

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5
Q

Examination findings in otitis media

A

Red, bulging, inflamed membrane if acute

may see discharge + hole

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6
Q

Otitis media management

A

Usually self resolving -> SIMPLE ANALGESIA for pain/fever

Antibiotics oft not recommended, but consider if:

  • SIGNIFICANT CO-MORB (systemically unwell, immunocompromised)
  • Kids < 2 YEAR with BILATERAL infection
  • OTORRHOEA (discharge)

Consider after 3 days if not improving/worsening without antibiotics.

1st line = AMOXICILLIN for 5 DAYS
2nd = macrolides (erythro/clarithro)

SAFTY NET

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7
Q

When is specialist referal required for pediatric otitis media

A

Refer for specialist assessment/admission in INFANTS:

  • < 3 MONTHS with FEVER > 38 DEGREES
  • 3-6 months with temp > 39 DEGREES
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8
Q

Complications

A
  • Otitis medial with effusion
  • Hearing loss (usually temporary)
  • Perforated eardrum
  • Recurrent infection
  • Mastoiditis - inflam of mastoid process (rare)
  • Abscess (rare)
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9
Q

Glue ear

A

AKA otitis media with effusion

FLUID builds up due to eustachian tube blokage

-> HEARING LOSS (most common cause in kids)

Usually caused by ear infection. Can also lead to ear infection.

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10
Q

Appearance of glue ear on otoscopy

A

DULL tympanic membrane with AIR BUBBLES or VISBLE FLUID LEVEL.

Can look normal.

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11
Q

Glue ear RFx

A
  • Childhood
  • URTI; acute otitis media
  • Cranio facial anomalies; Eustachian tube dysfunction
  • Genetic predisposition
  • Daycare attendance
  • Adenoiditis/hyperplasia blocking eustachian tubes

Weak:
Allergic rhinitis, tobacco smoke, nasopharyngeal malig, GORD, low socioeconomic status, male sex

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12
Q

Glue ear Sx

A
  • Aural fullness/signs of ear discomfort
  • HEARING LOSS; failed hearing screen;
  • slow progress at school; speech delay

HEaring problems/balance problems uncommonly.

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13
Q

Glue ear investigations

A

PNEUMATIC OTOSCOPY

Tympanometry if difficult to diagnose

Audiology if CHRONIC or an AT-RISK CHILD

If chronic/recurrent consider nasopharyngeal endoscopy

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14
Q

Which children are at risk of developmental sequelae as a result of glue ear

A
  • Permanent non-OME related hearing loss
  • Speech and language delay or disorder
  • Autism-spectrum disorder
  • Genetic syndromes or craniofacial disorders associated with cognitive or language delays
  • Blindness or uncorrectable visual impairment
  • Cleft palate
  • Developmental delay
  • Intellectual disability, learning disorders or attention deficit/hyperactivity disorder.
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15
Q

Glue ear Tx

A

Usually self resolves WITHIN 3 MONTHS - usually just watchful waiting

If risk of developmental sequelae or hearing loss:
- Grommet +/- adenoidectomy

May need hearing aid if co-morbid something affecting ear structure

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16
Q

Grommets

A

Tiny tubes inserted into tympanic membrane -> allows drainage; mainly for ventilation to help depressurise

Usually geneeral anaesthetic + day case procedure

Few complications. Usually fall out within a year. 1 in 3 require further grommets from chronic/recurrent.

17
Q

Causes of hearing loss

A

Congenital:

  • Maternal Antenatal RUBELLA or CMV
  • GENETIC
  • Associated with syndromes e.g. DOWN’S

Aquired:

Perinatal:

  • Premmie
  • Hypoxia

Postnatal:

  • Jaundice
  • Mening/encephalitis
  • Otitis media / Glue ear
  • Chemo
18
Q

Presentation of Hearing loss/deafness

A
  • Congenital = oft picked up during NEWBORN HEARING SCREENING PROGRAM (since 2006)
    - picks up if v profound loss; typically in high risk kids (prem, v ill, FHx)
    - can give hearing aids/cochlear implants to help the kid learn speech + language (otherwise will not develop SAL)
  • Parental concerns about behaviour problems/changes
    • Ignoring calls; bad behaviour, Poor salt; Poor school performance
  • SCHOOL SCREENING PROGRAMME when starting school
19
Q

How is hearing loss tested

A

Audiometry

  • < 3 y/o = basic response to sound
  • > 3 y/o = headphones with specific tones + volumes
20
Q

Hearing loss epidemiology

A
  • 1 in 6 people
  • Usually takes around 10 years before treated
  • 1 in every 100 babies spending > 48 HRS in ICU (norm only 1 in 1000)
21
Q

Which groups are high risk for hearing loss

A
  • CYSTIC FIBROSIS
  • DOWN’S
  • Head TRAUMA
  • Cleft lip/palate
  • CMV
  • CHEMO

These groups are monitored more closely

22
Q

Aims of hearing test

A
  • Measure threshold
  • Frequency specific
  • DIfferentiate which type of hearing loss: conductive, sensorineural or mixed
  • Compare aided + unaided response (check if aids helping)
  • Monitor if fluctuating / progressive
23
Q

Audiogram

A

Docment volume at which patients can hear diff tones.

  • Frequency (Hz) on x-axis (high pitched at right);
  • volume (dB) on y-axis (quiet at top)

ie lower on chart = louder volume required = worse hearing

24
Q

Symbol meanings on audiogram

A

X – Left sided air conduction
] – Left sided bone conduction
O – Right sided air conduction
[ – Right sided bone conduction

25
Q

What is normal range of volume needed for hearing

A

Between 0-20 dB (decibals)

26
Q

Conductive vs sensorineural hearing loss on audiogram

A

Sensorineural - both air + bone conduction will be charted > 20 dB

Conductive - bone conductions in normal range (0-20 dB); air conduction > 20 dB

If mixed: both will be > 20 dB but bone conduction will be >15 dB better than air

27
Q

Severity of Hearing loss

A
  • Mild = 20-40 dBHL
  • Mod = 41-70
  • Severe = 71-95
  • Profound = > 96
28
Q

Causes of conductive hearing loss

A
  • Glue ear
  • Ear wax
  • Middle ear infection
  • Perforated eardrum
  • Abnormality of the outer ear
  • Eustachian tube dysfunction
29
Q

Conductive hearing loss Tx

A
  • Oft self-resolving
  • Grommets
  • Hearing aid if persistent + don’t want surgery
  • Bone Anchored Hearing Aid if permanent
30
Q

Sensorineural hearing loss Tx

A

Usually permanent so HEARING AIDS
- aim to make speech audible

Chochlear implants if profoundly deaf

31
Q

Hearing loss Ix

A

Subjective (kid has to respond):

  • Distraction test (6-18 M)
  • Visual Reinforcement Audiometry (6-30 M)
  • Performance Testing (> 24 M)
  • Pure Tone Audiometry (>3 yrs)

Objective (no response needed - just need to be still + quiet environment)

  • Otoacoustic Emissions (in newborn screening)
  • Auditory Brainstem Response (more detailed; 2ndary)

Tympanometry - measures middle ear pressure
- abnormal = conductive

32
Q

Herpes zoster ophthalmicus definition + Px

A

Shingles reactivation in distribution of ophthalmic branch of trigeminal nerve

Px:

  • Painful red eye
  • Fever, malaise, headache
  • Erythematous vesicular rash over ophthalmic area

HUTCHINSON’S SIGN = lesion on nose - very indicative of ocular involvement

33
Q

Herpes zoster ophthalmicus Tx

A

Hospital admission + IV ACICLOVIR

Analgesia = NSAIDs (1st) then things for nerve pain if 1st doesn’t work (Amytriptyline, Duloxetine, Gabapentin/pregabalin)

Avoid contact with anyone immunocompromised (including preg ppl + babies) till all lesions crusted over

NB: hospital admission only needed if severe, ophthalmic involvement or suspicion of CNS infection
- mod/severe rash / pain or non-truncal (or mild in immunocomp) = oral aciclovir
- Normally, truncal shingles in healthy person self resolves without meds

34
Q

When is the shingles vaccine recommended to be taken

A

Within the 70s age range

35
Q

Complications of herpes zoster ophthalmicus

A
  • Corneal ulcers, scarring / blindness
  • 2ndry bacterial infection of skin lesions
  • Post herpetic neuralgia
36
Q
A

Phase 3a (26 decks)

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