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3a paediatrics > ENT > Flashcards

ENT Flashcards

1
Q

Paediatric ENT epidemiology

A

ENT problems common
-Up to 50% of GP consultations in winter months

Unique morbidity
- different physiology and anatomy

Congenital problems prominent

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2
Q

Ear embryology

A

Head and neck structures develop from pharyngeal (branchial) arches, pouches and clefts
External ear – pinna: 6 Hillocks of His (mesoderm) from 1st and 2nd branchial arch
Ear canal: ectoderm of 1st branchial cleft
TM: 3 layers - outer ectoderm, middle mesoderm and inner endoderm from 1st pouch

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3
Q

Basic ear anatomy

A

Outer cartilaginous and bony shorter
Middle; bones of hearing, Eustachian tube, promontory, facial nerve and chorda tympani
Inner: hearing and balance organs (cochlea, utricle, saccule and vestibule

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4
Q

Congenital problems of the ear

A

Absence of auricle/ microtia
Atresia of outer ear canal - dont have ear canal
Pre auricular sinus
Accessory auricles - body tried to make more than one ear
Prominent ears - bat ear
Outer ear abnormalities may herald middle ear problems
Inner ear develops earlier than middle/outer ear

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5
Q

Middle ear problems

A

Abnormal ossicles
- disruption of sound amplification mechanisms

Craniofacial syndromes

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6
Q

Inner ear problems

A

Scheibe (cochleosaccular) dysplasia
Mondini (cochlear) dysplasia
Bing-Siebenmann (vestibulocochlear) dysplasia – membranous labyrinth affected
Michel aplasia – complete labyrinthine aplasia

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7
Q

What does a malformed inner ear cause?

A

Profound hearing loss

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8
Q

How do we identify children with hearing loss

A

Newborn Hearing Screening Programme NHSP (2006)
Within 4-5 weeks of birth, before 3 months
Automated otoacoustic emissions, auditory brainstem responses
Look out if risk factors in the prenatal history
Neonatal check obvious structural abnormalities
Early referral to audiology; care and support
Early cochlear implantation
IF IN DOUBT- SEND FOR HEARING TESTING

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9
Q

RFs for deafness in newborns

A

FH
Illness in mother
Prematurity
Jaundice
Anatomical abnormalities

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10
Q

Ear infections

A

Otitis externa
Painful, inflamed EAM +/- pinna
Treat with microsuction, topical antibiotics

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11
Q

Otitis media features

A

Otitis media 90% of children at some point
- infection
- Eustachian tube dysfunction
- Fluid in middle ear: mucoid vs serous
- Often painless (can be sudden pain if perforation)
- OME persistent for >3/12
Self limiting
But risks of complications (mastoiditis)
Controversy about antibiotics (Finland prescription to fill if not better)
Chronic otitis media
- OME, cholesteatoma

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12
Q

Features of OME/Glue ear

A

NICE Guidelines CG60: Otitis media with effusion in under 12s: surgery (2008)
Hearing loss 25-30dB on 2 occasions 3/12 apart
Options
1. Conservative: Do nothing, Eustachian tube autoinflation (Otovent balloon)
2. Ventilation tubes (Grommets)
3. Hearing aids: alternative to surgical intervention where surgery is contraindicated or not acceptable

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13
Q

Features of a chronically discharging ear

A

Perforation
Retraction pockets
Chronic supparative otitis media
Cholesteatoma
- Present repeated infections
- Offensive discharge
- Can see perforation
- White material

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14
Q

What are the 2 types of Cholesteatoma

A

Acquired
Congenital

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15
Q

What happens in cholesteatoma

A

As cholesteatoma sac grows, it locally erodes.

Damage to middle ear/inner ear structures

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16
Q

What is the treatment for Cholesteatoma?

A

Rationale: Dry, safe ear
Perforation - Close it
Cholesteatoma remove it preserving hearing if possible or leaving scope for reconstruction
Mastoidectomy

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17
Q

What is the boggy swelling in ear known as?

A

Acute mastoiditis

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18
Q

Issues with foreign bodies in the ear

A

Have one go (cooperative child, parent, good light and equipment)-
If unable to remove: GA
- Foreign bodies often no harm if in for a few days in ear

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19
Q

What happens if there are button batteries in your ear, nose or has been swallowed?

A

IMMEDIATE EMERGENCY REFERRAL TO ENT

20
Q

Embryology of the nose

A

Starts to develop at week 5 (olfactory placodes)
Median and lateral processes
Thickening of ectoderm above stomodeum

21
Q

Issues with nose

A

Babies obligate nasal breathers
Facial anomalies can affect breathing

22
Q

What is choanal atresia and what are its features?

A

Failure of the nose to canalise
Bony or membranous
Bilateral rare but a neonatal emergency
Cyclical going blue, crying-going pink, stop crying going blue again
Cold spatula: no misting
Failure to pass an NG tube
If confirmed secure airway (Guedel or McGovern nipple)
Tertiary referral for dilatation +/- stent insertion (SCH)

23
Q

What are some types of craniofacial abnormalities?

A

Syndromic
Down, Apert, Pfeiffer, Crouzon, Treacher Collins
May have problems with airway
OSA, midfacial hypoplasia
Tracheostomy may be required (last resort)
Elective trache to cover facial surgery

24
Q

Features in foreign bodies of the nose

A

Nose contains erectile tissue…
( honeymoon rhinitis)
Unilateral discharge is a foreign body unless proven otherwise
Have one go (cooperative parents, good light, proper equipment) otherwise refer to ENT
Be wary of organic foreign bodies: risk of infection

25
Q

Features of nosebleeds (Epistaxis)

A

Nose richly supplied with blood
Little’s area
Nose picking, inflammation, foreign body, trauma, bleeding diathesis
ABC
Medical treatment:
Topical naseptin, silver nitrate cautery
Surgical treatment
Electrocautery
BEWARE teenage boy with persistent nosebleeds and nasal obstruction: ?juvenile nasopharyngeal angiofibroma

26
Q

When are the sinuses morphed?

A

Maxillary sinuses exists at birth, grows full size after second dentition
Ethmoids 2-3 cells at birth
Frontals rudimentary or absent at birth (develops by 7-8 years)
Sphenoid recognised at birth

27
Q

Sinusitis in children

A

Rare in children
If associated with nasal polyps consider cystic fibrosis
Complications most common presentation
- Periorbital cellulitis

28
Q

What is periorbital cellulitis?

A

Medical emergency
URTI followed by painful swollen eye
Proptosis
Red colour vision: sign of optic nerve compromise
Needs joint care between ENT, paeds and ophthalmology
IV Abx
Incision and drainage of abscess – open or endoscopic

29
Q

What needs to happen if there is periorbital cellulitis

A

IMMEDIATE REFERRAL TO ENT/PAEDS/OPTHALMOLOGY

30
Q

Anatomy of the throat

A

Oral cavity
Teeth, tongue
Pharynx: naso-/ oro-/ hypopharynx
Tonsils
Palatine (adenoids)
Pharyngeal (tonsils)
Larynx

31
Q

Anatomy of the airway

A

Absolutely and relatively smaller
Narrowest point is subglottis (vs VC in adults)
Loose mucosa
Less reserve

32
Q

Anatomy of the larynx

A

Find in ent slide 42

33
Q

What are some congenital larynx issues?

A

Laryngeal atresia – EXIT (ex utero intrapartum treatment) procedure
Tracheostomy while umbilical cord still attached to mother
Laryngomalacia

34
Q

What is laryngomalacia

A

Most common abnormality
Normal voice, stridor worse on feeding and exertion
Worse when supine
Failure to thrive
Increased work of breathing

35
Q

What is found on examination of laryngomalacia?

A

Normal child
Stridor
WOB, tracheal tug, recessions
Flexible nasendoscopy examination: omega shaped epiglottis, short aryepiglottic folds, bulky, prolapsing arytenoids

36
Q

What is the treatment of laryngomalacia?

A

Close monitoring
Weigh (?daily/weekly at first)
Antireflux
If not coping NG tube
?surgery – microlaryngobronchoscopy + aryepiglottoplasty
Is self limiting stridor lessens and gone by 2 years old

37
Q

Why is stridor important?

A

Phase important to detect location
Inspiratory: laryngeal
Biphasic: subglottis/trachea
Expiratory: bronchi
Tertiary referral
Consider flexible nasendsocopy (up to 1 year old, or over 7 years of age)
GA: Microlaryngobronchoscopy

38
Q

What are the causes of stridor

A

Laryngomalacia, cysts, papilloma, haemangiomas, clefts, post intubation subglottic stenosis, tracheobronchomalacia

39
Q

Inflammation of the larynx

A

Colds/URTIs
Epiglottitis rare age 2-5: sudden onset v unwell, drooling, stridor
Haemophilus influenzae B (HiB)
Medical emergency
Do not agitate child
Theatre (intubate if poss)

40
Q

What is croup and its features

A

Laryngotracheobronchitis
Common
Low grade fever
Not v unwell
Parainfluenza virus types 1 and 2
Stridor
O2, steroids, adrenaline nebulisers

41
Q

Features of Tonsils, adenoids and OSA

A

Tonsils and adenoids: collection of lymphoid tissue (Waldeyer’s ring)
Large in children
Obstruction sleep apnoea
- Apnoeas: cessation of breathing + desaturations

42
Q

History of Tonsils, adenoids and OSA

A

Snoring/stertor (upper airways noises)
Restless
Sweaty
Poor eaters (drink milk copiously)
Failure to thrive
Pauses in breathing at night, gasping – apnoeas
Behavioural problems: hyperactivity, tiredness

43
Q

Assessments

A

ENT exam (mouth breathing, adenoid facies)
Large tonsils
Pes excavatum

44
Q

Tests

A

Domiciliary sleep study/polysomnography (EEG, ECG, O2 sats, infra red cameras, movement detectors)
Management based on history and examination

45
Q

Treatment

A

Adenotonsillectomy
Intracapsular vs. extracapsular
Monitor O2 sats overnight post op
Most on surgical ward
May need HDU

46
Q

Airway foreign bodies

A

Rigid ventilating bronchoscope
Button batteries: emergency!

3a paediatrics (18 decks)

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