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Phase 3a Paeds > ENT > Flashcards

ENT Flashcards

1
Q

What 4 hearing tests are done to a child?
ages?

A

Newborn (within 4/5 weeks of birth)
Newborns with abnormal otoacoustic emission
6-9 months
3y 4 months

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2
Q

what hearing test is done to a newborn?

A

Newborn hearing screening programme
Computer clicks
Echo detection = healthy cochlea

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3
Q

what hearing test is done for Newborns with abnormal otoacoustic emission?

A

auditory brainstem response test

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4
Q

what hearing test is done at 6-9 months?

A

distraction test

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5
Q

what hearing test is done at 3y 4 months?

A

pure tone audiometry

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6
Q

what does an audiogram measure?
the bigger = ?

A

measures hearing in dB
Bigger = worse hearing

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7
Q

what dB is normal hearing?
what dB is deafness/HI?

A

normal = 20dB
deafness/HI = >20 dB

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8
Q

What are the 2 types of hearing loss?

A

Sensorineural

Conductive

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9
Q

What is webers test?
how to do it?

A

-Strike the tuning fork to make it vibrate and hum (use the palm of your hand or your knee – not the patient!)
-Place it in the centre of the patient’s forehead
-Ask the patient if they can hear the sound and which ear it is loudest in

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10
Q

what is rinnes test?
How to do it?

A

-Strike the tuning fork to make it vibrate and hum
-Place the flat end on the mastoid process (the boney lump behind the ear) – this tests bone conduction
-Ask the patient to tell you when they can no longer hear the humming noise
-When they can no longer hear the noise, remove the tuning fork (still vibrating) and hover it 1cm from the same ear
-Ask the patient if they can hear the sound now – this tests air conduction
-Repeat the process on the other side

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11
Q

what is sensorineural HL caused by?

A

problem caused by sensory system or vestibulocochlear nerve in inner ear

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12
Q

Sensorineural HL
Webers?
Rinnes?

A

Louder in normal ear, quieter in affected ear

Air>bone +ve

Contralateral HL

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13
Q

what is conductive HL caused by?

A

Problem with sound travelling into the inner ear, sensory system is fine

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14
Q

Conductive HL
Webers?
Rinnes?

A

Louder in affected ear (affected ear turns up volume, more sensitive to vibration, straight to cochlea)

-ve, abnormal - Air<bone, sound through air is quieter, bone conduction intact

Ipsilateral hearing loss

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15
Q

Causes of sensorineural HL?

A

Presbycusis
Noise exposure
Menieres disease
labyrinthitis
acoustic neuroma
infection

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16
Q

Medications causing sensorineural HL?

A

loop diuretics (furesomide)
Gentamicin
Chemo (cisplatin)

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17
Q

Causes of conductive HL?

A

ear wax
infection
fluid in middle ear
perforated tympanic membrane
cleft lip/palate
downs
otitis media
wax impaction
osteogenesis imperfecta

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18
Q

what are 2 other causes of Hearing loss?

A

Cholesteatoma (growth behind ear drum)
Otosclerosis

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19
Q

what are 3 congenital causes of hearing loss?

A

Rubella
syphillis
CMV

20
Q

What are some complications of hearing loss?

A

developmental delay (speech and language)
social/behavioural
education
friendships
psychological

21
Q

Tx of conductive HL?

A

self limiting
Grommets (tube to drain fluid from ear)
fluid drainage
hearing aids

22
Q

Tx for sensorineural HL?

A

Hearing aids
cochlear implants

23
Q

What is the MC paeds conductive Hearing loss cause?

A

otitis media with effusion (glue ear)

24
Q

What is otitis media?
what ages affected?

A

Middle ear infection due to immature eustachian tube
6m - 5y (75% incidence)

25
Q

what is the cause of otitis media?

A

S.pneumo MC
RSV

26
Q

recurrent otitis media could be caused by which organism?

A

P.auerg

27
Q

RF for otitis media?

A

Daycare
Cleft lip!
downs
absent breast feeding
low birth weight

28
Q

Sx of otitis media?

A

Tugs/rubs ear (ear pain)
Fever
Hearing loss
Poor feed
Vertigo
Vomiting

29
Q

Dx of otitis media?
what is seen?

A

otoscopy
Air fluid level + bulging erythematous tympanic membrane + loss of light reflection

30
Q

Tx of otitis media?

A

Most = self resolve within 7 days

Recurrent, systemically unwell, >3 days Sx = PO amoxicillin TDS 125-250mg for 7 days

31
Q

Complications of otitis media?

A

Mastoiditis
meningitis
CN7 palsy
abscess

32
Q

what is otitis media with effusion (glue ear)?

A

blockage of eustachian tube, accumulation of fluid in middle ear, hearing loss

33
Q

Rf of otitis media with effusion (glue ear)?

A

Male
daycare
parental smoking
winter

34
Q

Dx of otitis media with effusion (glue ear)?
what would you see?

A

Dull tympanic membrane with air bubbles/visible fluid level

35
Q

Tx of otitis media with effusion (glue ear)?

A

Audiometry (extent of HL)
May resolve in 3m
then Myringectomy (hole in TM) + Grommets (<10m last) as functional Eustachian tube +/- adenoidectomy

36
Q

what would audiometry show in otitis media with effusion (glue ear)?

A

> 25-30 dB HL on 2+ occasions 3m apart

37
Q

What is otitis externa?

A

Infection and inflammation of the ear canal (outer ear)

38
Q

Cause of otitis externa?

A

S.aureus

39
Q

RF for otitis externa?

A

swimming
daycare
itchy + thick DC

40
Q

Dx of otitis externa?
what would you see?

A

Otoscopy
Eczematous erythematous ear canal with normal TM

41
Q

Tx of otitis externa?

A

Topical flucoxacillin / Amoxicillin drops + steroid drops

42
Q

complications of otitis externa?

A

Malignant otitis externa (immunocompromised, DM) - infection spreads to surrounding masto-temporal bone

43
Q

what is mastoiditis?

A

Infected mastoid bone usually 2* to otitis media untreated (mastoid air cells)

44
Q

Sx of mastoiditis?

A

Otalgia (ear pain)
protruding anterior displaced pinna
post auricular swelling

45
Q

Dx of mastoiditis?

A

Clinical +/- otoscope (OM/normal), CT head (r/o IC abscess)

46
Q

Tx of mastoiditis?

A

Admission
IV Abx - Piperacillin tazobactam (Pip tazo)

47
Q

Complications of mastoiditis?

A

abscess
meningitis

Phase 3a Paeds (14 decks)

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