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Phase 3a - Paediactrics > ENT > Flashcards

ENT Flashcards

1
Q

Otitis Media

A

Infection of the middle ear

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2
Q

Aetiology of Otitis Media

A

Viral - Pneumococcus/Haemolytic Streptococcus/Hib

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3
Q

Symptoms of Otitis Media

A

Ear pain - Fever - Bulging tympanic membrane - Discharge - Earache -Hearing loss

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4
Q

Secondary Otitis Media

A

glue ear) - Child may have hearing loss - Retracted eardrum - > 3 months: referral for grommets and adenoidectomy

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5
Q

Ix for Otitis Media

A

Otoscopy :bright red, bulging membrane

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6
Q

Managment of Otitis Media

A

Paracetamol + obseve (most resolve spontaneously). If symptoms don’t improve = 5 days Amoxicillin/Erythromycin

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7
Q

What are the key clinical features of otitis externa?

A

Pain, often worsened by pinna or tragal movement
Pruritus (itchiness)
Discharge (purulent or serous)
Swelling and redness of the external auditory canal
Hearing loss (due to swelling or debris in the canal)

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8
Q

What are the indications for ENT referral in otitis externa?

A

Failure to improve with treatment
Suspicion of malignant otitis externa
Severe canal obstruction preventing topical treatment application
Systemic symptoms or severe pain not responsive to initial management

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9
Q

What is the role of cleaning the ear canal in otitis externa management?

A

Cleaning removes debris, allowing medications to penetrate effectively and improving symptoms.

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10
Q

Malignant otitis externa is a severe infection that typically occurs in _________ or __________ patients.

A

Immunocompromised; diabetic

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11
Q

The topical antibiotic of choice for bacterial otitis externa is _______

A

Ciprofloxacin

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12
Q

Fungal otitis externa may present with _________ or _________ discharge.

A

Fluffy white; black

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13
Q

Which of the following are common causes of otitis externa?
A. Ear canal trauma
B. Pseudomonas aeruginosa
C. Prolonged exposure to water
D. All of the above

A

D. All of the above

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14
Q

What is the first step in treating otitis externa with significant ear canal debris?
A. Systemic antibiotics
B. Cleaning of the ear canal
C. Immediate referral to ENT
D. Prescribing oral analgesia

A

B. Cleaning of the ear canal

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15
Q

A 15-year-old swimmer presents with ear pain and pruritus after a week of swimming practice. Examination reveals redness and swelling of the external auditory canal, with no fever or systemic symptoms.
Q: What is the likely diagnosis, and what steps would you take to manage this patient?

A

Diagnosis: Otitis externa. Management: Clean the ear canal, prescribe topical ciprofloxacin with a steroid, and advise the patient to avoid water exposure until symptoms resolve.

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16
Q

A 70-year-old diabetic patient presents with severe ear pain, swelling, and cranial nerve weakness.
Q: What condition should you suspect, and how would you manage it?

A

Suspect malignant otitis externa. Management involves urgent ENT referral, imaging (e.g., CT scan), and IV antibiotics (e.g., ciprofloxacin).

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17
Q

Arrange the steps for treating fungal otitis externa:
A. Topical antifungal agents
B. Ear canal cleaning
C. Avoidance of water/moisture

A

B → A → C

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18
Q

Match the symptom with its likely cause:

Severe pain and cranial nerve palsies →
Purulent discharge →
Fluffy white or black discharge →

A

Severe pain and cranial nerve palsies → Malignant otitis externa
Purulent discharge → Bacterial infection
Fluffy white or black discharge → Fungal infection

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19
Q

Red Flags for Otitis Externa

A

Include systemic symptoms, unrelenting pain, or cranial nerve involvement for malignant otitis externa.

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20
Q

Prevention for Otitis Externa

A

Advice against using cotton swabs and prolonged water exposure.

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21
Q

What are grommets, and what is their purpose?

A

Grommets are small tubes inserted into the tympanic membrane to allow ventilation of the middle ear and prevent fluid buildup, commonly used to treat otitis media with effusion (glue ear).

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22
Q

What are the indications for grommet insertion?

A

Recurrent otitis media with effusion (OME) causing hearing loss
Persistent OME >3 months with significant hearing loss or speech delay
Recurrent acute otitis media (AOM) unresponsive to medical treatment

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23
Q

What conditions might benefit from grommet insertion apart from otitis media with effusion?

A

Barotrauma
Recurrent acute otitis media
Persistent eustachian tube dysfunction

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24
Q

What is the usual duration of grommet placement?

A

Grommets typically stay in place for 6-12 months before naturally falling out as the tympanic membrane heals.

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25
Q

Grommets are most commonly indicated for _________ with significant hearing loss.

A

Otitis media with effusion (OME)

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26
Q

The procedure to insert grommets is called __________.

A

Myringotomy

27
Q

Grommets function by __________ the middle ear to prevent fluid accumulation.

A

Ventilating

28
Q

What is the primary complication associated with grommet insertion?
A. Tympanic membrane perforation
B. Hearing improvement
C. Cranial nerve damage
D. Sinusitis

A

A. Tympanic membrane perforation

29
Q

Which of the following is NOT an indication for grommet insertion?
A. Persistent OME causing speech delay
B. Chronic otitis externa
C. Recurrent barotrauma
D. Recurrent AOM unresponsive to antibiotics

A

B. Chronic otitis externa

30
Q

Scenario: A 4-year-old child has recurrent ear infections and a hearing test showing mild conductive hearing loss. The parents report delayed speech development. Examination reveals fluid behind the tympanic membrane bilaterally.
Q: What is the likely diagnosis, and how would you manage this child?

A

Diagnosis: Otitis media with effusion.
Management: Consider grommet insertion after a 3-month observation period if hearing loss and speech delay persist.

31
Q

Scenario: A child with grommets develops discharge from the ear.
Q: What is this condition, and how should it be managed?

A

Likely diagnosis: Otorrhoea due to infection.
Management: Treat with topical antibiotic drops, such as ciprofloxacin.

32
Q

Arrange the steps of a myringotomy with grommet insertion:
A. Local or general anaesthesia
B. Small incision in the tympanic membrane
C. Suctioning of middle ear fluid
D. Placement of the grommet into the incision

A

A → B → C → D

33
Q

Myringotomy

A

A surgical procedure to make an incision in the tympanic membrane.

34
Q

Grommet

A

A small tube used for middle ear ventilation.

35
Q

OME

A

Otitis media with effusion.

36
Q

What are the benefits and risks of grommet insertion?

A

Benefits:

Improves hearing
Reduces recurrent infections
Prevents speech and language delay
Risks:
Tympanic membrane perforation
Scarring of the tympanic membrane (tympanosclerosis)
Infection causing otorrhoea

37
Q

Why might grommet insertion not be immediately offered for otitis media with effusion in a child?

A

OME often resolves spontaneously within 3 months.
Risks of surgery, such as anaesthesia and complications, must be weighed against benefits.

38
Q

Otitis Media with Effusion

A

Glue Ear

39
Q

Symptoms of Glue Ear

A

Hearing loss, Hx of recurrent OM

40
Q

Ix for Glue Ear

A

Otoscopy
Dull/opaque/retracted TM
Air bubbles
Visible fluid level
Audiology (if hearing loss)

41
Q

Management of Glue Ear

A

Active Observation -1st presentation
-50% resolve within 3 months
-Otovent (sx relief)
Surgical
-Who?
-Craniofacial abnormality (Trisomy 21, cleft palate)
-Hearing loss impacting development (language delay)
-Hx recurrent AOM or OME
-Grommets ± Adenoidectomy
Hearing aids (surgery contraindicated)

42
Q

What are the two main types of deafness?

A

Conductive deafness and sensorineural deafness.

43
Q

What are common causes of conductive deafness in children?

A

Otitis media with effusion (glue ear)
Tympanic membrane perforation
External ear canal obstruction (e.g., wax, foreign body)
Congenital malformations of the ear

44
Q

What are common causes of sensorineural deafness in children?

A

Genetic factors (e.g., syndromic or non-syndromic hearing loss)
Infections (e.g., congenital CMV, rubella, meningitis)
Ototoxic drugs (e.g., aminoglycosides)
Noise-induced hearing loss
Hypoxic-ischaemic encephalopathy

45
Q

What are some key syndromes associated with congenital deafness?

A

Usher syndrome
Waardenburg syndrome
Pendred syndrome

46
Q

What is the most common cause of permanent childhood hearing loss?

A

Genetic causes, with non-syndromic autosomal recessive inheritance being the most common.

47
Q

__________ is the most common cause of conductive hearing loss in children.

A

Otitis media with effusion

48
Q

Hearing loss that occurs due to damage to the cochlea or auditory nerve is called __________ deafness.

A

Sensorineural

49
Q

The most common infection causing congenital sensorineural hearing loss is __________.

A

Cytomegalovirus (CMV)

50
Q

A __________ test is commonly used in newborn hearing screening.

A

Otoacoustic emission (OAE)

51
Q

__________ is a syndrome characterized by congenital deafness and pigmentary abnormalities such as a white forelock.

A

Waardenburg syndrome

52
Q

Which of the following is NOT a feature of sensorineural hearing loss?
A. Noise-induced hearing loss
B. Tympanic membrane perforation
C. Ototoxic drug exposure
D. Congenital CMV infection

A

B. Tympanic membrane perforation

53
Q

Which of the following syndromes is NOT typically associated with congenital deafness?
A. Usher syndrome
B. Marfan syndrome
C. Waardenburg syndrome
D. Pendred syndrome

A

B. Marfan syndrome

54
Q

A 3-year-old child presents with delayed speech development and frequent episodes of otitis media. Audiometry reveals mild conductive hearing loss.
Q: What is the likely diagnosis, and how should it be managed?

A

Diagnosis: Otitis media with effusion (glue ear).
Management: Observation for 3 months, followed by grommet insertion if persistent hearing loss or speech delay is significant.

55
Q

A newborn fails the otoacoustic emissions (OAE) screening test.
Q: What is the next step in evaluation?

A

Perform auditory brainstem response (ABR) testing to confirm hearing loss and determine its severity.

56
Q

T/F: Genetic causes account for most cases of permanent childhood hearing loss.

A

True

57
Q

T/F: Conductive hearing loss can result from abnormalities in the auditory nerve.

A
58
Q

T/F: Usher syndrome is associated with both hearing loss and retinitis pigmentosa.

A

True

59
Q

Arrange the steps in a newborn hearing screening pathway:
A. Initial otoacoustic emissions (OAE) screening
B. Follow-up auditory brainstem response (ABR) test if OAE fails
C. Referral to audiology for diagnostic assessment
D. Early intervention and management if hearing loss is confirmed

A

A → B → C → D

60
Q

Name a cause for Conductive hearing loss

A

Otitis media with effusion

61
Q

Name a cause for Sensorineural hearing loss

A

Ototoxic drugs

62
Q

Name a cause for Mixed hearing loss

A

Congenital abnormalities with secondary infections

63
Q

What are the advantages and disadvantages of hearing aids in children with hearing loss?

A

Advantages:

Improves communication and language development
Non-invasive
Customizable for degree of hearing loss
Disadvantages:
May not restore normal hearing
Requires maintenance and regular adjustment
Social stigma in some cases

64
Q

Why is early detection and intervention crucial in paediatric hearing loss?

A

Early detection is critical to prevent speech and language delay, facilitate normal social and cognitive development, and ensure timely access to interventions such as hearing aids or cochlear implants.

Phase 3a - Paediactrics (17 decks)

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