ENT Flashcards
Conductive hearing loss
Very common
Usually due to otitis media with effusion (OME, ‘glue ear’)
>50% all pre-school children have at least one episode of OME
Much smaller percentage have persistent OME with hearing impairment - can delay language acquisition
Other causes: foreign body, wax
Sensory-neural hearing loss
Less common
Causes: congenital infection; prematurity (<32/40); genetic (rare); meningitis
Risk factors: hypoxia; jaundice; ototoxic drugsNewborn screening may not pick up all as some genetic causes and congenital infections are progressive
Acquired hearing loss
Sensory-neural
After CNS infections (eg meningitis)
All children should have hearing tested after acute infection has resolved
Treatment with cochlear implant
Child with delayed speech
Refer!
OME/Glue ear
Can be history of acute OM or not
If no hx of acute infection, probably due to poor eustation tube ventilation due to enlarged adenoids or allergy
Treatment with surgical drainage and grommet insertion if persistent
Adenoidal enlargement
Causes: viral or bacterial infection; allergy; no apparent cause
Noisy/rattly/diffifult nose breathing => mouth breathing
Constantly runny nose
Snoring/sleep apnoea
Glue ear
Mostly no treatment - mild symptoms that flare up in infection, shrink in adulthood
Surgical removal if difficulty sleeping or maybe glue ear
Allergic Rhinitis
IgE-mediated inflammation and histamine release
Seasonal or persistent
Sneezing immediately
Runny nose 15-20 mins later
Nasal obstruction 6-12 hours later
Atopy
Education, allergy avoidance, antihistamine, topical steroids
Acute OM
Can be viral (RSV) or bacterial (Pneumococcus, Haemophilus influenzae, group B strep, Moraxella catarrhalis)
Common in preschool children: fever, vomiting and distress
Young children will not localise pain to ear
Red eardrum with loss of light reflex
Eardrum may bulge or perforate - purulent discharge
Symptomatic management usually all that is needed
Antibiotics can reduce symptoms but not complications
