ENT Flashcards
1
Q
Common causes, resolution, diagnosis and management ASOM
A
- Very common, most self limiting, spontaneous resolution in 80% in 24-48 hours.
- Viral infections, H influenza, S pneumonia and Moraxella catarrhalis
- Acute onset, MEE->bulding, limited movement, air fluid level, perforation or redness
- Antibiotic therapy usually recommended in ATSI due to suppurative complications
- it is estimated that up to 20 children must be treated at first presentation to prevent pain in one child at 2 to 7 days.
- For every 14 children treated with antibiotic therapy, one child will experience an adverse drug reaction such as vomiting, diarrhoea or rash.
- W/O systemic
>6mo->symptomatic, >2 days/worsens consider antibiotics/wait and see script
<6mo->symptomatic, r/v in 24 hours, if B/L/discharge->antibiotics
- W/ systemic->high fever, vomiting, lethargy
Amoxycillin 15mg/kg up to 500mg tds or 5 days. If no response after 48 hours, amoxyclav
2
Q
Risk factors for recurrent bacterial OM
A
Risk factors for recurrent bacterial otitis media include:
- exposure to smoke (cigarettes, wood fires)
- group child care
- allergic rhinitis
- adenoid disease
- various structural anomalies, such as cleft palate and Down syndrome.
3
Q
What is otitis media with effusion, traditional management, referral
A
Presence of middle ear effusion for longer than 3 months
- Visible loss of lucency of tympanic membrane
- Visible grey-white/blue fluid
- An immobile tympanic membrane w/ dilated vessels
Treatment
- Grommets->ventilation tube
- Optomise learning
- Modify risk factors
Referral
- Effusion > 3 months w/ speech delay or educational handicap
- Effusion > 3 months, audiometry showing bilateral hearing loss
- Structural damage to tympanic membrane
4
Q
Define CSOM, complications, management
A
- Infection of middle ear w/ perforated eardrum and discharge at least 6 weeks
- Can cause hearing impairment
- Can lead to mastoiditis, intracranial infections
Management
- Dry aural toilet
- Ear drops->ciprofloxacin ear drops BD until free of D/C for at least 3 days
- May require hearing aid, grommet, addenoidectomy
5
Q
Mastoiditis
A
- Following ASOM
- May have subperiosteal abscess, may develop IC abscess
- Requires admission, IV antibiotics, fluid, analgesia, follow up.
- May require mastoid surgery w/ grommet
6
Q
What is cholesteatoma
A
- Keratinising squamous epithelium
- Skin in incorrect place
- Offensive discharge
- Conductive hearing loss
- Serious complications
- Surgery
7
Q
Complications of periorbital cellulitis
A
- Chandlers classification
- Potential orbital abscess
- Loss of red/green discrimination
- Permanent optic neuroppathy damage in 1 hour
- Requires urgent drainage