ENT Flashcards
How long does it take for effusion to clear after AOM
- 3 months
What are the indications for myringotomy and tubes
- Recurrent AOM with middle ear effusion
- Bilateral OME (> 3 months with CHL)
- Unilat/bilat OME (> 3 months) with other problems: vestibular, behavioural problems, discomfort, school performance
- at risk children
- other uncommon indications: complications of AOM (mastoiditis), lack of response to medical therapy, chronic retractions of TM
List 5 complications of AOM
List 4 intracranial complications of AOM
- TM perforation
- mastoiditis
- post-auricular absces
- labyrinthitis
- labyrinthine fistula
- facial nerve paresis/paralysis
- Bezold’s abcess (abcess in sternoclinomastoid
- cholesteatoma
Intracranial
- meningitis
- brain abscess ( subdural empyema, epidural abscess, usually temporal lobe)
- sino-venous thrombosis
- Gradenigo’s syndrome
- otic hydrocephalus
- CSF leak
How do you treat a TM perforation?
- likely heal in 6 weeks
- ciprodex (no tobra or gent drops)
- water precaution
- refer if otorrhea persistent or perforation present aver many months
What are the ABCD’s of hearing loss risk factors
- Affected family member
- Bilirubin
- Congenital intrauterine infections
- Defects of the ears, nose and throat
- Small at birth (BW < 1500g)
- neonatal intensive care grads
- parent or physician concern
- only 50% of children with SNHL have risk factors
If you don’t screen for hearing loss - what’s the mean age of detection
- 18 to 30 months (around 2 years of age)
How to diagnosis CMV?
< 3 wks of age:
- urine culture gold standard
- saliva or urine PCR other options
> 3 weeks of age:
- CMV PCR - neonatal dry blood spot (sensitivity 35%)
- MRI - non-specific white matter changes, cysts in the anterior temporal lobe, cortical dysplasia, periventricular calcifications
What to do with a 13 yr old boy with severe unilateral chronic epistaxis - blood tests normal
Refer to ENT for endoscopy/possible imaging to rule out Juvenile Nasal Angiofibroma
What is Chandler’s Classification?
I - pre-septal II - post-septal III - subperiosteal abscess IV - orbital abscess V - cavernous sinus thrombosis
What are the Indications for adenotonsillectomy?
Absolute:
- OSA (AHI > 5/hr and large tonsils)
- cor pulmonale
- suspected malignancy
- hemorrhagic tonsilitis
- severe dysphagia
Relative:
- tonsillar hypertrophy
- recurrent tonsillitis
- complications of tonsillitis
- tonsilloliths and halitosis
What are the red flags for referral for stridor
SEPCS-R -Severity -Progression -Eating and Feeding -Cyanosis -Sleep Radiology
Biphasic stridor is the most concerning
What is the expected course of Laryngomalacia and when to refer?
- presents in first few days of life
- worsens over first 6 months
- plateaus from 6 - 12 months
- resolves by 18 - 24 months
Refer when:
- severe obstruction/desaturation
- failure to thrive
- diagnosis in question
Indications for Neck Adenopathy Biopsy
History:
- family hx
- previous cx/RTX
- immunosuppressed
- B symptoms
Physical:
- neonate
- size > 2 cm
- firm/hard/fixed
- CN abnormal
- supraclavicular
Duration:
- increased at 2 weeks
- no change at 4 weeks
What is Mycobacterial avium adenitis?
- mass over submandibular or partoid area, purplish in hue, non tender
- treatment: biaxin x 7 - 10 days, can also do I&D with curettage and excision if not improved
