ENT Flashcards
What condition is trismus most commonly associated with?
- how do they present
- most common organisms?
- treatment?
- when to consider tonsillectomy? (2)
- most serious complication?
Peritonsillar abscess!!!!!
unilateral tonsil bulge
in palate
uvular deviation (away)
trismus (pterygoids go into spasm)
-most common in adolescents (older children and teenagers, less common in younger children)
-GAS most common cause; can also be from oral anaerobe
-treatment:
1. Surgical drainage (needle aspiration)
2. Abx against GAS and anaerobes (Amoxi-clav)
Consider tonsillectomy if:
- Recurrence
- No improvement after abx or needle aspiration
Most serious complication: aspiration pneumonia if BURSTS
What position worsens stridor in laryngomalacia/tracheomalacia?
Worsens when lying supine, improved when prone
What is a pathognomonic sign of a thyroglossal duct cyst?
Vertical motion of the mass with swallowing and tongue protrusion
When does rebound nasal congestion occur after the use of otrivin?
Use > 3 days
What is an associated condition that may worsen laryngomalacia?
Reflux = may need to treat to see improvement in laryngomalacia
how do you treat septal hematoma?
urgent incision and drainage- do not want to have perforation (associated with saddle nose deformity)
nasal packing and biaxin (prevents toxic shock from the nasal packs)
what is the most common extra cranial complication of acute otitis media?
TM perforation
what are the extracranial complications of acute otitis media? (8)
TM Perforation mastoiditis post-auricular abscess labyrinthitis labyrinthine fistula facial nerve paresis/paralysis Bezold’s Abscess cholesteatoma
what are the intracranial complications of acute otitis media? (7)
Intracranial (0.36% of all AOM) ** meningitis ** brain abscess (subdural/epidural) ** sino-venous thrombosis ** Gradenigo’s Syndrome (Petrositis) otic Hydrocephalus CSF Leak
** know the first 4
what is the criteria for Tympanostomy tubes
recurrent AOM with middle ear effusion
bilateral OME (>3 mos) with CHL
unilat/bilat OME (>3 mos) with other problems
vestibular, behavioural problems, discomfort, school performance
at-risk children (immuniocompromised)
other uncommon indication
complications of AOM (i.e. mastoiditis)
lack of response to medical therapy
chronic retraction of TM
what is the treatment for perforated TM? how long does it take to heal? when do we repair perforated TM?
ciprodex drops (heat them up)
most heal within 6 weeks
typically repair around 9 or 10 years of age
refer if otorrhea is persistent/ perf visible many months after acute otitis media
what should be used in the setting of a draining ear?
ciprodex drops!!
not ototoxic
12 years old draining left ear
x 1 year. What is the most
likely diagnosis?
cholesteatoma
what are the features of otorrhea from cholesteatoma
unilateral
foul smelling
persistent/recurrent
responds to ototopicals (Ciprodex) but recurs
what are the risk factors for hearing loss?
risk factors (ABCD’s)
affected family member
bilirubin
congenital intrauterine infection (TORCH)
defects of the ear, nose and throat
small at birth (<1500 g), low apgar, NICU
what percentage of children with SNHL have risk factors?
ONLY 50% of children with SNHL have risk factors
what is the most common congenital birth defect
sensorineural hearing loss
what is the goal of hearing tests?
diagnosis and rehabilitation by 6 months
prior to screening hearing loss was diagnosed at 18-30 months
**no child is too young to have a hearing test
what is connexion 26
- most common genetic cause of congenital SNHL
- autosomal recessive
- mutations in GJB2 gene
- codes trans-membrane gap junction protein
- allows fluids and small molecules to pass
- recycles K+ between endolymph and stria vascularis
most common non-genetic cause of hearing loss?
what percentage are symptomatic?asymptomatic?
congenital CMV
5-10% symptomatic (50% have SNHL)
90-95% asymptomatic (5-15% have SNH)
what are the features of SNHL associated with cCMV
high frequency
progressive (>50% in first 5 years)
unilateral loss (40%)
What percentage of newborn hearing screening misses congenital CMV induced SNHL?
Newborn hearing screening miss over 50% CMV induced SNHL
What is the most common cause of bilateral
nasal obstruction in a child?
adenoid hypertrophy
when should a closed reduction be performed on the nose
within 7-14 days
If a child presents with nasal trauma what is the one thing you need to rule out
septal hematoma
requires emergent drainage
where does most epistaxis come from
little’s area in kiesselbach’s plexus
what are the treatment options for epistaxis
humidify lubrificate cauterize pack treat underlying coagulopathy
13 years old boy – severe
chronic unilateral epistaxis
– blood tests normal
what should you be worried about?
angiofibroma (Juvenile Nasal Angiofibroma)
teenage boy with unilateral epistaxis
What is Chandler’s classification
Chandler's classification- know this!! it is not a progression of infection I – pre-septal II – post-septal III – subperiosteal ABCESS IV – ORBITAL abscess V – cavernous sinus thrombosis (spread to the cavernous sinus back in the brain)
what is the treatment for complicated sinonasal infections?
medical management:
antibiotics
decongestants
nasal corticosteroids
surgical management:
abscess drainage
what are the indications for adenotonsillectomy
Absolute OSA (AHI>5/hr) and large tonsils *** Cor pulmonale suspected malignancy hemorrhagic tonsillitis severe dysphagia
Relative tonsillar hypertrophy (no need to take out if no symptoms) recurrent tonsillitis *** complications of tonsillitis tonsilloliths and halitosis
** two most common reasons
do not give routine preoperative antibiotics
what is the criteria for retropharyngeal abscess on x ray
prevertebral soft tissues > 7mm (c2),
14mm (c6/c7) or
> 1 x the width of the vertebral body
what does inspiratory stidor suggest? biphasic stridor? expiratory stridor?
inspiratory- supraglottis (chirpy sound)
biphasic (the most worrisome- smallest part of the pediatric airway)- level of the vocal cords
or the subglottis
expiratory- trachea
bronchiwhat is the differential for inspiratory (supraglottic) stridor? (5)
laryngomalacia vallecular cyst saccular cyst foreign body epiglottitis
what is the differential for biphasic stridor? (9)
bilateral vocal cord paresis subglottic stenosis glottic web subglottic hemangioma subglottic cyst laryngeal cleft foreign body papillomatosis croup
what is the differential for expiratory stridor?
tracheomalacia*
foreign body
tracheoesophageal fistula*
complete tracheal rings*
what is potts puffy tumor?
osteomyelitis of the frontal region coming typically from the frontal sinus (does not have to be overlying- can have vascular spread as opposed to direct spread)
what are the red flags for complicated sinusitis
proptosis diplopia altered vision severe pain headache altered LOC
Retropharyngeal abscess
what is it?
who gets them?
tratement?
*present with limited lateral motion of their neck
mid line bulge in the retropharynx
have to do a lateral x ray
posterior to the palate
younger children (1-toddler age) beacuse they have large lymph nodes in that area
tx: antibiotics
+/- drainage
Red flags for referral for stridor
biphasic stridor- often need surgery your comfort level parental concern diagnosis in question S- severity P- progression E- eating and feeding C- cyanosis S- sleep R- radiology
severity (getting work)
affecting eating and feeding
cyanosis
if it is happening in sleep or moving about
any radiographic evidence of narrowing (AP film)
How does someone with subglottic hemangioma present?
what is the treatment?
50% have an associated cutaneous hemangioma
present with a label of croup, but too young (baby who is 1 -3 months)
biphasic stridor
they will get better with steroids but the alarm bell is the age
“beard” distribution hemangioma- the probability goes up that they will have an airway hemangioma
tx: propranolol
steroid (systemic/intralesional)
laser/surgical excision
unilateral, more likely to be left sided
