ENT and ophthalmology Flashcards
What is otitis media
infection of the middle ear
What usually precedes otitis media
viral upper respiratory tract infections
Give 3 bacteria that commonly cause otitis media
- Streptococcus pneumoniae
- Haemophilus influenzae
- Moraxella catarrhalis
Describe the presentation of otitis media
- ear pain (otalgia)
- hearing loss
- fever
- ear discharge if tympanic membrane perforates
Give 4 possible otoscopy findings of otitis media
- bulging tympanic membrane → loss of light reflex
- opacification or erythema of the tympanic membrane
- perforation with purulent otorrhoea (ear drainage)
- decreased mobility if using a pneumatic otoscope
How is otitis media diagnosed
Criteria
* acute onset of symptoms
* presence of a middle ear effusion
* inflammation of the tympanic membrane
How is otitis media managed
- majority are self-limiting and only need analgesia
- parents should be advised to reattend if symptoms haven’t improved after 3 days
- amoxicillin for 5 days, alt - erythromycin or clarithromycin
Under what circumstances should antibiotics be prescribed at initial presentation of otitis media
- Symptoms lasting more than 4 days or not improving
- Systemically unwell
- Immunocompromise or high risk of complications
- Younger than 2 years with bilateral otitis media
- Otitis media with perforation and/or discharge in the canal
Complications of otitis media
- mastoiditis
- meningitis
- brain abscess
- facial nerve paralysis
What is glue ear
otitis media with an effusion
RFs for glue ear
- male sex
- siblings with glue ear
- higher incidence in Winter and Spring
- bottle feeding
- day care attendance
- parental smoking
Features of glue ear
- hearing loss is usually the presenting feature
- secondary problems - speech and language delay, behavioural or balance problems
- peaks at 2 years of age
How is glue ear managed
- active observation for 3 months - no intervention is required
- grommet insertion - to allow air to pass through into the middle ear and hence do the job normally done by the Eustachian tube
- adenoidectomy
What is a squint
misalignment of the eyes
aka strabismus
What is the complication of untreated childhood squints
amblyopia (lazy eye) - the brain fails to fully process inputs from one eye and over time favours the other eye
What are concomitant squints
Due to imbalance in extraocular muscles
Convergent (inwards) is more common than divergent (outwards)
What causes paralytic squints
paralysis of extraocular muscles
How is a squint investigated
- Cover test: ask the child to focus on an object, cover one eye, observe movement of uncovered eye, cover other eye and repeat test
- corneal light reflection test: holding a light source 30cm from the child’s face to see if the light reflects symmetrically and centrally on their cornea
How is a squint managed
- refer to secondary care (ophthalmology)
- occlusive eye patch to cover good eye
What is periorbital cellulitis
infection of the soft tissues anterior to the orbital septum - this includes the eyelids, skin and subcutaneous tissue of the face, but not the contents of the orbit
Give 3 causative organisms of periorbital cellulitis
- staph. aureus
- Staph. epidermidis
- streptococci
How does periorbital cellulitis present
- red, swollen, painful eye - acute onset
- erythema and oedema of eyelid
- Partial or complete ptosis of the eye due to swelling
How is periorbital cellulitis investigated
- raised CPR/ ESR
- Swabs of any discharge
- contrast CT of orbit may help to differentiate between periorbital and orbital cellulitis
How is periorbital cellulitis managed
- referral to secondary care
- oral antibiotics - co-amoxiclav TDS for 7 days
Give 4 RFs for orbital cellulitis
- Childhood
- previous sinus infection
- Lack of Haemophilus influenzae type b (Hib) vaccination
- Recent eyelid infection/ insect bite on eyelid (periorbital cellulitis)
- ear/ facial infection
Most common bacterial causes of orbital cellulitis
- Streptococcus
- Staphylococcus aureus
- Haemophilus influenzae B
How does orbital cellulitis present
- Redness and swelling around the eye
- Severe ocular pain
- reduced visual acuity
- Proptosis (bulging)
- pain with eye movements
- Eyelid oedema and ptosis
- Drowsiness +/- Nausea/vomiting in meningeal involvement (Rare)
How is orbital cellulitis investigated
- FBC - raised WBC, CPR/ ESR
- Clinical exam - Decreased vision, afferent pupillary defect, proptosis
- CT with contrast - assess posterior spread of infection
- blood culture and swabs to determine causative organism
How is orbital cellulitis managed
- medical emergency - admission to hospital
- IV antibiotics (cefotaxime or clindamycin) due to risk of cavernous sinus thrombosis and intracranial spread
*
What presentation would differentiate orbital from preseptal cellulitis
reduced visual acuity, proptosis, ophthalmoplegia/pain with eye movements are NOT consistent with preseptal cellulitis
