ENT and Respiratory Conditions in Children Flashcards
Outline the pathophysiology of otitis media with effusion (and link this to diagnostic time cutoff)
- During events such as regular OM or resp infection, eustachian tube can become swollen/obstructed
- This creates negative-pressure chamber, causing fluid accumulation
- When fluid is trapped for >3 months, we call this OME
- This can cause conductive hearing loss (less ossicle movement)
Why is glue ear (OME) more common in children?
- Smaller tube = easier blocked
- More horizontal tube = less influence of gravity
- Softer tube = easier to collapse
Complications of OME
- Hearing loss (not a big deal if transient)
- Longer term hearing loss for months on end can lead to speech and developmental delays (can’t mimic)
Treatment of OME
- Observe for 3 months
- If doesn’t resolve, refer to ENT for grommets
Aetiology of sleep disordered breathing in children
- Relatively larger pharyngeal and palatine tonsils can obstruct airway
- Even if obstruction is only partial, reduced airflow means not enough pressure to keep airways open
Diagnosis of OME in children
- Clinical diagnosis
- Visible on otoscopy (+ history findings)
Complications of sleep disordered breathing
- Irritability/difficulty focusing
- Reduced growth (energy sapped during night)
- Diabetes
- Pulmonary hypertension and CVD (recurrent increased sympathetic drive overnight)
How do we treat sleep disordered breathing in children
- Nasal steroids can reduce inflammation
- Surgery can remove/shrink tonsils
- CPAP can help keep airways open
What do OME and AOM look like on otoscopy?
- OME (glue ear): dull eardrum and loss of visibility of structures behind
- AOM: erythema, opaque/outwards bulgind eardrum
Acute otitis media aetiology
- Like OME, where eustachian tube is blocked
- However, infectious agent travels from nasopharynx into middle ear transiently, before it’s blocked off again
Three most common pathogens involved in ENT infection
- Haemophilus influenza
- Strep pneumoniae
- Moraxella catarrhalis
Complications of acute otitis media
- Pressure can block tympanic membrane vessels -> ischaemia -> necrosis
- Leads to popping of eardrum, escape of infectious agent, and potential transfer to surrouding brain, jugular IJV, common carotid artery, and mastoid air cells
- Can cause meningitis, mastoiditis, brain abscess
Treatment of acute otitis media
- Analgesia
- Observation
(Most cases self-resolve; RCH does not recommend antibiotics in all cases, but may be indicated if doesn’t get better w/ time)
Viral vs bacterial tonsillitis exam finding
Viral typically has white, pus-like stuff on the surface of the tonsil
Peritonsillar asbcess aetiology. Is this a complication of tonsilits?
- Salivary gland around tonsil (weber’s glands) blocked
- Saliva stasis -> infection & purulence
- Forms growing asbcess
(Not a complication of tonsillitis ; different)
Pathophysiology of atypical mycobacterial ent infection
- Mycobateria despoit in neck nodes
- T cell mediated immune response
- Inability to clear -> granuloma in lymph node
(What other infection does this remind you of?)
What are atypical mycobacterial ent infections?
- Non-tuberculosis infection (often in neck lymph node)
- Painless, isolated, otherwise asymptomatic
Atypical mycobacterial ent infection treatment
- Prolonged antibiotics (3-6 months)
- Surgery
Aetiology, diagnosis, complications & treatment of bronchiolitis
Aetiology: mostly viral (of those, mostly respiratory syncytial virus [RSV])
Diagnosis: clinical diagnosis (cough, sore throat, runny nose, wheeze, increased effort of breathing) +/- PCR for exact aetiology
Complications: respiratory failure/arrest, poor feed -> dehydration
Treatment: supportive (fluids/electrolytes, O2, NGT)
Aetiology, diagnosis, complications & treatment of LaryngoTracheoBronchitis (Coup)
Aetiology: Viral (most common parainfluenza virus)
Diagnosis: clinical (“cold” followed by barking, seal-like cough)
Complications: hypoxia, resp failure
Treatment: supportive care + steroids if upper airway inflammation becomes a problem
Aetiology, diagnosis, complications & treatment of Pneumonia
Aetiology: infection leading to inflammation of the lungs, and filling of alveoli with fluid/pus
Diagnosis: clinical (cough, fever, tachypnoea) + x ray findings
Complications: sepsis, resp failure, empyema (pus in pleural space)
What investigations would we consider in a suspected case of pneumonia?
- FBC + CRP
- CXR
- Chest radiograph
- Resp viral PCR
- Sputum gram stain and culture
Aetiology, diagnosis, complications & treatment of Asthma
Aetiology: recurrent airway inflammation triggered by irritants or allergens
Diagnosis: clinical (wheeze, SOB, cough, chest tightness), physical exam, bronchodilator response on spirometry
Complications: increased risk of COPD, flare-ups, frequent hospitalisations
Treatment: preventer (ICS -> what are side effects? remember the old man from GP), reliever (SABA), and spacer to improve absorption
