ENT conditions

Question 1

Organisms that cause tonsilitis

Answer 1

Tonsillitis is most often caused by common viruses, but bacterial infections also can be the cause. The most common bacterium causing tonsillitis is Streptococcus pyogenes (group A streptococcus), the bacterium that causes strep throat

Question 2

Clinical features of tonsilitis

Answer 2

• Sore throat, fever and halitosis
• Diagnosed clinically when large red tonsils are seen
• Management: supportive with analgesia. Antibiotics given if bacterial infection thought to be likely

Question 3

When is tonsillectomy considered in children?

Answer 3

6+ bouts/ year

Question 4

Acute otitis media

Answer 4

• Acute inflammation of middle ear, common in first 3yrs of life, peaks in winter
• Diagnosed when tympanic membrane is red and bulging
• Usually settles without antibiotics but amoxicillin given if persists

Question 5

Otitis media with effusion

Answer 5

• Chronic effusion lasting >3months
• Associated with recurrent upper resp tract infections and acute otitis media

Clinical features

• Difficulties with hearing and speech
• Diagnosed when otoscopy shows loss of normal tympanic membrane translucency giving a dull appearance
• Effusion impairs motility of the tympanic membrane and causes conductive hearing loss

Management

• Usually resolves after 4-6months
• Grommets can be inserted - tympanostomy tubes - to allow ventilation of middle ear and promote drainage of effusion

Question 6

Laryngomalacia

Answer 6

• Diagnosed when the soft cartilage of the larynx collapses inwards during breathing and narrows the airway causing a soft stridor
• Most common cause of stridor in infants

Clinical features: stridor, diagnosis confirmed using laryngoscopy

Management

• Resolves spontaneously by 12 months
• If airway compromise is severe surgery may be needed
• Occasionally requires tracheostomy

Question 7

Obstructive sleep apnoea

Answer 7

Snoring - full airway obstruction

• Night time waking and poor sleep
• Affects 1/20
• Associated with obesity, large adenoids and a NM condition

Clinical features: snoring, waking, restlessness, morning headache, irritability, mouth breathing, sleepiness, poor growth

Diagnosis: pulse oximetry showing desaturation clusters, full polysomnography required is symptoms persist

Management

• Most children who snore have adenotonsillar hypertrophy and this warrants tonsillectomy
• If not due to tonsils, children can be given ventilatory support at night
• Weight loss measures if fat

Prognosis: if due to tonsils, once removed prognosis is good but if apnoea is untreated and persists can cause pulmonary hypertension, behavioural problems and failure to thrive