ENT Conditions in children Flashcards
How does Epiglottis occur in children ?
Inflammation & swelling of the epiglottis
Can obstruct the airway
What are the symptoms of Epiglottis ?
stridor, drooling, fever, upright ‘leaning forward’ posture
What is Croup ?
Viral infection of the voice box (larynx) and windpipe (trachea)
The virus cause inflammation in the trachea and the vocal box(larynx ) of the children which narrow the trachea space.
Classic triad of Croup ?
barking cough, stridor, hoarse voice, and respiratory distress
How does it start and present with ?
mild fever & runny nose usually child <4
Laryngeal swelling & secretions cause barking cough & stridor
Cough starts at night – worse with crying and parental anxiety
what are the differential diagnosis for croup ?
Bacterial tracheitis (uncommon)
Foreign body
Epiglottitis (rare)
What is the management of croup ?
It depends on the severity of the symptom
Mild croup and management ?
seal-like barkingcough rx dexamethasone (0.15 mg/kg) oral single dose
Moderate croup and its management ?
barkingcough + stridor and sternal recession at rest, RR>60/min
Croup when it’s severe ?
barking cough + stridor and sternal/intercostal recession +agitation or lethargy
What is considered as respiratory failure ?
recession,
asynchronous chest wall and abdominal movement, fatigue, pallor, cyanosis, decreased consciousness. RR>70/min
How would you practice the child when they have croup symptoms?
sitting the child upright may improve the croup
humidification using warm steam
Management of mild croup ?
Dexamethasone (0.15 mg/kg) oral stat.
Advise on courseof croup, resolves <48 hours.
Distress due to fever: paracetamol or ibuprofen
Regular check on in night & fluids
Patient information leaflets are available from patient.Info and NHS choices.
Go to hospital ifstridor , recession restless or agitated.
Call 999 if pale, cyanosed, drowsy, recession, agitated
Follow up
What is the further management of croup ?
. ADMIT if:
Moderate – barkingcough + stridor and sternal recession at rest, RR>60/min
Severe –barking cough + stridor and sternal/intercostal recession +agitation or lethargy.
Impending respiratory failure –recession, asynchronous chest wall and abdominal movement, fatigue, pallor, cyanosis, decreased consciousness. RR>70/min
While waiting Rx oxygen if severe
Dexamethasone (0.15 mg/kg) orally or
Budesonide 2 mg nebulised or
Dexamethasone (0.6 mg/kg) im
What is Quinsy ?
A peritonsillar abscess- collection of pus above the tonsil
What are the features of quinsy?
Of cellulitis + trismus (unable to open the mouth), reffered ear pain, neck pain,swollen tendor lymph nodes
What is Peritonsillar cellulitis ?
Develops from tonsillitis & is a pre-suppurative stage of quinsy
What are the features of peritonsillar cellulitis ?
Unilateral peritonsillar swelling & redness
What is Bronchiolitis ?
inflammation of the bronchioles, commonest LRT disease in 1st year of life (1 in 3)
Epidemics occur in winter
Bronchiolitis caused by ?
Respiratory synctial virus
How does it bronchiolitis present with ?
coryzal, cough, tachypnoea, chest recession
fever, poor feeding
often be confused with a common cold, though widespread wheeze and/or crackles on auscultation
What is the treatment for Bronchiolitis in a hospital for severe infection?
Isolated nursing
Oxygen
Possibly ventilation
monitor for apnoea and bradycardia
paracetamol
antibiotics only if secondary infection
NG feeds or intravenous support
What is Acute otitis media ?
acute inflammation of the middle ear cavity
common in children between 3- 6 years
Usually caused by UTRi
What is the management of Acute otitis media ?
80% recover < 3 days without antibiotics
Complications rare
Review concluded antibiotics should not be prescribed routinely for acute otitis media in children (1)
Antibiotic treatment reduces pain versus the risk of causing adverse effects such as vomiting, diarrhoea or rashes
Antibiotic treatment for children: (amoxicillin, clarithromycin, erythromycin.)
Under two years with bilateral infection or
With discharge from the ear or
Who are systemically unwell (Fever or vomiting) or
With recurrent infections
Watchful waiting and use of delayed prescriptions may be appropriate paracetamol for earache
What is the Golden rule for ENT?
Early detection of hearing loss is vital
If parents think that a child is deaf then assume that the child is deaf until proved otherwise
If a child fails to speak by 16 months then assume that the child is deaf until proved otherwise
A discharging ear for more than a month is (cholesteatoma in adults) foreign body until proved otherwise.
Foreign body in the ear - refer to ENT for removal; the child will only trust one person on one occasion
