ENT, ophthalmology and audiology Flashcards
How common are ENT problems in children?
Up to 50% GP consultations in winter
Unique morbidity - different physiology and anatomy in children
Congenital problems prominent
What is the embryology of the face?
Formed from pharyngeal pouches/branchial arches, pouches, and clefts that go on to form different structures of the face/neck
Can predict which structures are going to be abnormal due to which arch is developing abnormally
What is the embryology of the ear?
External ear - pinna, 6 hillocks of his (mesoderm) from 1st and 2nd branchial arch
Ear canal - ectoderm of 1st branchial cleft
Tympanic membrane - outer ectoderm, middle mesoderm, and inner endoderm from 1st pouch
- Pars tensa (lower 2/3) mesoderm, ectoderm, and endoderm (tough as contains mesoderm)
- Pars falccida (upper 1/3) only endoderm and ectoderm so more prone to damage
What is the anatomy of the ear?
Outer cartilaginous and bony structures
Middle - bones of hearing, eustachian tube, promontory, facial nerve, chorda tympani (encased in temporal bone)
Inner - hearing and balance organs (cochlear, utricle, saccular, vestibule)
Name 3 examples of congenital problems with the ear
Absence of auricle/micotia Atresia of outer ear canal Pre-auricular sinus Accessory auricles Prominent ears
What might outer ear problems mean?
Middle ear problems
When does the inner ear develop relative to the outer and middle?
Earlier
Name 2 congenital abnormalities of the middle ear
Abnormal ossicles - disruption of sound amplification mechanisms - develop from 1st and 2nd branchial arteries
Craniofacial syndromes - also associated with 1st and 2nd branchial artery problems
Name 2 congenital abnormalities of the inner ear
Schiebe (cochleosaccular) dysplasia
Mondini (cochlear) dysplasia
Bing-Seibenmann (vestibulocochlear) dyplasia - membranous labyrinth affected
Michel aplasia - complete labryinthine aplasia
How are children with hearing loss identified?
Newborn hearing screening programme
- Within 4-5 weeks of birth, before 3 months
- Automated otoacoustic emission, auditory brainstem responses
Look out if risk factors in prenatal history
Neonatal check obvious structural abnormalities
Early referral to audiology - care and support
Early cochlear implantation
If in doubt send for hearing tests
What are the risk factors for deafness in newborns?
FHx - first degree relative needing hearing aids in childhood Illness in mother - hepatitis, rubella Prematurity Jaundice Anatomical abnormalities
What are the symptoms and what is the treatment for otitis externa?
Painful, inflamed external auditory meatus +/- pinna
Treat with microsuction, opical antibiotics
How common is otitis media?
90% of children at some point
What are the symptoms of otitis media?
Eustachian tube dysfunction Fluid in middle ear - mucoid vs serous Often painless (can be sudden perforation) OME persistent for > 3 months Self-limiting Risk of complications (mastoiditis) Chronic - OME, cholesteatoma
How is otitis media treated?
Controversy about antibiotics
- Can give prescription for later on if symptoms haven’t abaited
What is OME?
AKA glue ear
Otitis media with effusion in under 12s
Hearing loss 25-30dB on 2 occasions at least 3 months apart
What are the options for OME treatment?
Conservative - do nothing, Eustachian tube autoinflation (otovent balloon)
Ventilation tubes - Grommets
Hearing aids - alternative to surgical intervention where surgery is CI or not acceptable
What are the possible causes of the chronically discharging ear?
Perforation - close it
Retraction pockets - ear drum collapses inwards due to problem with Eustachian tube and decreased pressure in inner ear
Chronic suppurative otitis media
Cholesteatoma
What is a cholesteatoma?
'Greasy tumour' Present repeat infection Offensive discharge - really smelly Can see perforation White material Acquired vs congenital
What are the complications associated with cholesteatoma and why?
As it grows it locally erodes - intracranial complications, implications to inner ear and middle ear structures, implications to facial nerve
How is cholesteatoma treated?
Remove surgically preserving hearing if possible or leaving scope for reconstruction as may have to remove structures that might be encased in structure - mastoidectomy - refer to ENT surgeon
What does the removal of the middle ear bone lead to?
Maximal conductive hearing loss 60dB
What is acute mastoiditis?
Boggy swelling behind ear
Abscess
Complication of spreading otitis media
How is acute mastoiditis treated?
Surgery