ENT/ophtho Flashcards
Sensory neural hearing loss (syndromic vs. non)
Syndromic 25% - AD 75%, AR 25%
Non synd 75% - AD 25%, AR 75%
most common cause of SNHL (congenital)
#1 CMV: infect 1/100, about 75% of affected have SNHL - can be progressive #2 AR, 1/500 - 75% of non-syndromic deafness due to mutation, GJB2 most common
cochlear implant indications
<1 year (or younger with meningitis) –> cochlea ossifies and electrode won’t fit after
profound bilateral SNHL
no medical contraindication
high motivation from entire family
enrolment in program to emphasize auditory skills
results are age dependent (MUST BE <2 years)
Neonate hearing screen indications
Fam Hx SNHL
TORCH infection
craniofacial anomalies, esp involving pinna or ear canal
BWt <1500g
hyperbili requiring exchange transfusion
ototoxic meds (aminoglycosides, loop diuretics)
bacterial meningitis
apgar 0-4 at 1 min or 0-6 at 5 min
mechanical ventilation > 5 days
findings associated with a known syndrome
hearing screen in infants (29 d-2 yrs)
parent/caregiver concern
bacterial meningitis
other acquired infection (lye, EBV, H flu, lassa virus, measles, enterovirus, malaria, VZV)
head trauma with LOC or skull #
ototoxic meds/chemo meds
recurrent or persistent OM with effusion > 3months
causes of delayed onset SNHL
family history of childhood hearing loss
in utero infection (TORCH)
NF 2 (acoustic neuroma)
when to refer for hearing assessment (by age)
12 mo: no differentiated babbling or vocal imitation
18 mo: no use of single words
24 mo: single word vocab <10 words
30 mo: <100 words, no 2 word combos, unintelligible
36 mo: <200 words, no use of telegraphic sentences, <50% intel
48 mo: <600 words, no simple sentences, <80% clear
waardenburg syndrome
deafness associated with pigmentary anomalies and defects in neural crest-derived tissues (white forelock, heterochromia)
prominent nasal root, hypertrichosis of medial part of eyebrow
heterochromia
irises of 2 different colours, or a portion of the iris is different from remainder. Can be:
AD, part of waardenburg syndrome
laryngomalacia vs. tracheomalacia and red flags
laryng: inspiratory, common, starts first few weeks, outgrow, usually fine feeding and growing
tracheo: expiratory component, collapse during exp with increased air flow (crying, feeding, coughing etc), can have feeding difficulties, FTT
Red flags: Severity, Progression, Eating/feeding, Cyanosis, Sleep, Radiology (SPECS-R)
tracheomalacia 3 types
type 1: congenital/intrinsic - may be associated with TEF or EA
type 2: extrinsic defects (e.g. vascular ring)
type 3: prolonged intubation, chronic tracheal infection, inflammatory conditions (e.g. relapsing polychondritis)
most common congenital neck mass
thyroglossal duct cysts
thyroglossal duct cysts
most common cong neck mass, 3/4 midline, moves with up/down with tongue protrusion/swallowing surgical removal (after resolution of any infection)
epidermal and sebaceous cyst
round, mobile, smooth surfaced
slow growing 5mm to 5 cm
may see pore in center of lesion
branchial cleft cyst
lateral neck mass
2nd brnachial cleft cyst most common at border of SCM
2nd branchial fistula: associated with syndromes
1st branchial cyst: recurrent parotid swelling
cystic hygroma
congenital lymphatic malformation (lymph vessel fails to connect and drain), large multiloculated cyst
mass transilluminates, mal fluctuate, Sx excision (risk of airway comp)
ranula
large soft, mucous containing swelling in the floor of mouth, occurs at any age
if large can present as neck mass if they extend through the melohyhoid musc
cyst should be excised
common head and neck tumors
- lymphoma/leukemia (48%)
- rhabdomyosaarcoma (most common soft tissue malignancy of head/neck)
- CNS - neuroblastoma
- teratoma
- thyroid: familial (MEN II, papillary), if familial the prophylactic throidectomy by age 5
Ramsay Hunt syndrome
VSV oticus - acute peripheral facial neuropathy associated with erythematous vesicular rash of the skin of the ear canal, auricle
50% don’t recover facial nerve function completely
treat: antivirals and steroids (both systemic)
Sinus development
born with ethmoid
maxillary present at birth but pneumatized at 4 yrs
sphenoid @5yrs
Frontal bigin at 7-8 years and complete by teens
Sinusitis
fever, purulent nasal discharge >10days, periorbital tenderness, halitosis
treat with same abc for OM, may need longer course (3 weeks) + decongestant/saline spray/stroid spray
sinusitis complications
meningitis abscess (frontal, epidural, brain) periorbital cellulitis orbital cellulitis cavernous sinus thrombosis blindness
allergic fungal sinusitis
10-15% chronic rhinosinusitis in adolescents (usually bipolar is or curvularia)
- production of eosinophili containing noninvasive fungal hyphae
- nasal polyposis
- unilateral sinus disease
- immunocompetence
- IgE to fungi with skin testing of serum IgE
treat: oral steroids after surgical debridement
chronic sinusitis predisposing factors
- adenoidal hypertrophy allergic fungal sinusitis allergic rhinitis anatomic chronic bacterial CF, PCD humoral immunodeficiency sarcoid Wegeners granulomatosis (associated with nasal polyposis)
