ENT - paediatric otology

Question 1

what surgery comprises otology

Answer 1

External, Middle & Inner Ear Surgery

Lateral Skull Base Surgery

Question 2

what are common symptoms in otology

Answer 2

hearing loss - onset, rate of progression

otalgia - earache

otorrhoea - discharge

tinnitis

vertigo - hallucination of movement

Question 3

what are important questions to ask during history

Answer 3

birth history

• pre term
• traumatic
• neonatal jaundice +/- phototherapy

breast vs bottle feeding

passive smoking

speech development

Question 4

what groups are at risk for sensorineural hearing loss

Answer 4

family history of hearing loss

meningitis

perinatal sepsis (ToRCH)

• toxoplasmosis
• rubella
• CMV
• herpes

Question 5

what examinations should be carried out

Answer 5

otoscopy
nose exam
throat exam

Question 6

what are objective tests that can be used

Answer 6

otoacoustic emmisions (OAE)
auditory brainstem response (ABR)
tympanometry

Question 7

what tests can be used for different age groups

Answer 7

6-18months - distraction tests

12 months-3 years - visually reinforced audiometry

3-5 years - play audiometry

4years + - pure tone audiometry

Question 8

what is otitis media with effusion (OME)

Answer 8

thick or sticky fluid behind the eardrum in the middle ear - occurs without an ear infection

Question 9

what groups are at risk of OME

Answer 9

day care
older siblings
parental smoking
cleft palate
downs syndrome

Question 10

what are the symptoms of OME

Answer 10

hearing loss
speech delay
behavioural problems 
academic decline
imbalance

Question 11

what are the signs of OME

Answer 11

dull Tympanic Membrane
fluid level
bubbles

Question 12

what are the three causes of OME

Answer 12

eustachian tube dysfucntion - anatomy of skull mase
- muscular immaturity

adenoidal hypertrophy

resolving Acute Otitis Media

Question 13

what is the treatment of OME

Answer 13

autoinflation
valsalva
hearing aids

surgery
- grommet insertion
+/- adenoidectomy (better long term effect for recurrent OME)

Question 14

what are the symptoms of acute otitis media

Answer 14

short history
pain +++
fevre
systemic upset 
sleep disturbance
ear discharge

Question 15

what three bacteria are most likely to cause AOM

Answer 15

haemophilus influenzae
strep pneumoniae
moraxella catarrhalis

Question 16

what are the signs of AOM

Answer 16

often vague

• unwell screaming child
• rubbing their ears
• high fever

Question 17

what is the diagnostic procedure for AOM

Answer 17

otoscopy 90%

Question 18

what is the management for AOM

Answer 18

analgesia

antibiotics (5-7 days)

• 1st line = amoxycillin/co-amoxicalv
• 2nd line = erythromycin/clarithromycin

recurrent AOM

• long course low dose antibiotics
• 4-6 weeks

Question 19

what are extra cranial complications of AOM

Answer 19

acute mastoiditis / mastoid abscess
facial nerve palsy
ossicular / cochlear damage
labyrinthitis
chronic perforation (com)

Question 20

what is acute mastoiditis

Answer 20

an infection that extends to the air cells of the skull behind the ear

Question 21

what are intracranial complications of AOM

Answer 21

febrile convulsion
brain abscess
meningitis
sub/ extradural empyema

Question 22

what is the treatment for recurrent/complicated AOM

Answer 22

grommet insertion

+/- adenoidectomy

Question 23

what are the different types of hearing loss

Answer 23

congenital vs. acquired

static vs. progressive

unilateral vs. bilateral

conventional vs. surgical aiding

Question 24

what are different types of treatment for hearing loss

Answer 24

bone anchored hearing aid

cochlear implant

Question 25

what are the different types of foreign bodies

Answer 25

organic vs inorganic