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ENT - Paediatrics Flashcards

1
Q

What are the most commonly presenting ear problems in children?

A 
Hearing loss
Otorrhea
Otalgia
Tinnitius
Vertigo
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2
Q

How do hearing problems typically manifest in children?

A

Behavioural issues

Speech and language therapy

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3
Q

What is conductive hearing loss?

A

Issue with Outer or middle ear, sound not being CONDUCTED through to the cochlea

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4
Q

What is sensorineural hearing loss?

A

Issue with the nerve or the cochlea

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5
Q

What is the common history of a child with hearing loss?

A 
Ear symptoms
Speech/school/behaviour issues
Maternal perinatal infection
Delivery issues
Neonatal infections
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6
Q

How are the ears of a child typically examined?

A

Otoscope > endoscope - much more comfortable

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7
Q

What are the different age groups and tests performed for children with hearing loss?

A

6-18mo: Distraction tests
12mo-3yr: Visual Reinforced audiometry
3-5yr: Play audiometry
4yrs+: Pure tone audiometry

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8
Q

What are the direct assessments of the auditory system?

A

Otoacoustic emissions
Auditory Brain stem responses
Tympanometry

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9
Q

What is tympanometry?

A

Test for pressure behind the tympanic membrane

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10
Q

What are the results of tympanometry and what do they mean?

A

Type A - normal tympanogram

Type B - FLAT tympanogram (fluid in middle ear)

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11
Q

What does auditory brain stem response measure?

A

Test to see if auditory nerve is working

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12
Q

What is glue ear?

A

Otitis media with effusion - fluid in middle ear

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13
Q

What are the peak ages of otitis media with effusion to occur?

A

80% before 10y

2yrs and 5 years

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14
Q

What are the risk factors for otitis media with effusion?

A

Day care
Smoking
Cleft palate
Down’s syndrome

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15
Q

What is the management for otitis media with effusion?

A

Observe for 3 months
Hearing aids
Grommets
Autoinflation

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16
Q

What are the symptoms of otitis media with effusion?

A 
Hearing loss
Speech delay
Behavioural problems
Academic decline
Imbalance
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17
Q

What are the signs of otitis media with effusion?

A

Dull tympanic membrane
Fluid level behind TM
Bubbles behind TM

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18
Q

What is the cause of otitis media with effusion?

A

Eustachian tube dysfunction
Adenoidal hypertrophy
Resolving Acute Otitis media

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19
Q

Why are children at increased risk of otitis media with effusion?

A

Eustachian tubes are straight in children

Adenoids are larger, apply more pressure

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20
Q

How long do Grommets last?

A

6-18mo

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21
Q

What type of hearing aids are used in children with hearing loss?

A

BAHA - bone anchored hearing aid

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22
Q

Why are BAHAs more useful in children?

A

Nothing has to be put inside the ear

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23
Q

What additional treatment is needed with cochlear implant?

A

Speech and language therapy to understand how to use the implant

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24
Q

What are the most common causes of ear pain/discharge in children?

A

Otitis externa
Acute otitis media
Chronic otitis media
Cholesteatoma

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25
Q

How is otitis externa managed in children?

A

Aural microsuction with cleaning
Topical antibiotics
Water precautions

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26
Q

What are the most common pathogens in acute otitis media?

A

Haemophilius influenza
Strep pneumonia
Moraxella catarrhalis

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27
Q

Acute otitis media is most common in which age group?

A

3-18mo

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28
Q

How does acute otitis media present?

A 
Short history
Pain
Fever 
Discharge
Bulging tympanic membrane
Perforation
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29
Q

How is acute otitis media treated?

A

Antibiotics

co-amoxiclav

30
Q

How is recurrent otitis media treated?

A

Grommets

Adenoidectomy

31
Q

What is a dangerous complication of acute otitis media?

A

Mastoiditis

32
Q

What is the biggest risk associated with mastoiditis?

A

Brain abscess

33
Q

How is mastoiditis treated?

A

Mastoidectomy

34
Q

How does chronic otitis media present?

A

Chronic discharging ear

Hearing loss DESPITE grommets

35
Q

How does chronic otitis media/cholesteatoma damage hearing?

A

Eating away of ossicles in middle ear

36
Q

How is Chronic otitis media investigated?

37
Q

How is Chronic otitis media treated?

A

Mastoidectomy

38
Q

When do the ethmoid sinuses develop?

39
Q

When do the maxillary sinuses develop?

A

0-4 months

40
Q

When do the sphenoid sinuses develop?

41
Q

When do the frontal sinuses develop?

A

8yrs - adolescence

42
Q

Always enquire for what in children with blocked/runny noses

A

POSSIBILITY OF FOREIGN BODY

43
Q

What factors must be enquired to for a child with a blocked/runny nose?

A 
Pain
Discharge
Loss of function
Feeding issues
Snoring/quality of sleep
44
Q

How would you examine a child with a blocked nose?

A

Suspected foreign body - Examination under anaesthesia
Otoscope
Cold spatula test

45
Q

What is the cause of a blocked/runny nose?

A 
Foreign body
Rhinitis
Large adenoids
Sinusitis
Polyps
Choanal atresia
46
Q

Large adenoids commonly present with what?

A

Sleep apnoea

47
Q

How is rhinitis treated?

A

Test for allergen first (IgE)
Nasal douching
Antihistamines
Nasal steroids

48
Q

When will a child benefit from the removal of adenoids?

A

Unknown - perform sleep studies

49
Q

Sinusitis and polyps are associated with what?

A

Cystic fibrosis

50
Q

When are nasal polyps removed?

A

Very large causing obstruction of breathing

51
Q

Why is sinusitis so high risk in children?

A

Can pass through the thin sinus walls to eyes

52
Q

What is the management for sinusitis spreading to the eye?

A

CT scans observing for evidence of abscess and compression – SURGERY

53
Q

What is choanal atresia?

A

One side of rear nasal passage is unopened

54
Q

Bilateral choanal atresia presents with what?

A

Inability to breathe

55
Q

What is the occurence rate of choanal atresia?

A

1 in 6-8000

56
Q

What must be considered in epistaxis?

A

Digital trauma

Coagulopathy

57
Q

Bleeding in epistaxis typically comes from where?

A

Little’s area/Kiesselbach’s plexus

58
Q

How is epistaxis managed?

A

Lean forward and pinch
Antibiotic ointments
Cauterising
Nasal packing

59
Q

What are the possible processes for cauterising epistaxis?

A

Silver nitrate under LA

Diathermy under GA

60
Q

What is the common presenting history for a child with a sore throat?

A

Pain (swallowing, ears)
Discharge
Loss of function (dysphagia, hoarseness)
Snoring/drooling

61
Q

What are the causes of tonsillitis?

A

Bacterial (B haem Strep B)

Viral (EBV)

62
Q

Tonsillitis has a risk of progressing to what?

A

Glomerulonephritis

63
Q

When are antibiotics indicated in childhood tonsillitis?

A

Systemic unwellness

64
Q

What is a common complication of tonsillitis? How is it treated?

A

Peritonsillar abscess

Needs to be drained

65
Q

What structural differences in children can lead to airway issues?

A

Large tongue/tonsils
Short/floppy epiglottis
Short neck
Narrow sub-glottis

66
Q

Cause of airway issues in children?

A

Foreign body
Epiglottitis
Laryngomalacia

67
Q

Airway issues in children normally present how?

A

Stridor
Feeding problems
History of foreign body
Recent illness

68
Q

How is epiglottitis managed?

A

Conservative treatment
?Airway support
IV Antibiotics
Observe overnight

69
Q

How are foreign body airway issues managed?

A

Removal

Overnight observation

70
Q

How does laryngeomalacia present?

A

‘unusual’ crying

Can breathe well when prone

71
Q

What are the most common causes of neck lumps in children?

A 
Thyroglossal duct cyst
Branchial cyst
Cystic Hygroma
Cervical lymphadenopathy
Abscess
72
Q

How is a neck abscess managed?

A

Clear infection
Give antibiotics
Drain abscess

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