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Head and Neck > ENT - Paediatrics > Flashcards

ENT - Paediatrics Flashcards

1
Q

What are common otology symptoms?

A
  • Hearing loss
  • Otorrhoea
  • Otalgia
  • Tinnitus
  • Vertigo
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2
Q

What does hearing loss usually present as in children?

A

Behavioural problems or speech delay

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3
Q

What are the different sections of the ear?

A

Ear divides to externa (EAC and pinna), middle ear (TM and ossicles) and inner ear (cochlea to transmit sound waves to cochlea nerves or balance transmited through vestibular nerve)

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4
Q

What are the two different types of hearing loss?

A

Conduction loss (TM perforation or ossicle problem) or sensorineural loss (in cochlea)

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5
Q

What are three things you have to distinguish with hearing loss?

A
  • Congenital vs acquired
  • Unilateral vs bilateral
  • Conductive vs sensorineural
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6
Q

What is important to know in the history of the child with hearing loss?

A
  • Ear symptoms
  • Speech development, school performance
  • Behavioural problems
  • Maternal perinatal infections
  • Delivery issues (prematurity, anoxia)
  • Neonatal infections, drugs, jaundice
  • Growth, immunisations, passive smoking, breast vs bottle feeding
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7
Q

How are children usually examined?

A
  • Usually kept on mother’s lap

* Otoscope used as more comfortable

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8
Q

Name four different subjective assessment tests of hearing for children of different ages

A
  • 6-18 Months: Distraction test
  • 12 months – 3 years: Visual reinforced audiometry
  • 3 - 5 years: Play audiometry
  • 4 years +: Pure tone audiometry
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9
Q

Name thee tests for objective assessment of the auditory system

A
  • Otoacoustic emissions
  • Auditory brainstem responses
  • Tympanometry
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10
Q

What does tympanometry measure?

A

Measure noise or pressure coming through middle ear which can detect is there is any abnormality i.e. fluid

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11
Q

How are otoacoustic emissions measured?

A

With probe placed in ear canal which picks up sound or vibration form the cochlea (shows if the cochlea is working to determine if it’s a problem with the nerve)

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12
Q

What is the purpose of the auditory brainstem response?

A

See if auditory nerve is functioning (cochlea nerve)

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13
Q

Name four risk factors for otitis media with effusion (glue ear)

A
  • Day care
  • Smoking
  • Cleft palate
  • Down syndrome
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14
Q

What is the treatment for otitis media with effusion?

A

Most improve by themselves within 3 months

If still not recovered, treat with hearing aids, auto-inflation or grommets

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15
Q

Name five symptoms of otitis media with effusion

A
  • Hearing loss
  • Speech delay
  • Behavioural problems
  • Academic decline
  • (Imbalance)
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16
Q

Name three symptoms of otitis media with effusion

A
  • Dull TM
  • Fluid levels
  • Bubbles
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17
Q

Name three causes of OM with effusion

A
  • Eustachian tube dysfunction
  • Adenoidal hypertrophy
  • Resolving acute OM
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18
Q

What is the effect of autoinflation?

A

Forcefully opens the eustacian tube to improve ventilation

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19
Q

Name two hearing aids used to treat children with hearing loss

A
  • Bone anchoring hearing aid (BAHA) - transmits sound via bone conduction to stimulate cochlea and this auditory nerve
  • Cochlea implant - surgery to put it inside cochlea directly and then speech therapy
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20
Q

Name some causes of painful / discharging ear

A
  • Otitis externa
  • Acute otitis media
  • Chronic otitis media -> Cholesteatoma
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21
Q

What is the treatment of otitis externa?

A
  • Aural microsuction
  • Topical antibiotics
  • Water precautions
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22
Q

What are causative organisms of acute otitis media?

A
  • Haem. Influenza
  • Strep. Pneumonia
  • Moraxella catarrhalis
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23
Q

What are the symptoms of acute otitis media?

A
  • Short history
  • Pain
  • Fever
  • Discharge
24
Q

What is the treatment of otitis media?

A
  • Antibiotics (i.e. co-amoxiclav)

* Grommets + adenoidectomy if recurrent

25
Q

What are possible complications of AOM?

A
  • Perforation

* Mastoiditis - emergency in children as can cause brain abscess

26
Q

Name five rhinology symptoms

A
  • Blocked nose
  • Runny nose
  • Sneezing
  • Reduced sense of smell
  • Facial pain
27
Q

At what ages do the sinuses develop?

A
  • 0-4months: ethmoids/maxillary
  • 2-7yrs: sphenoid
  • 8yr - adolescent: frontal
28
Q

What is important to find out in the history of a child with a blocked/runny nose?

A
  • Nasal symptoms
  • History of foreign body
  • Feeding
  • Snoring, quality of sleep
29
Q

What is used to examine the function of the nose?

A
  • Rigid endoscope in older children with local anaesthetic

* Cold spatula misting - shows if nasal passage is blocked

30
Q

What treatments are used to manage rhinitis?

A
  • Nasal douching
  • Antihistamines
  • Nasal steroids
31
Q

What are four causes of a blocked/runny nose?

A
  • Rhinitis
  • Large adenoids
  • Sinusitis and polyps
  • Choanal atresia
32
Q

What is investigation is used to decide treatment of blocked/runny nose caused by large adenoids?

A

Sleep study to check for sleep apnoea to see if they would benefit from adenoid removal

33
Q

How would a foreign body in the EAC present?

A

Unilateral symptoms - requires urgent removal (especially if it’s a battery which erodes mucosa)

34
Q

What condition are sinusitis and polyps associated with?

A

Cystic fibrosis

35
Q

What are polyps?

A

Enlarged mucosal lining filled with fluid

36
Q

How are polyps treated?

A

If not big, then it is conservative and treated with steroid and anti-histamines

If obstructing nose, then remove surgically

37
Q

What is the complication of sinusitis and polyps?

A

Sinus infection can spread to the eye

38
Q

What is Little’s Area of the nose?

A

Region in the anteroinferior part of the nasal septum where four arteries anastomose to form Kiesselbach’s plexus and common site for epistaxis

39
Q

What is epistaxis?

A

Nose bleed

40
Q

What are three management options for epistaxis?

A
  • First aid - pinch tip of nose and bend head slightly forwards for 15-20mins
  • Antibiotic ointments
  • Cautery
  • Nasal packing
41
Q

What is used for cautery of epistaxis?

A
  • Silver nitrate under LA

* Diathermy under GA

42
Q

Give two examples of antibiotic ointments to treat epistaxis

A
  • Naseptin

* Bactroban

43
Q

What are common symptoms of laryngology?

A

• Sore throat

  • Airway issues
  • Hoarseness
  • Dysphagia
44
Q

What is important to determine in the history of a child with a sore throat?

A
  • Throat symptoms - pain (odynophagia, ear ache), discharge (cough), loss of function (dysphagia, breathing problems, hoarse voice)
  • Snoring, drooling
45
Q

What should be examined in a child with a sore throat?

A
  • Throat
  • Neck
  • Ears and nose
46
Q

Name a cause of a sore throat in a child

A

Tonsilitis

47
Q

What are causative organisms for tonsillitis?

A

Bacterial (B haem., Strep B) or viral (EBV)

48
Q

What are possible complications of tonsillitis?

A
  • Glomerulonephritis

* Peritonsillar abscess

49
Q

What is the treatment of tonsillitis?

A

Supportive and antibiotics

50
Q

What is peritonsillar abscess?

A

Pus collection just behind tonsils - must be drained and then start IV antibiotics

51
Q

What could cause airway issues in a child?

A
  • Large adenoids
  • Large tonsils
  • Large tongue
  • Large/floppy epiglottis
  • Short neck
  • Sub-glottis narrowest
52
Q

What do you need to ask about in a history of a child with airway issue?

A
  • Usually as an Emergency (can be chronic)
  • History of foreign body
  • Recent illness
  • Feeding problems
  • Stridor
53
Q

What two conditions cause airway issues?

A
  • Epiglottitis

* Laryngomalacia

54
Q

What is laryngomalacia?

A

Laryngeal cartilage not developed properly and if properly, so if supine it collapses and develop breathing problems, fine if standing up

55
Q

What are four different types of neck lumps?

A
  • Thyroglossal duct cyst
  • Branchial cyst
  • Cystic hygroma
  • Cervial lymphadenopathy
56
Q

What is a complication of lymphadenopathy?

A

Neck abscess

Head and Neck (12 decks)

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