ENT - Paediatrics Flashcards
What are common otology symptoms?
- Hearing loss
- Otorrhoea
- Otalgia
- Tinnitus
- Vertigo
What does hearing loss usually present as in children?
Behavioural problems or speech delay
What are the different sections of the ear?
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)
What are the two different types of hearing loss?
Conduction loss (TM perforation or ossicle problem) or sensorineural loss (in cochlea)
What are three things you have to distinguish with hearing loss?
- Congenital vs acquired
- Unilateral vs bilateral
- Conductive vs sensorineural
What is important to know in the history of the child with hearing loss?
- 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
How are children usually examined?
- Usually kept on mother’s lap
* Otoscope used as more comfortable
Name four different subjective assessment tests of hearing for children of different ages
- 6-18 Months: Distraction test
- 12 months – 3 years: Visual reinforced audiometry
- 3 - 5 years: Play audiometry
- 4 years +: Pure tone audiometry
Name thee tests for objective assessment of the auditory system
- Otoacoustic emissions
- Auditory brainstem responses
- Tympanometry
What does tympanometry measure?
Measure noise or pressure coming through middle ear which can detect is there is any abnormality i.e. fluid
How are otoacoustic emissions measured?
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)
What is the purpose of the auditory brainstem response?
See if auditory nerve is functioning (cochlea nerve)
Name four risk factors for otitis media with effusion (glue ear)
- Day care
- Smoking
- Cleft palate
- Down syndrome
What is the treatment for otitis media with effusion?
Most improve by themselves within 3 months
If still not recovered, treat with hearing aids, auto-inflation or grommets
Name five symptoms of otitis media with effusion
- Hearing loss
- Speech delay
- Behavioural problems
- Academic decline
- (Imbalance)
Name three symptoms of otitis media with effusion
- Dull TM
- Fluid levels
- Bubbles
Name three causes of OM with effusion
- Eustachian tube dysfunction
- Adenoidal hypertrophy
- Resolving acute OM
What is the effect of autoinflation?
Forcefully opens the eustacian tube to improve ventilation
Name two hearing aids used to treat children with hearing loss
- 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
Name some causes of painful / discharging ear
- Otitis externa
- Acute otitis media
- Chronic otitis media -> Cholesteatoma
What is the treatment of otitis externa?
- Aural microsuction
- Topical antibiotics
- Water precautions
What are causative organisms of acute otitis media?
- Haem. Influenza
- Strep. Pneumonia
- Moraxella catarrhalis
What are the symptoms of acute otitis media?
- Short history
- Pain
- Fever
- Discharge
What is the treatment of otitis media?
- Antibiotics (i.e. co-amoxiclav)
* Grommets + adenoidectomy if recurrent
What are possible complications of AOM?
- Perforation
* Mastoiditis - emergency in children as can cause brain abscess
Name five rhinology symptoms
- Blocked nose
- Runny nose
- Sneezing
- Reduced sense of smell
- Facial pain
At what ages do the sinuses develop?
- 0-4months: ethmoids/maxillary
- 2-7yrs: sphenoid
- 8yr - adolescent: frontal
What is important to find out in the history of a child with a blocked/runny nose?
- Nasal symptoms
- History of foreign body
- Feeding
- Snoring, quality of sleep
What is used to examine the function of the nose?
- Rigid endoscope in older children with local anaesthetic
* Cold spatula misting - shows if nasal passage is blocked
What treatments are used to manage rhinitis?
- Nasal douching
- Antihistamines
- Nasal steroids
What are four causes of a blocked/runny nose?
- Rhinitis
- Large adenoids
- Sinusitis and polyps
- Choanal atresia
What is investigation is used to decide treatment of blocked/runny nose caused by large adenoids?
Sleep study to check for sleep apnoea to see if they would benefit from adenoid removal
How would a foreign body in the EAC present?
Unilateral symptoms - requires urgent removal (especially if it’s a battery which erodes mucosa)
What condition are sinusitis and polyps associated with?
Cystic fibrosis
What are polyps?
Enlarged mucosal lining filled with fluid
How are polyps treated?
If not big, then it is conservative and treated with steroid and anti-histamines
If obstructing nose, then remove surgically
What is the complication of sinusitis and polyps?
Sinus infection can spread to the eye
What is Little’s Area of the nose?
Region in the anteroinferior part of the nasal septum where four arteries anastomose to form Kiesselbach’s plexus and common site for epistaxis
What is epistaxis?
Nose bleed
What are three management options for epistaxis?
- First aid - pinch tip of nose and bend head slightly forwards for 15-20mins
- Antibiotic ointments
- Cautery
- Nasal packing
What is used for cautery of epistaxis?
- Silver nitrate under LA
* Diathermy under GA
Give two examples of antibiotic ointments to treat epistaxis
- Naseptin
* Bactroban
What are common symptoms of laryngology?
• Sore throat
- Airway issues
- Hoarseness
- Dysphagia
What is important to determine in the history of a child with a sore throat?
- Throat symptoms - pain (odynophagia, ear ache), discharge (cough), loss of function (dysphagia, breathing problems, hoarse voice)
- Snoring, drooling
What should be examined in a child with a sore throat?
- Throat
- Neck
- Ears and nose
Name a cause of a sore throat in a child
Tonsilitis
What are causative organisms for tonsillitis?
Bacterial (B haem., Strep B) or viral (EBV)
What are possible complications of tonsillitis?
- Glomerulonephritis
* Peritonsillar abscess
What is the treatment of tonsillitis?
Supportive and antibiotics
What is peritonsillar abscess?
Pus collection just behind tonsils - must be drained and then start IV antibiotics
What could cause airway issues in a child?
- Large adenoids
- Large tonsils
- Large tongue
- Large/floppy epiglottis
- Short neck
- Sub-glottis narrowest
What do you need to ask about in a history of a child with airway issue?
- Usually as an Emergency (can be chronic)
- History of foreign body
- Recent illness
- Feeding problems
- Stridor
What two conditions cause airway issues?
- Epiglottitis
* Laryngomalacia
What is laryngomalacia?
Laryngeal cartilage not developed properly and if properly, so if supine it collapses and develop breathing problems, fine if standing up
What are four different types of neck lumps?
- Thyroglossal duct cyst
- Branchial cyst
- Cystic hygroma
- Cervial lymphadenopathy
What is a complication of lymphadenopathy?
Neck abscess
