ENT - paediatrics Flashcards
History of a child presenting with hearing loss/ENT related illness (7)
Behavioural problems Maternal infection Premature Neonatal infection Poor growth Lack of immunisations Passive smoking
Examination of a child with hearing loss
Otoscope/auriscope
Subjective investigations of child with hearing gloss (4)
Distraction test (6-18 months) Visual reinforced audiometry (1-3 years) Play audiometry (3-5 years) - child plays with toy then sound played in the room which makes them turn towards it Pure tone audiometry (4+)
Objective investigations of child with hearing loss (2)
Otoacoustic emissions
Auditory brain stem responses
Otitis media with effusion prognosis in children
80% don’t need treatment, heal within 3 months
Symptoms of otitis media with effusion in children (3)
Hearing loss
Speech delay
Behavioural problems
Signs of otitis media with effusion in children (3)
Dull tympanic membrane
Fluid behind tympanic membrane
Academic decline
Treatment of otitis media with effusion in children (only needed if severe)
Hearing aids - bone anchored hearing aid (implanted device into skull bone to transmit
sound to the bone)
Otovent (forceful expiration to open up eustachian tube)
Grommets
Causes of otitis media (3)
- Eustachian tube dysfunction
- Hypertrophy of adenoids
- Resolving acute otitis media
Differentials of a child with painful discharging ear (4)
Otitis externa
Acute/chronic otitis media
Cholesteatoma
Otitis externa treatment (3)
Aural microsuction
Topical antibiotics
Keep water out
Causative organisms of acute otitis media (3)
H. influenza
Strep. pneumoniae
Moraxella catarrhalis
Symptoms/signs of acute otitis media (3)
Otalgia
Fever
Otorrhoea
Complications of acute otitis media
Mastoiditis –> brain abscess possible
Chronic otitis media is AOM that hasn’t resolved for how many months
3
Definitive treatment of cholesteatoma
Mastoidectomy
Possible symptoms of a child with blocked/runny nose (5)
Blocked nose Rhinorrhoea Sneezing Reduced smell Facial pain
If rhinorrhoea is unilateral, could be due to what
Foreign body
Examination of blocked/runny nose
Auriscope (otoscope)
Differentials of child with blocked/runny nose (5)
Rhinitis (allergic or non-allergic) Adenoid hypertrophy Foreign body Sinusitis & polyps Choanal atresia
Treatment of rhinitis (3)
Nasal douching (washing) Antihistamines Topical intranasal steroids
What condition can adenoid hypertrophy cause
Sleep apnoea
What is choanal atresia + how does it present
Congenital condition where back of nasal passage is blocked by bony or soft tissue
Presents bilaterally with breathing obstruction
Causes of epistaxis (2)
Trauma, e.g. nose picking, fracture, foreign body
Coagulopathy
Treatment of epistaxis (3)
Pinch tip/soft part of nose
If severe:
Cautery - to seal blood vessel by scarring it
Nasal packing
Symptoms of a child with sore throat (7)
Cough (+/- mucous) Dysphagia Odynophagia Difficulty breathing Hoarse voice
Snoring
Drooling
Examination of child with sore throat
Examine ears, nose, throat, neck
Tonsillitis mostly caused by what
Virus - EBV
Complications of tonsillitis (2)
Post streptococcal glomerulonephritis (injury of glolmeruli in kidney)
Quinsy - peritonsillar abscess
Children typically have larger what compared to adults (3)
Tongue
Tonsils
Epiglottis
Differentials of child with airway issues (3)
Foreign body
Epiglottitis
Laryngomalacia
Investigations of foreign body in airway (2)
Laryngoscopy
X-ray
Symptoms/signs of epiglottis
Stridor/noisy breathing
Treatment of epiglottis (3)
Antibiotics
Fluids
Anti-pyretics
What is laryngomalacia
Congenital softening of the larynx cartilage above the vocal cords –> floppy larynx –> tissue collapse above the glottis (vocal cord) during inspiration –> upper airway obstruction
Treatment of laryngomalacia
Just observe - will get better as child grows up
Intervention needed if breathing severely affected
Differentials of neck lump (4)
Thyroglossal cyst
Branchial cyst
Cystic hygroma (fluid filled sac) - due to blockage in lymphatic system
Cervical lymphadenopathy
