ENT problems Flashcards
tonsils
lymph tissue that filter pathogens
adenoids
nasopharynx
palatine tonsils
both sides of the oropharynx
tubal tonsils
entrance to the eustachian tubes
lingual tonsils
base of the tongue
tonsillitis
infection/inflammation of the palatine tonsils
adenitis
infection/inflammation of the adenoids
etiology of tonsillitis
-can be either viral or bacterial -viral: most common in children <3 yrs -bacterial: GABHS in school age children -incidence peaks from 4-7 years old
s/s of bacterial tonsillitis
-swollen uvula -whitish spots -red swollen tonsils -throat redness -gray furry tongue **come to the health center
s/s of viral tonsillitis
-red swollen tonsils -throat redness **monitor at home, gargle with salt water
general s/s of tonsillitis
-painful or difficulty swallowing -drooling -high fever -pus
s/s of adenoiditis
-nasal speech -mouth breathing -difficulty hearing -halitosis (bad breath) -sleep apnea GABA -HA -abd pain -N/V
tx of viral tonsillitis
-analgesic/antipyretic -fluids -rest -saline gargles -throat sprays
tx of bacterial tonsillitis
antibiotics
tonsillectomy
removes palatine tonsils
adenoidectomy
removes pharyngeal tonsil
reasons for surgery for tonsillitis
-recurrent throat infections (>3yo, x3) -tonsils interfere with eating, sleeping & breathing
frequent swallowing and throat clearing in tosillitis
sign of swallowing blood
foods to avoid with tonsillectomy
-dairy will increase mucus -popsicle & jello okay -avoid red jello (d/t bleeding)
otitis media
middle ear infection or effusion
- viral or bacterial
- presence of uninfected fluid
if otitis media is left untreated…
- permanent hearing loss
- mastoiditis
- meningitis
increased incidence of otitis media
- 6-36 mo
- 4-6 yrs
- males
- Alaskan and Native American
- home w/ smoker
- cleft palate
- formula fed infants (bottle propping)
- winter/spring
- pacifier use
infant s/s of otitis media
- rub and pulling affected ear
- rolls head from side to side
- crying, fussy, restless, irritable
- difficulty comforting child
- loss of appetite
older child s/s of otitis media
- verbalizes pain
- irritability
- lethargy
- loss of appetie
objective s/s of acute otitis media
- reddened membrane, inflamed
- malleus
- no cone of light
- fluid present
s/s of acute otitis media
rapid onset of
- sharp pain
- rhinitis, URI
- sudden fever
causative organisms of acute otitis media
- strep pneumoniae
- HIB
- moraxella catarrhalis
- staph
if tx of acute otitis media is unsuccessful
tympanocentesis is done to obtain culture
tx of acute otitis media
- watchful waiting
- antibiotics
- analgesics/antipyretics
- nasal decongestants
parent teaching for acute otitis media
- complete antibiotics
- conductive hearing loss up to 6mo
- do not clean ears with q-tips
- dont use nasal decongestants for 3+ days
- offer liquids and soft foods (hurts to chew)
- return to clinic if no improvement in 24-48 hrs
otitis media with effusion
- result of chronic OM
- children 3-10yrs
assessment of otitis media with effusion with otoscope
- retracted tympanic membrane
- malleus prominent
- absent cone of light
- no movement with puff of air
s/s of otitis media with effusion
- c/o fullness, ringing or popping
- hearing loss (temporary)
management of otitis media with effusion
- goal: to supply air
- control the cuase of allergies, enlarge adenoids
- meds: antihistamines, decongestants
- surgeries (for hearing loss >20dB): tympanocenesis; tubal myringotomy with pressure equalizing tube insertion; tympanostomy tubes (PE tube)
PE tube
tympanostomy tube
- depending on tube size, lasts 6 mo to 2-3 yrs
- as ears grow, tubes will fall out
- place in 5-10 minutes under brief general anesthesia
parent teaching for myringotomy
- no water in ears
- bathe rather than shower
- shower/swimming w/ ear plugs
- possible temp hearing problem (notify teacher, PE tube falls out)
croup
narrow, swollen airway
- acute laryngotracheobritis (viral)
- acute spasmodic laryngitis (viral)
- acute (bacterial) tracheitis
- acute (bacterial-Hib) epiglottis (life threatening)
assessment of croup
- respiratory assessment: croupy/barking cough; inspiratory stridor, resp distress
- history of recent ear infections
- xrays, labs, cultures
common s/s of respiratory distress
- contractions
- nasal flaring
treatment of croup
- airway mgmt: corticosteroids, racemic epinephrine(vasoconstricts)
- fluids
- rest
- humidification
- humidified O2
- antibiotics
acute laryngotracheobronchitis vs acute spasmodic laryngitis
- viral
- LTB gradual onset : spasmodic rapid onset
- LTB more severe
- can be managed with O2, hospitalization, IV fluids, racemic epi, rest
s/s of acute tracheitis
- purulent secretions
- high fever
- tripod position (helps with breathing)
tx of acute tracheitis
- humidified O2
- possible intubation
- antipyretics
- IV antibiotics
- fluids
s/s of acute epiglottis
- drooling
- dysphagia
- dysphonia
- distress
- fever
tx of acute epiglottis
- do not inspect throat
- humidified O2
- emergency intubation
- antipyretics
- IV antibiotics
- fluids
- racemic epi
