ENT problems Flashcards
Impaired hearing in children
Conductive causes
Glue ear
Earwax impaction or foreign body
Tympanic perforation
Cholesteatoma
Impaired hearing in children
Sensorineural causes
Genetic deafness Neonatal problems - congenital infection, prematurity etc. Meningitis or encephalitis Neurodegenerative disease Ototoxic drugs - furosemide
Impaired hearing in children
Investigations - what is the first test used if hearing loss is suspected?
Other tests that can be used? What do they depend on?
Tympanometry for all children - measures pressure in the middle ear and tympanic membrane compliance.
Visual reinforcement audiometry (6-18 months) Speech perception (2-5 yrs) Pure tone audiometry (3-5yrs) Tuning fork test (5 yrs)
Impaired hearing in children
Management for:
Conductive
Sensorineural
Tympanic perforation usually heals spontaneously but refer to ENT if problem not resolved by 6 wks.
Consider early hearing aids or cochlea implants to aid normal language development
Glue ear
What is it also known as?
Pathophysiology
Risk factors:
- Lungs
- Anatomy
- Sex
- Allergy
- Trisomy
Otitis media with effusion
Middle ear inflammation and fluid accumulation due to eustachian tube dysfunction.
Smoking, URTI, winter Adenoids, cleft palate Male Atopy Down's
Glue ear
S+S
What would you see on otoscopy? - 3
Investigations - 2
Conductive hearing loss/impairment
Painful/painless
Drum either retracted or bulging
Bubbles and fluid level
Loss of light reflex
Age appropriate hearing tests
Microbiology - bacteria found in a third
Glue ear
Management:
What usually happens?
What can be added if the above doesn’t happen?
When should they be reviewed?
What are ventilation tubes called?
What can be done if the above doesn’t happen?
When is an adenoidectomy considered?
Usually resolves on its own
Decongestants and antibiotics
3 months
Ventilation tubes (grommets)
Small tubes that sit in the tympanic membrane and spontaneously comes out after 9 months
If they are enlarged and thought to contribute
Laryngomalacia
What is it?
What is it caused by?
What is it the commonest cause for in infants?
When does it usually present?
When do symptoms vary and what may exacerbate them?
What would you see on endoscopy?
Management - usual and if severe?
Congenital abnormality
Soft, immature laryngeal cartilage causes collapse of supraglottic structures on inspiration.
Stridor
First few weeks to months
Position
Feeding and excretion
Omega snapped epiglottis
Conservative and if severe, epiglottoplasty.
Tracheomalacia
Define
Type 1 - what type of problem is it? What is it linked to?
Type 2 - what type of problem is it? What causes it?
Type 3 - What type of problems is it? What causes it?
Tracheal collapse during respiration
Congenital instrinsic problem - trachea-oesophageal fistula
Extrinsic compression - vascular ring, tumour, cystic hygroma
Airway inflammation/irritation - from intubation
Tracheomalacia
Presentation
Expiratory sounds if lesion is …..
Inspiratory sounds if lesion is …..
When does it usually resolve?
What is it exacerbated by?
Wheezing and strider
Expiratory if lesion is intrathoracic
Inspiratory if extra thoracic
<1 yr
Activity and URTI’s
Tracheomalacia
Investigations - 2
Management - if mild and if severe?
Airway fluoroscopy and bronchoscopy shows airway collapse.
Conservative as self resolves
Tracheostom, aortopexy or tracheal stenting
Allergic rhinitis
What is it commonly known as?
Causes?
S+S
Hay fever
Inflammation of the inside of the nose caused by an alleged such as pollen, dust, mouth etc.
Cold-like symptoms - sneezing, itching, blocked nose
Allergic rhinitis
Management
Further problems
Avoid triggers
Non-sedating anti-histamines
Rinsing nasal passages with salt water
Nasal spray containing corticosteroids
Nasal polyps
Sinusitis
Middle ear infections
