Eyes and ENT Flashcards
What is the outer ear made up of
Auricle: made up of bone and cartilage
What is the middle ear made up of
Ossicles: Malleus, Staples and Incus Eustachian tube Promontory Facial Nerve Chordates Tympani
What is the inner ear made up of
Hearing and Balance organs
- Cochlear
- Vestibule
- Utricle
- Saccule
What are congenital abnormalities of the outer ear
- Absence of auricle/ microtia
- Atresia of outer ear canal
- Pre auricular sinus
- Accessory auricles
- Prominent ears
What are congenital abnormalities of the middle ear
- Abnormal Ossicles
- Craniofacial Syndrome
What are the congenital abnormalities of the inner ear
- cochleosaccular dysplasia
- cochlear dysplasia
- Vestibulocochlear dysplasia
What are risk factors in the Hx for hearing problems?
How are hearing problems detected?
How are the managed?
Risk factors for Hx:
- Family Hx (AD ans AR disorders)
- Maternal illness (TORCH infections)
- Jaundice
- Prematurity
- Anatomical Abnormalities
Newborn Hearing Screening Programme
Early referral to audiology for help and support
Early Cochlear implant/ Hearing aids
What instrument can be used to detect the function of the cochlear/ inner ear
Otoacoustic Emissions
What is infection if the outer ear called
Otitis Externa
How does otitis externa present
Painful and Inflamed enteral acoustic meatus
+/- Auricle
May see discharge
What is the most common cause of otitis externa
Excess canal moisture
Others: Trauma, Absence of wax, narrow ear canal
How do you treat otitis externa
Microsuction
Topical Abx
What is infection of the inner ear
Otitis Media
What causes otitis media usually
Usually URTI - (pnemococcus, haemophillus)
What are the differentials for otitis media
Infection
Eustachian tube Dsyfunction
How does otitis media present
Self Limiting!!!
- Earache
- Fever +/- irritability
- Young children: holding/tugging ear, crying, restlessness
What will be seen on examination
Otoscopy - Erythema/ Yellow tympanic membrane
How is otitis media treated
Analgesia
Only give Abx if systemically unwell or no improvement >4 days or immunocomprimised
- Amoxicillin
What is a complication of Otitis Media
Perforation
Mastoiditis - rare but serious
What is chronic otitis media
Perforation of the tympanic membrane from chronic/ recurrent infections
How does chronic suppurative otitis media present
Ottorhea: Persistent purulent discharge through perforation
Hearing loss
Otalgia
What are complications of chronic suppurative otitis media
Retraction pockets (part of the ear drum collapses inwards) this can lead to Cholesteatoma
How does Cholesteatoma present
Presents after recurrent infections
- Offensive discharge +/- gradual hearing loss
Otoscopy: White material discharging from defect in tympanic membrane
Can cause hearing loss, meningitis
How do you treat Chronic Suppuritive Otitis Media
Aim is to make a dry safe ear
Perforation: Close it - Myringoplasty
Cholesteatoma: Mastoidectomy - to remove it but trying to preserve hearing as much as possible
What is otitis media with effusion/ glue ear
When fluid builds up behind the ear drum
most commonly occurs after an episode of acute otitis media
What causes otitis media with effusion
Dysfunction of the Eustachian tubes
How may OME present
Hearing loss of 25-30 dBs Poor Speech and Listening Language Delay Hearing Fluctuations (there may be no pain)
How may OME look on examination
May look normal but can be variable presentation:
- Drum may be retracted/bulging
- Dull/Grey/Yellow
- May be air bubbles/fluid level
What is the treatment for OME
50% with bilateral hearing loss of 20dB will resolve in 3 months
- Conservative: Do nothing just observation, Eustachian tube autoinflation may help during
- Ventilation Tubes - Grommets
- Hearing aids if surgery contraindicated
What is Choanal Atresia
• Failure of the nose to canalise
– Bony or membranous
• Bilateral rare but a neonatal emergency
How does Choanal Atresia Present
And how can you easily test for it
• Cyclical going blue, crying-going pink, stop crying going blue again
- Cold spatula: no misting
- Failure to pass an NG tube
How do you manage Choanal Atresia
Secure the Airway
Tertiary referral for dilatation and stent insertion
What causes craniofacial disorders
What can it cause
What may be required as a last resort
Syndromic e.g Downs
Problems with airways
- Obstructive Sleep Apnoea
- Midfacial Hypoplasia
- Tracheostomy
What is unilateral discharge until proven otherwise and how should it be managed
Foreign Object (batteries emergency)
- Try once at removing it otherwise GA
What is the area in nose which is a rich supply of blood vessels and what can this lead to
Littles Area - Epistaxis
How are nose bleeds caused
Nose picking, inflammation, foreign body, trauma, bleeding diathesis
How are nose bleeds managed
• ABC • Medical treatment: – Topical naseptin, silver nitrate cautery • Surgical treatment – Electrocautery
A teenage boy presents with recurrent nosebleeds and nasal congestion what should you be aware of
Juvenile Nasopharnygeal angiofibroma
Is sinusitis common in children
No its RARE
Sinusitis with nasal polyps what may be the diagnosis
CF
What is the most common complication Sinusitis
Periorbital Cellulitis - can progress to orbital cellulitis
What is Periorbital Cellulitis
What is Orbital Cellulits
Which ones more serious
Infection of the soft tissues anterior to orbital septum - Medical Emergency
Infection of soft tissues posterior to orbital septum
Orbital cellulitis
How does orbital cellulitis present
How does Periorbital Cellulitis present
Fever, lid swelling, reduced eye movements, painful eye movements, dipoplia, proptosis, red colour vision
Swelling of eyelid and ocular pain, no painful eye movements, no diplopia, no visual impairment
What is red colour vision a sign of in orbital cellulitis
Sign of optic nerve compromise
How is orbital cellulitis managed
How is periorbital cellulitis managed
Joint care of paeds, opthalomology and ENT
IV Abx - amoxicillin
Surgery - incision and drainage of abscess
Amoxicillin
How is laryngeal atresia managed
EXIT procedure
What is the most common abnormality of the larynx
Laryngomalacia - floppy malformed larynx due to softening of the larynx tissues causing tissues to fall over airways blocking them
How does laryngomalacia present
- Normal voice, stridor worse on feeding and exertion • Worse when supine
- Failure to thrive
- Increased work of breathing
How will Larngomalacia look in examination and how is it examined
tools
- flexible nasoendoscopy
- More detailed - GA: Microlaryngobronchoscopy
- Normal Child
- Stridor
- WOB, tracheal tug, recessions
- Flexiblenasendoscopy examination: omega shaped epiglottis, short aryepiglottic folds, bulky, prolapsing arytenoids
How is Larngomalacia managed
Often resolves on its own • Close monitoring • Weigh (?daily/weekly at first) • Antireflux • If not coping NG tube • ?surgery – microlaryngobronchoscopy + aryepiglottoplasty
What high risk groups is hearing monitored in long term
Cystic Fibrosos Chemotherapy CMV Head Trauma Cleft lip/pallet Downs syndrome
What are the four types of strabismus
Esotropia
Exotropia
Hypertropia
Hypotropia
What are the most common causes of strabismus
- Hereditary
- Refractive Errors - most commonly uncorrected hypermetropia and accommodative esotropia
- Secondary to vision loss
- Neurological defects e.g cerebral palsy
- Anatomical/Mechical defects
How are strabismus investigated
- Hx e.g age of onset etc
- Corneal Reflection -reflection from bright light falls centrally and symmetrically on each cornea if no suint and asymmetrically if squint present
- Cover Test - movement of uncovered eye yo take up fixation as other eye is covered
what hearing test is used for neonates
Otoacoustic Emissions
What is the hearing test used in 3+
Pure Tone Audiometry
What is pseudostrabisus
False appearance of cross eyes
Due to e.g. - facial asymmetry, unilateral ptosis, deep set or prominent squint
What is amblyopia
Defective visual acuity which persists after correction of refractive error (with glasses/contacts) and removal of any pathology - Lazy Eye
What should all patients with amblyopia have and what is the management
Early Referral important! better outcome!!!
ALL patients need refraction/glasses test and fundus and media check under cyclopegia (paralysis of cillary muscle resulting in loss of accommodation
- Refractive Adaption - wear appropriate glasses for 16-18 weeks
- Occlusion of better seeing eye (eye patch)
- Atropine Drops/ointment in better seeing eye
What is it important to rule out when investigations strabismus
Paralytic Strabismus - check eye movements
How do you manage strabismus
Aim: To restore binocular single vision and eliminate diplopia
The 3O’s
- Optical - assess refractory state with cyclopegia for glasses
- Orthoptic - patching good eye to encourage exercise of strabismus eye
- Operations - Resession or Resection of Rectus muscle to help alignment OR Botulinum Toxin can help (medial rectus esotropia and lateral rectus exotropia)
What is it important to understand about transient eye misalignments
- They are normal in the first few months of life
- They should be transient
- Improve from age 2 mths onwards
- Gone after 4 mths
What is it important to note about sudden onset childhood strabismus
- Most don’t have sudden onset may be present with other neurological signs
- Urgent Referral
What are two complications of Strabismus
Ambylopia
Diplopia