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Paediatrics > Otolaryngology > Flashcards

Otolaryngology Flashcards

1
Q

What is the most common age group for AOM?

A

18 months to 6 years

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2
Q

What are the common causative organisms for AOM in children?

A
  • *Bacteria**
  • *- Streptococcus pneumoniae
  • Hemophilus influenzae (non-typable)
  • Moraxella catarrhalis**
  • Group A streptococcus
  • Staphylococcus aureus
  • *Viral**
  • Adenovirus
  • Parainfluenza
  • RSV
  • Influenza

>> Most common due to bacterial/viral co-infection

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3
Q

What are the signs of AOM on otoscopy?

A
  • *Inflammation**
  • Bulging tympanic membrane (TM)
  • TM with marked discoloration (erythematous, hemorrhagic etc.)
  • *Effusion**
  • Acute otorrhea
  • Opacification of TM
  • Loss of bony landmarks
  • Air-fluid level behind TM
  • Immobile TM
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4
Q

What is the management approach for a child with AOM?

A

>80% of AOM resolve spontaneously

  • Hydration and rest
  • Symptomatic relief
    >> Paracetamol
    >> Ibuprofen
    >> Decongestants
  • Watchful waiting in certain cases
    >> Child >6 months old
    >> Severity of AOM is mild: U/L, otorrhea is mild and temperature is <39C
    >> Child has no history of immunosuppression, anatomical abnormalities of the head and neck, chronic cardiac or pulmonary diseases, history of severe/complicated AOM, or Down syndrome
    >> Parents educated and alert to signs of worsening illness
    >> Medical help readily available
  • Otherwise, consider starting antibiotics
    >> First-line: amoxicillin: 75-90mg/kg/day
    >> Second-line: cefuroxime, ceftriaxone (1 dose), azithromycin or clarithromycin
    >> Mainly to hasten resolution

If initial therapy fails with no symptomatic improvement after 2-3 days:

  • Augmentin for 10 days
  • IM ceftriaxone

For future prevention

  • Encourage exclusive breastfeeding until 6 months
  • Recommend annual influenza (and pneumococcal – now part of the immunization programme) vaccine to all children
  • Avoid tobacco smoke
  • Tympanostomy tubes for recurrent AOM (3 episodes in 6 months or 4 episodes in 1 year)
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5
Q

What are the complications of AOM?

A

Extracranial
- TM perforation
- Extension of suppurative process to adjacent structures
>> Mastoiditis
>> Petrositis
>> Labyrinthitis
- Cholesteatoma
- Ossicular necrosis
- Vestibular dysfunction
- Facial nerve palsy
- Hearing loss and speech delay

  • *Intracranial**
  • Meningitis
  • Epidural and brain abscess
  • Subdural empyema
  • Lateral/cavernous sinus thrombosis
  • Carotid artery thrombosis
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6
Q

What are the common presenting features of AOM?

A
  • Otalgia
  • Fever
  • Conductive hearing loss

+/- Tinnitus
+/- Vertigo
+/- Facial nerve palsy

>> Ear-tugging: NOT a good indicator of pathology
>> Irritability
>> Poor sleeping
>> Poor feeding
>> Vomiting and diarrhea

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7
Q

What is recurrent AOM?

A

3 episodes in 6 months, or 4 episodes in 1 year

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8
Q

What is otitis media with effusion (OME)?

A

Presence of fluid in the middle ear without signs or symptoms of an ear infection

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9
Q

What is the most common cause of hearing loss in children?
How does it present

A

Otitis Media with Effusion (OME)

>> Hearing loss
>> Tinnitus
>> Fullness from blocked ear
>> +/- Pain and low grade fever

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10
Q

What are the physical examination findings of OME?

A
  • *Otoscopy**
  • Discolouration of TM – amber/dull grey (“glue ear”)
  • Meniscus fluid level behind TM
  • Air bubbles
  • TM atelectasis/retraction bubbles
  • Immobility with pneumotoscopy
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11
Q

What are the common causative organisms of acute tonsilitis?

A
  • Group A streptococcus
  • EBV
  • Other bacteria: S. pneumoniae, S. aureus, H. influenzae, M. catarrhalis
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12
Q

What investigations would be useful in diagnosing the cause of acute tonsilitis?

A
  • CBC with d/c
  • ESR, CRP
  • Throat swab for C/ST
  • Monospot test (less accurate in <2 years; try EBV titre)
  • +/- ASOT; may not be elevated that early on
  • NPA for latex agglutination test/PCR virology
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13
Q

What are the presenting features of quinsy?

A

(Quinsy = Peritonsillar abscess)

  • *Clinical Triad**
  • *1. Trismus – involvement of the motor branch of CNV
    2. Uvular deviation
    3. **Dysphonia (“Hot-potato” voice)

>> Sore throat
>> Dysphagia/odynophagia
>> Edema of the soft palate
>> Unilateral referred otalgia
>> Cervical lymphaednitis

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14
Q

How does one manage a case of quinsy?

A

Secure airway

  • Surgical drainage >> C/ST
  • IV penicilin G x 10 days (if cultures are positive for GAS)
  • IV/PO metronidazole/clindamycin x 10 days (if cultures are positive for Bacteroides)
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15
Q

What are some common causative organisms for quinsy?

A

Group A streptococcus (50%)

  • Staphylococcus aureus
  • H. influenzae
  • Anaerobes
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16
Q

NEONATES ARE OBLIGATE NOSE BREATHERS.

A
17
Q

The narrowest portion of the pediatric airway is CRICOID RING.

A
18
Q

How does croup present?

A
  • Usually preceded by URITI symptoms
  • Symptoms usually occur at night
  • **The three Ses of croup:
    1. Stridor
    2. Subglottic swelling
    3. Seal-like barking cough**

>> Appears less toxic than epiglottitis
>> Rule out foreign body and subglottic stenosis
>> Steeple sign on AP X-ray of NECK

19
Q

What are the common causative organisms for croup?

A

RSV

  • Parainfluenza I, II and III
  • Influenza A and B
20
Q

What is the common age for croup?

A

4 months to 5 years

21
Q

How does one manage a case of croup?

A
  • Adequate hydration
  • Close observation: BP/P, temperature, RR, SaO2, signs of respiratory distress
  • Systemic corticosteroids (e.g. dexamethasone, prednisone)
  • Racemic epinpehrine via nebulizer Q1-2H PRN (if respiratory distress present)

Hospitalize if poor response to steroids after 4 hours and persistent stridor at rest

22
Q

How does manage a case of acute epiglottitis?

A
  • Secure airway
  • IV access and fluids
  • IV antibiotics: cefuroxime, cefotaxime or ceftriaxone
    >> Common organisms: H. influenzae type B, beta-hemolytic strep (pneumococcus)
  • Moist air supplement
  • Watch out for meningitis
23
Q

What is subglottic stenosis?

A

Diameter of subglottis <4mm in a neonate

>> Due to thickening of soft tissue of subglottic space
>> OR due to maldevelopment of the cricoid cartilage
>> OR due to prolonged, repeated, or traumatic (endotracheal) intubation
>> OR due to foreign body

This is why nasal intubation is preferred in neonates if prolonged tubing is neededd

24
Q

What is the most common cause of stridor in infants?

A

Laryngomalacia

25
Q
A

Paediatrics (16 decks)

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