Otolaryngology Flashcards
What would you look for in a history of a child with hearing loss?
Ear symptoms Pain Discharge Loss of function- hearing loss, dizziness, tinnitus Speech development, school performance Maternal perinatal infections Maternal drugs/alcohol Delivery issues (prematurity, anorexia) Neonatal infections, drugs, jaundice PMH, Growth, immunisations, passive smoking, breast vs. bottle feeding
Explain the subjective assessment of hearing in children
6-18 months: Distraction test
12 months-3 years: Visual reinforced audiometry
3-5 years: play audiometry
4+ years: Pure tone audiometry
Describe the objective assessment of the auditory system in children with hearing loss
Otoacoustic Emissions
Auditory brain stem response
Tympanometry
These usually require a quiet baby and testing environment so are carried out when the baby is asleep or under anaesthetic
What is tympanometry?
Allows you to assess the pressure of the middle ear
Is it filled with fluid?
How to you test Otoacoustic emissions?
Check if the active hair cells move with putting a tiny microphone in the ear and listening for the otoacoustic emissions in response to a click sound
If presence then cochlea healthy
What is auditory brain response audiometry?
Measure the electrical activity of the acoustic nerve and the brain in response to sounds
What is the commonest cause of conductive hearing loss in children?
Otitis media with glue ear
It effects children around 2 and 5 years old and resolves by itself in the majority.
If it persists more than 3 months and causes hearing loss give hearing aids or put grommets in (removing adenoids also)
Who is otitis externa common with?
How do you treat?
Patients who have eczema in the ears, swimmers
Not a very common cause of discharging ear in children
Treat with:
- Aural microsuction
- Topical antibiotics
- Water precautions
A child presenting with painful discharging ear probably has what?
What is the clinical presentation
Acute otitis media
Unwell - fever
Irritable - pain
Child pulling at ears with discharge if the ear drum bursts
What is the microbiology and treatment of acute otitis media?
Microbiology:
- Haemophilus influenza
- Strep pneumonia
- Moraxella catarrhalis
Treat with antibiotics (co-amoxiclav)
Grommets and adenoidectomy if recurrent
What are the complications of acute otitis media?
Infection may spread back causing mastoiditis (needs draining)
If it spreads upwards it can cause meningitis or even cerebral abscess
Children with chronically discharging ears or unexplained hearing loss you may suspect what?
A more serious but rare condition, cholesteatoma
This is the presence of squamous epithelium in the middle ear cleft causing infections and bony erosions.
This requires surgery - mastoidectomy
Describe the conditions you consider with a child presenting with blocked/ runny nose
Most common = Rhinitis (allergic or non-allergic)
Check for specific IgE for allergens
Treat with:
-Reducing allergen load (avoidance and saline irrigation)
-Reducing body reaction (antihistamines and nasal steroid spray)
Large adenoids can mimic
Check for sleep apnoea
How can you distinguish rhinosinusitis?
Foul smelling nasal discharge
What are the complications of sinusitis?
In acute sinusitis the infection can spread to the soft tissues causing periorbital cellulitis and sometimes into the orbit
This is an emergency (get an ophthalmologist)
