Paediatric Flashcards
Congenital sensorineural risk factors
prematurity
Jaundice
NICU stay
Fhx
Syndromes e.g. Down’s syndrome
What is otoacoustic emissions
hearing test where the cochlea itself makes a sound in response to being stimulated- can be used at any age
What is auditory brainstem response testing
Measure EEG changes in response to sound
-Can be used at any age
-Useful in those <7 months as can be used without child cooperating
When is visual reinforcement audiometry used
Child turns head to sound and is rewarded with a visual reward e.g. dancing toy
When is play audiometry used
Carry out play action in response to sound (2-5 years)
When is a cochlear implant used instead of a hearing aid
When SNHL is severe or a hearing aid doesn’t work well
Tactics for removing foreign bodies
What need immediate removal
Wax hook for circular bodies
Croc forceps (not for beads)
Suction
Oil/alcohol to kill buzzing insects
Syringing best avoided
GA if uncooperative
Batteries need immediate removal
What sounds as recurrent AOM
> 3 in 6 months
4 in 12 months
Symptoms of acute otitis media in children
Temp
Pulling ear
Discharge if ear drum bursts
What is chronic otitis media
Effusion, no symptoms/signs of acute inflammation
What is chronic suppurative otitis media
Chronic otitis media with perforated ear drum
What is cholesteatoma
Squamous epithelium in middle ear
What is otitis media with effusion
Middle ear fluid in absence of symptoms/signs of acute infection
-Causes hearing loss, school problems, speech delay
Treatment of otitis media with effusion
Try valsalva or otovent balloon to open Eustachian tube
-If persists >3 months with symptomatic hearing loss, speech, behaviour problems: grommets (ventilation tube= tympanostomy tube) or hearing aids
What would an adult with glue ear indicate
Could be a sign of nasopharynx tumour
Symptoms of acute otitis media
Pain, deafness, fever, ear tugging, discharge as TM ruptures and pain improves
Management of otitis media
Analgesia
Most don’t need abx. Give abx if <6/12 old, at risk of infectious complications, symptoms >4 days, systemically unwell, (consider if bilateral, perf/discharge, <2 yo). Eg PO amoxicillin. Drops work well if discharge
ENT referral if not settling or complication (eg mastoiditis, facial palsy, intracranial sepsis)
Recurrent acute otitis media management
Avoid pacifiers
No smoking of all family members
Treat each episode individually
Long term abx?
Grommets
However advise as child gets older it usually resolves itself
TM perforation management
Direct trauma, blow or due to AOM
Most heal within 6 weeks
Keep dry
GP follow up after 6 weeks
ENT to see if:
-Severe bleeding
-Significant symptoms (deafness, tinnitus, vertigo, facial palsy)
Give drops
Acute mastoiditis examination and symptoms
Otalgia, hearing loss, swelling behind ear, malaise
Pyrexia
Post auricular swelling
Pinna- down and forwards
Loss of post aural sulcus
Watch out for complications e.g. intracranial abscess
Rx: admit, IV abx;grommet =- cortical mastoidectomy if not settling or abscess or intracranial complication
Symptoms of foreign body in nose
Unilateral offensive discharge in a child is FB until proven otherwise
Management of foreign body in nose
‘Parental kiss’- parent blows fast into child’s mouth while occluding good nostril
Wax hook/suction
May need GA
Treatment of rhinosinusitis
Majority need no treatment even if something suspicious shows on CT
What to do if see a child under 10yo presenting with polyps
Refer to resp to test them for cystic fibrosis
