Paediatric ENT Flashcards
List the Centor critiera
Score 3 or more gives 40-60% probability of bacterial tonsilitis:
- Fever over 38°C
- Tonsillar exudates
- Absence of cough
- Tender anterior cervical lymph nodes (lymphadenopathy)
CENTOR
- Cough absense
- Exudates
- Nodes
- Temperature (>38)
- young OR old
List the features of Fever PAIN score
Score 2-3 gives 34-40% probability of bacterial tonsilitis, 4-5 gives 62-65%:
- Fever during previous 24 hours
- Purulence
- Attended within 3 days of onset of symptoms
- Inflamed tonsils (severely inflamed)
- No cough or coryza
What is the most common bacterial cause of tonsillitis
Streptococcus pyogenes (Group A streptococcus)
Treated with penicillin V ( phenoxymethylpenicillin)
Management of suspected bacterial tonsillitis
Phenoxymethylpenicillin (Penicillin V) for 10 days
Clarithromycin if pencillin allergy
What are the most common agents of otitis media
Most commonly a bacterial infection of the middle ear- enter from back of throat through eustachian tube:
- Streptococcus pneumoniae
- Haemophilus influenzae
- Moraxellae catarrhalis
bacterial infection is often preceeded by a viral URTI
What is 1st line treatment of otitis media if antibiotics are needed
Amoxicillin
Management of glue ear
This is where the middle ear becomes filled with fluid
Referred to audiometry
Treated conservatively- normally resolves within 3 months
May need hearing aids or grommets- especially if with co-morbidities like Down’s syndrome or cleft palate
When to prescribe antibiotics immediately for otitis media
- Younger than 2 years with bilateral otitis media
- Those with perforation +/- discharge
- Symptoms lasting more than 4 days or not improving
- Systemically unwell but not requiring admission
- Immunocompromised or high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease
Management of otitis externa
Topical antibiotic +/- steroid
e.g. Ciprofloxacin and dexamethasone
