Paediatric ENT Flashcards
Screening for deafness in children
all infants screened shortly after birth with automated ABR (auditory brainstem response)
what type of deafness is most common in permanent deafness
sensorineural
prevalence of deafness in children
1/1000 born w moderate or worse hearding imparied
1/1000 deveopo moderate hearing impairment by 8yrs
how are acquired causes of deafness classified
prenatal
perinatal
postnatal
causes of prenatal deafenss 3 examples
toxoplasma
rubella
CMV
causes of perinatal deafness 3
SCBU babies (special care baby unit)
-from things like
-jaundice (kernicteus)
-hypoxia
-aminoglycoside ABx
causes of post natal deafness 3
menigitis -HEARING TEST SHOULD BE ARRANGED AT DISCHARGE
head injury
ototoxic drugs
examples of ototoxic drugs 3
cisplatin
aminoglycosides -gentamicin, amikacin, tobramycin, neomycin, and streptomycin
furosemide
how are congenital causes of deafness split
syndromic 1/3
nonsyndromic - 2/3
syndromic causes of congenital deafness 5
Ushers
Pendreds
Brachio-oto-renal
Jervell & Lange-Nielsen
sticklers
nonsyndormic cuases of congenital deafness 1
any condition where deafness is an isolated feature
-most are autosomal receessive due to mutation in connexin 26 gap junction protein gene
treatement options for hearing rehabilitation
moderate
-bilateral,digital, behind the ear hearing aids
sever-profound hearing impairment
-cochlear implantation (direct stimulation of tehcochlear nerve)
-produces excellent hearing and speech
another name for otitis media with effusion
glue ear
cause of otitis media with effusion
mucus in the middle ear space
what can cause otitis media with effusion 2
effusion in middle ear v common after a URTI or an episode of otitis media
when is otitis media with effusion conisdered pathological
has to have been there for at least 3 months
-usually short lived
appearance of tympanic membrane with otitis media with effusion
dull and retracted
may have yellow or grey colour
prominent blood vessels on surface running radially
how is otitis media with effusion diagnosed
-what is the prevalence of glue ear in kids
daignosed w otoscopy
-tympanometry 9middle ear pressure testing) will demonstrate ear fluid
-*signs of infection are absent
20% of 2 yo have it on any given day
80% have had at least a three month episode
symptoms of otitis media with effusion 1
most minimal
few are severely afected with persistnet conductive hearing impairment
how does persistent conductive hearing impairment usually present
as speech delay
why is hearing testing essential in otitis media with effusion
to exclude a more serious sensorineual hearing loss cause
managemnt of otitis media with effusion 2
most watch and wait
small minority - grommets
-small ventilation tubes inserted into tympanic membrane
-v effective at clearing fluid and improving hearing
what can be done to prevent reccurence of otitis media with effusion 1
removal of adenoids from the nasopharynx
-alos improves health of ears in the long term
classical presentation of tonsilitis 5
sore throat lasting more than a few days
tonsillar exudate
fever
cervical lymphadenopathy
malaise
what is the cut off for episodes of tonsilitis where tonsilectomy would be considered
more than 5 per year over 2yo
or
7 in a year
*also reasonable to watch and wait as many children will outgrow the problem
what is nasal obstruction in pre-school children likely due to
-what syx are often associated with this 2
physiological hyperthrophy of the adenoids (nasopharyngeal lymphoid tissue)
-ofeten associated with snoring and rhinoorhea
how to manage obstructive adenooids in kids 3
shrink sponaneously by 6yo so can just leave
adenoidectomy can be considered in severe cases
saline nasal douches can be helpful for milder cases
what is nasal obstruction more common in for children of school age
-what are the syx 2
allergic rhinitis
sneezing and clear rhinorrhoea
treatment for allergic rhinitis 2
topical nasal steroids spray
+
oral non-sedating antihistamines
what is the most important aspect of the history regarding nasal obstruction 1
sleep quality
what is the most common cause of obstructive sleep apnoea in children
physiological hypertrophy of the tonsils and adenoids
therefore common in 2-7yo
management of obstructive sleep apnoea
adenoidectomy and tonsillectomy curative in majoriyu of cases
daignoiss of obstructive sleep apnoea
good hisotry
can do sleep studies (overnight pulse oximetry or full 12 cahllen polysomnography)
aspects of a sleep history of a child 8
- Does he/she get a good night’s sleep?
- Does he/she snore?
- Have you ever noticed him/her stop breathing/ hold their breath during the
night? - Does he/she wake during the night?
- Is he/she restless or sweaty at night?
- Is he/she difficult to wake in the morning?
- Does he/she have night terrors?
- Does he/she wet the bed?
most common cause of chronic stridor
laryngomalacia
differnrtials for acute stirdor 4
inhaled foreing body
CROUP
epliglottis
anaphylaxis
causes of chronic stridor 4
laryngomalacia
sobglottic stenosis
airway haemangioma
tracheal stenosis
if a child presents with stridor what is an important aspect of their care
every child needs a diagnosis
-that means some kind of airway endoscopy
what cancers of the neck are kids at the main risk of 2
lymphoma
rhabdomyosarcoma
