PAEDIATRIC ENT

Question 1

Risk Factors of Otitis Media?

Answer 1

Question 2

____________________________: Chronic mucosal inflammation leads to disorganised de-differentiation into thickened pseudo-stratified epithelium with subsequent mucus retention

Answer 2

OTITIS MEDIA WITH EFFUSION (OME): Chronic mucosal inflammation leads to disorganised de-differentiation into thickened pseudo-stratified epithelium with subsequent mucus retention

Question 3

Why are children more prone to Middle Ear Disease?

Answer 3

Children are more susceptible to middle ear disease as their Eustachian tubes are less efficient at ventilating and draining the middle ear space. Their eustachian tubes are shorter, more horizontal and softer thus more collapsible

Question 4

Symptoms/Signs of Ottis Media

Answer 4

Question 5

When is Treatment indicated for Otitis Media with Effusion (OME)?

Answer 5

Children with persistent bilateral OME documented over a period of 3 months with a persistent dip in hearing as confirmed on audiometry should be considered for surgical intervention with the insertion of ventilation tubes (Grommets).

Question 6

Microbiology of Acute Otitis Media?

Answer 6

Question 7

Pathology of Acute Otitis Media leading to tympanic Membrane perforation?

Answer 7

Question 8

Treatment of Acute Otitis Media?

Answer 8

Question 9

Causes of recurrent episodic Acute Otitis Media. Treatment?

Answer 9

Question 10

Risk Factors for Chronic Suppurative Otitis Media?

Answer 10

Question 11

________________________________: a perforated tympanic with persistent drainage from the middle ear for more than 2-6 weeks. It can occur with or without __________________. The presentation of both conditions can be very similar.

Answer 11

Chronic suppurative otitis media: a perforated tympanic with persistent drainage from the middle ear for more than 2-6 weeks. It can occur with or without cholesteatoma. The presentation of both conditions can be very similar.

Question 12

________________________________: Acute Inflammation of the middle-ear cavity with infection. Commonly bilateral. Follows a U.R.T.I. either viral/bacterial.

Answer 12

Acute Otitis Media (AOM): Acute Inflammation of the middle-ear cavity with infection. Commonly bilateral. Follows a U.R.T.I. either viral/bacterial.

Question 13

There is a direct correlation between _____________________ and the progression from acute suppurative otitis media to chronic suppurative otitis media.

Answer 13

There is a direct correlation between the size of tympanic membrane perforation and the progression from acute suppurative otitis media to chronic suppurative otitis media.

Question 14

Diagnosis/Treatment of Chronic suppurative otitis media?

Answer 14

Question 15

______________________________ is a benign growth found in the nasopharynx. Any teenage boy who presents with recurrent severe epistaxis should have the presence ruled out.

Benign or Agressive?

Answer 15

Juvenile Nasopharyngeal Angiofibroma is a benign growth found in the nasopharynx. Any teenage boy who presents with recurrent severe epistaxis should have the presence of an angiofibroma ruled out.

Histologically benign but aggressive and capable of eroding bone.

Question 16

What are the following signs/symptoms indicative of?

How is this condition Treated?

Answer 16

JUVENILE ANGIOFIBROMA

Question 17

Components of Waldeyer’s ring?

Answer 17

Waldeyer’s ring of lymphoid tissue, which is a ring of lymphoid tissue in the oropharynx and nasopharynx that consists mainly of:

• the adenoids
• the palatine tonsils
• the lingual tonsils

Question 18

___________ can contribute to recurrent sinusitis and chronic persistent or recurrent ear disease because they can harbor a chronic infection. Their impact on recurrent ear disease is also likely related to ___________________.

Answer 18

Adenoids can contribute to recurrent sinusitis and chronic persistent or recurrent ear disease because they can harbor a chronic infection. Their impact on recurrent ear disease is also likely related to eustachian tube obstruction.

Question 19

________________ has improved the signs and symptoms of rhinosinusitis and has reduced the recurrence of persistent middle ear effusion in studies evaluating children older than 3 years.

What is the indication for this treatment?

Answer 19

Adenoidectomy, regardless of size of the adenoids, has improved the signs and symptoms of rhinosinusitis and has reduced the recurrence of persistent middle ear effusions in studies evaluating children older than 3 years.

Question 20

Adenoids normally regress before _______, large adenoids in adults are rare. However, if an adult has nasal obstruction due to post-nasal lymphoid tissue, _________ is essential to exclude malignancy.

Answer 20

Adenoids normally regress before puberty, large adenoids in adults are rare. However, if an adult has nasal obstruction due to post-nasal lymphoid tissue, biopsy is essential to exclude malignancy.

Question 21

Acute Tonsillitis can occur at any age but is most prevalent in children under _______, the organism which usually causes tonsillitis is ____________________.

Answer 21

Acute Tonsillitis can occur at any age but is most prevalent in children under 9, the organism which usually causes tonsillitis is Streptococcus.

Question 22

What are the following signs/symptoms indicative of?

How is this condition treated in Adults vs. Children?

Answer 22

Tonsillitis

Question 23

When is a Tonsillectomy Indicated?

Answer 23

Tonsillectomy is indicated if the frequency of tonsillitis meets following criteria:

• 7 episodes in one year
• 5 episodes per year for two years
• 3 episodes per year for three years

benefit of tonsillectomy exceeds the risks of surgery when children are getting tonsillitis at these frequencies

Question 24

Choice of Antibiotic for Severe Tonsilitis?

Answer 24

Antibiotics should be reserved for severe cases: Penicillin V as Amoxicillin can cause rash in glandular fever

Question 25

What are the following signs/symptoms indicative of? How is this condition treated?

Answer 25

**ACUTE MASTOIDITIS**: Extension of a middle ear infection into the mastoid air cell system with suppuration and bone necrosis. Acute mastoiditis occurs most frequently though not exclusively in children. _Treatment for Acute Mastoiditis_ => Admission to hospital * **IV antibiotics (Amoxicillin, Metronidazole)** * **Cortical mastoidectomy** - if there is a periosteal abscess or if the condition does not improve on antibiotic treatment. Surgery entails drilling out the mastoid air cell system in order to exenterate the disease

Question 26

**Factors making children's airway's prone to obstruction?** * Obligate _____ breathers * Large _______ relative to body size * Large ________ relative to mouth * Larynx positioned high in the neck * Laryngeal and tracheal cartilages are soft and easily compressible- extreme flexion or extension can compress the airway * Larynx _______ at top/glottis but _______ at subglottis * Lax mucosa in subglottis- predispose to __________

Answer 26

* Obligate nasal breathers * Large head/occiput relative to body size * Large tongue relative to mouth * Larynx positioned high in the neck * Laryngeal and tracheal cartilages are soft and easily compressible- extreme flexion or extension can compress airway * Larynx wider at top/glottis but narrow at subglottis ( funnel shaped) * Lax mucosa in subglottis- predispose to oedema

Question 27

Commonest cause (60%) congenital stridor in babies? * _________ X2 ____________ * Worse during ___________________ * _____________ in up to 80%- may contribute to feeding issues * Feeding difficulties, aspiration due to __________________________ * **Three main types?** * **Surgery?**

Answer 27

**LARYNGOMALCIA** * Males X2 as females * Worse during feeding, crying, supine position * GERD in up to 80%- may contribute to feeding issues * Feeding difficulties, aspiration due to uncoordinated breathing & swallowing _Three Main Types_ * Grade 1- **inward collapse arytenoid cartilages** * Grade 2- **curled tubular epiglottis** * Grade 3- **overhanging epiglottis that collapses posteriorly, obstructing laryngeal inlet on inspiration** **Surgical Intervention**: SUPRAGLOTTOPLASTY

Question 28

____________________ is a leading cause of death in children aged 1-3 years

Answer 28

**Foreign body in the airway** is a leading cause of death in children aged 1-3 years * Presents with coughing/ choking/ cyanosis/ stridor/ wheeze

Question 29

_________________________: barking cough, insp. stridor, coryzal symptoms What is it caused by? Typical Age Affected? Indication for MLB?

Answer 29

**Croup** (LARYNGOTRACHEITIS) * Parainfluenza/RSV/Adenoviruses * 6months- 3years typically * Self limiting in 5-7 days Microlaryngoscopy and bronchoscopy (MLB) indicated if: * 3 episodes of croup * Abnormal voice between episodes * History of intubation

Question 30

_______________________is an unusual congenital condition in which the anomalous configuration of the arch, associated vessels, or both surrounds the trachea and esophagus, forming a complete or incomplete ring around them. **Types?**

Answer 30

**Vascular Ring** is an unusual congenital condition in which the anomalous configuration of the arch, associated vessels, or both surrounds the trachea and esophagus, forming a complete or incomplete ring around them. * **Double Aortic Arch** * **Right Aortic Arch** with aberrant LSA & left ligamentum arteriosum

Question 31

Benign vascular tumour characterized by hyperplasia of endothelial cells, pericytes, mast cells, fibroblasts?

Answer 31

**SUBGLOTTIC HAEMANGIOMA** * cutaneous haemangioma in beard distribution * F>M * All infants symptomatic by 6mths

Question 32

What are the majority of laryngotracheal stenoses caused by? * What predisposes someone * Grading Scale?

Answer 32

**Post Intubation Injuries** are primary cause of Laryngotracheal Stenoses (SGS) _Predisposing Factors_: Ø **Patient Age**, laryngeal size & shape, systemic disease , GERD Ø **ET tube**- oversized, poor biocompatibility Ø **Intubation**- traumatic, multiple, duration Ø **Nursing**- poor patient sedation, excessive ET tube movement **Process of SGS**: Capillary mucosal perfusion pressure compromised →ischaemic necrosis→ oedema, erosions, ulceration → exposed perichondrium and cartilage **Process of repair** → granulation tissue ( provides vascualarised bed for reepithelialisation)→ excess tissue→ airway obstruction → scarring **Cotton & Meyer Grading Scale**

Question 33

_________________________: Abnormal communication between two epithelial lined surfaces. What does this represent?

Answer 33

**Fistula**: Abnormal communication between two epithelial lined surfaces. **Represent persistence of both the cleft and the corresponding pouch**

Question 34

_______: Blind ending sac, “pocket” What does this represent?

Answer 34

**Sinus**: Blind ending sac, “pocket” **Persistent pouch or sinus**

Question 35

________: Epithelial lined sac that contains a liquid or semi-solid material. Lined by: * Stratified squamous epithelium (_____________) * Columnar epithelium (____________).

Answer 35

**Cyst**: Epithelial lined sac that contains a liquid or semi-solid material. Lined by: * Stratified squamous epithelium (**ectoderm-cleft**) * Columnar epithelium (**endoderm-pouch**).

Question 36

_____________________________: * Autosomal dominant. * 1 in 40,000 births. * EYA1, SIX1 & SIX5. * Branchial cysts and sinuses. * Preauricular pits, skin tags, microtia & hearing loss. * Hypoplasia/aplasia of kidneys.

Answer 36

**Branchio-Oto-Renal syndrome** * Autosomal dominant. * 1 in 40,000 births. * EYA1, SIX1 & SIX5. * Branchial cysts and sinuses. * Preauricular pits, skin tags, microtia & hearing loss. * Hypoplasia/aplasia of kidneys.

Question 37

______________________________: * Autosomal dominant. * 1 in 500,000 births. * TCOF1. * First branchial arch. * Down sloping palpebral fissures. * Ear abnormalities. * Lower eyelid coloboma * Hearing loss * Airway difficulties.

Answer 37

**Treacher Collins Syndrome** * Autosomal dominant. * 1 in 500,000 births. * TCOF1. * First branchial arch. * Down sloping palpebral fissures. * Ear abnormalities. * Lower eyelid coloboma * Hearing loss * Airway difficulties.

Question 38

____________________________: * 1 in 2,000 births. * 22q11. * Poor prognosis. * Neural crest cell issue=> craniofacial and cardiac issues. * Hypertelorism and microstomia.

Answer 38

**Di Geroge Syndrome** * 1 in 2,000 births. * 22q11. * Poor prognosis. * Neural crest cell issue=> craniofacial and cardiac issues. * Hypertelorism and microstomia.

Question 39

_______________________________: * X-linked. * 1 in 7,500 births. * COL4A3, COL4A4 and COL4A5. * Type IV collagen. * Glomerulonephritis & hearing loss.

Answer 39

**Alport's Syndrome** * X-linked. * 1 in 7,500 births. * COL4A3, COL4A4 and COL4A5. * Type IV collagen. * Glomerulonephritis & hearing loss.