PAEDIATRIC ENT Flashcards
Risk Factors of Otitis Media?
____________________________: Chronic mucosal inflammation leads to disorganised de-differentiation into thickened pseudo-stratified epithelium with subsequent mucus retention
OTITIS MEDIA WITH EFFUSION (OME): Chronic mucosal inflammation leads to disorganised de-differentiation into thickened pseudo-stratified epithelium with subsequent mucus retention
Why are children more prone to Middle Ear Disease?
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
Symptoms/Signs of Ottis Media
When is Treatment indicated for Otitis Media with Effusion (OME)?
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).
Microbiology of Acute Otitis Media?
Pathology of Acute Otitis Media leading to tympanic Membrane perforation?
Treatment of Acute Otitis Media?
Causes of recurrent episodic Acute Otitis Media. Treatment?
Risk Factors for 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 __________________. The presentation of both conditions can be very similar.
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.
________________________________: Acute Inflammation of the middle-ear cavity with infection. Commonly bilateral. Follows a U.R.T.I. either viral/bacterial.
Acute Otitis Media (AOM): Acute Inflammation of the middle-ear cavity with infection. Commonly bilateral. Follows a U.R.T.I. either viral/bacterial.
There is a direct correlation between _____________________ and the progression from acute suppurative otitis media to chronic suppurative otitis media.
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.
Diagnosis/Treatment of Chronic suppurative otitis media?
______________________________ 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?
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.
What are the following signs/symptoms indicative of?
How is this condition Treated?
JUVENILE ANGIOFIBROMA
Components of Waldeyer’s ring?
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
___________ 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 ___________________.
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.
________________ 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?
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.
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.
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.
Acute Tonsillitis can occur at any age but is most prevalent in children under _______, the organism which usually causes tonsillitis is ____________________.
Acute Tonsillitis can occur at any age but is most prevalent in children under 9, the organism which usually causes tonsillitis is Streptococcus.
What are the following signs/symptoms indicative of?
How is this condition treated in Adults vs. Children?
Tonsillitis
When is a Tonsillectomy Indicated?
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
Choice of Antibiotic for Severe Tonsilitis?
Antibiotics should be reserved for severe cases: Penicillin V as Amoxicillin can cause rash in glandular fever
What are the following signs/symptoms indicative of?
How is this condition treated?
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
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 __________
- 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
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?
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
____________________ is a leading cause of death in children aged 1-3 years
Foreign body in the airway is a leading cause of death in children aged 1-3 years
- Presents with coughing/ choking/ cyanosis/ stridor/ wheeze
_________________________: barking cough, insp. stridor, coryzal symptoms
What is it caused by?
Typical Age Affected?
Indication for MLB?
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
_______________________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?
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
Benign vascular tumour characterized by hyperplasia of endothelial cells, pericytes, mast cells, fibroblasts?
SUBGLOTTIC HAEMANGIOMA
- cutaneous haemangioma in beard distribution
- F>M
- All infants symptomatic by 6mths
What are the majority of laryngotracheal stenoses caused by?
- What predisposes someone
- Grading Scale?
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
_________________________: Abnormal communication between two epithelial lined surfaces.
What does this represent?
Fistula: Abnormal communication between two epithelial lined surfaces.
Represent persistence of both the cleft and the corresponding pouch
_______: Blind ending sac, “pocket”
What does this represent?
Sinus: Blind ending sac, “pocket”
Persistent pouch or sinus
________: Epithelial lined sac that contains a liquid or semi-solid material. Lined by:
- Stratified squamous epithelium (_____________)
- Columnar epithelium (____________).
Cyst: Epithelial lined sac that contains a liquid or semi-solid material. Lined by:
- Stratified squamous epithelium (ectoderm-cleft)
- Columnar epithelium (endoderm-pouch).
_____________________________:
- 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.
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.
______________________________:
- Autosomal dominant.
- 1 in 500,000 births.
- TCOF1.
- First branchial arch.
- Down sloping palpebral fissures.
- Ear abnormalities.
- Lower eyelid coloboma
- Hearing loss
- Airway difficulties.
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.
____________________________:
- 1 in 2,000 births.
- 22q11.
- Poor prognosis.
- Neural crest cell issue=> craniofacial and cardiac issues.
- Hypertelorism and microstomia.
Di Geroge Syndrome
- 1 in 2,000 births.
- 22q11.
- Poor prognosis.
- Neural crest cell issue=> craniofacial and cardiac issues.
- Hypertelorism and microstomia.
_______________________________:
- X-linked.
- 1 in 7,500 births.
- COL4A3, COL4A4 and COL4A5.
- Type IV collagen.
- Glomerulonephritis & hearing loss.
Alport’s Syndrome
- X-linked.
- 1 in 7,500 births.
- COL4A3, COL4A4 and COL4A5.
- Type IV collagen.
- Glomerulonephritis & hearing loss.
