Paediatric ENT Flashcards
What is the most common cause of tonsillitis
-> viral infection : EBV
What is the most common cause of bacterial tonsilitis
-> Group A strep (streptococcus pyogenes) : treated with penicillin V for 10 days
-> Clarithromycin if penicllin allergy
What is used to estimate the probability that tonsitilits is due to a bacterial infection
FeverPain score
- Fever in previpus 24 hrs
- P : purulence on the tonsils
- A : attened within 3 days of symptom onset
- I : inflamed tonsils
- N : no cough or coryza
4-5 = 62-65% probablility of bacterial tonsilitis
What is the most common bacterial cause of otitis media and what is it ?
- > Streptococcus pneumoniae
- > Infection of the middle ear
How does otitis media commonly present ?
-Ear pain +/- sore throat
-Reduced hearing
-Preceding viral URTI : fever, cough, coryzal symptoms, sore throat
-Otoscopy : red, inflamed, bulging tymopanic membrane -> loss of light reflex
What is glue ear and how is present and how does does it look when using an otoscopy ?
-> Otitis media with effusion
- > Fluid build up in the middle ear due to blockage of the eustachian tube
- > Reduction in hearing
- > Dull / cloudy tympanic membrane with air bubbles or visual fluid level
What is a complication of tonsilitis
Peritonsillar abscess (quincy)
Hx suggest tonsilitis
Uvular deviation
Tonsillar bulge
Trismus = unable to open mouth
Change in voice = ‘hot potato voice’
Quincy
Referral to ENT
Incision and drainage of abscess
Abx : co-amoxicla and dexamethosone
What are 2 complications of otitis media
- Acute mastoiditis : tender, boggy swelling behind ear
- Intracranial abscess
How would otitis media with effusion present
- Smelly or gunky discharge from the ear + hearing loss
- Grey tympanic membrane
- Loss of cone light reflex
- Visible fluid behind tympanic membrane
= glue ear, peaks at 2 yrs
How is otitis media with effusion managed
- Urgent referral
- Hearing formally tested
- Managed with Grommet insertion
what 2 conditions would require urgent ENT referral if they present with recurrent otitis media ?
- Cleft palate
- Down’s syndrome
give 5 risk factors for glue ear
male
siblings with glue ear
bottle feeding
nursery
parental smoking
How is glue ear managed
Grommet insertion
Give 7 complications of tonsilitis
- Chronic tonsillitis
- Quinsy
- Otitis media
- Scarlet fever
- Rheumatic fever
- Post-streptococcal glomerulonephritis
- Post-streptococcal reactive arthritis
when are antibiotics given for acute otitis media ?
- 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
- Younger than 2 years with bilateral otitis media
- Otitis media with perforation and/or discharge in the canal
what is the Abx treatment of otitis media when required ?
- > 5-7 day course amoxacillin
- > Erythromycin or clarithryomycin if penicillin allergy
Give 3 congenital causes of hearing loss
- Maternal rubella or cytomegalovirus infection during pregnancy
- Genetic deafness
- Associated syndromes, for example Down’s syndrome
Give 2 perinatal and 4 postnatal causes of hearing loss
- > Perinatal = prematurity, hypoxia during or after birth
- > Postnatal = jaundice, meningitis and encephalitis, otitis media or glue ear, chemotherapy
what is the most likley location of the bleeding in epistaxis in children
Little’s area (Kiesselbach’s plexus)
When would admission to hospital be considered for epistaxis ?
- Doesn’t stop after 10-15 mins
- Severe
- Bilateral
- Management : nasal packing, nasal cautery with silver nitrate stick
what is given post treatment for epistaxis ?
- Naseptin 4x daily for 10 days
- Reduce crusting, inflammation and infection
- CI in peanut or soya allergy
what is tongue tie ?
- > Baby is born with short and tight lingual frenulum (attachment of tongue to floor of mouth)
- > Makes it hard for them to latch onto breast
What is a cystic hygroma amnd where are they most commonly found ?
- Malformation of lymphatic system = cyst filled with lymphatic fluid
- Typically located in posterior triangle of neck on left hand side
How do cystic hygromas present and how can they be managed if necessary ?
- Can be very large
- Are soft
- Are non-tender
- Transilluminate
- Aspiration, surgical removal, sclerotherapy
What are the key features of a thyroglossal cyst ?
- Mobile, non tender, soft, fluctuant swelling in the midline of the neck
- MOVE UP AND DOWN WITH TONGUE MOVEMENT
How are thyroglossal cysts confirmed and then managed ?
- USS or CT
- Surgically removed
What is the common presentation of a brachial cyst ?
- Pt >10 yrs
- Round, soft, cystic swelling between the angle of the jaw and the sternocleidomastoid muscle of the anterior triangle
- Do not transluminate
Where is the most likely origin of a brachial cyst ?
Second brachial cleft
What are the indications for a tonsillectomy ?
7 or more in 1 year
5 per year for 2 years
3 per year for 3 years
What is the most significant complication of a tonsillectomy and when would you immediately return to theatre
- Post tonsillectomy bleeding.
- Primary bleeding (within 24 hrs).
what are the two options for stopping severe bleedings from a tonsillectomy prior to going back to theatre
Hydrogen peroxide gargle
Adrenalin soaked swab applied topically
What is a secondary haemorrhage following a tonsillectomy and how is it managed ?
- Occurs between 5 and 20 days after surgery
- Treatment with admission and antibiotics.
Management of a child with their first presentation of glue ear
Active observation for 3 mnths
Management of glue ear in a pt with a background of Down’s syndrome or cleft palate
Refer to ENT
Presentation of mastoiditis
- Fever
- Patient is typically very unwell
- Swelling, erythema and tenderness over the mastoid process
- External ear may protrude forwards
- Ear discharge may be present if the eardrum has perforated
Management of mastoiditis
IV antibiotics
When would a child without a background of Down’s or cleft palate be referred to ENT for glue ear ?
Persisting significant hearing loss on two separate occasions (usually 6-12 wks apart)
