Paediatric ENT

Question 1

what is otitis media?

Answer 1

middle ear infection.

very common in young kids, half of kids will have 3 or more episodes by 3.

Question 2

pathophysiology of acute otitis media

Answer 2

although viral urti precede otitis media, most infections are secondary to bacteria:
streptococcus pneumonia
haemophilus influencae
moraxella catarrhalis

virual urti disturb normal nasopharyngal microbiome, so bacteria infects the middle ear via the eustachian tube

Question 3

features of otitis media

Answer 3

otalgia - ear pain - kids may tug/rub their car

fever occurs in 50% of cases

hearing loss

recent viral URTI symptoms are common (coryza)

ear discharge may occur if tympanic membrane perforates

Question 4

possible OTOSCOPY findings - otitis media

Answer 4

bulging tympanic membrane - loss of light reflex

opacification or erythema of tympanic membrane

perforation with purulent otorrhea

decreased mobility if using a pneumatic otoscope

Question 5

criteria for diagnosing otitis media

Answer 5

acute onset symptoms - otalgia or ear tugging

presence of middle ear effusion - bulging of tympanic membrane or otorrhoea, decreased mobility on pneumatic otoscopy

inflammation of the tympanic membrane : erythema

Question 6

how would you manage otitis media?

Answer 6

dont need abx. self limiting.

analgesia

seek med help if not improved in 3 days.

Question 7

in what situation would you give abx for otitis media?

Answer 7

symptoms over 4 days not improving

systemically unwell

immunocompromised or high risk of comps secondary to significant heart,lung,kidney,liver or neuromuscular disease

under 2 with bilateral otitis media

otitis media with perforation and/or discharge in canal

Question 8

what abx would you give if you decided to for otitis media?

Answer 8

5-7 day course of amoxicillin 1st line.

if allergy: erythromycin or clarithromycin

Question 9

sequelae (conditions that happen as a consequence) of otitis media

Answer 9

hearing loss
labrynthitis
perforation of tympanic membrane - otorhea
- unresolved with acute otitis media with perforation might develop into chornic suppurative otitis media (CSOM) which is perforation of tympanic membrane with otorrhoea for over 6 weeks.

Question 10

complications of otitis media

Answer 10

mastoiditis
meningitis
brain abscess
facial nerve paralysis

Question 11

what is glue ear?

Answer 11

otitis media with an effusion.

common in kids

Question 12

risk factors of glue ear

Answer 12

male sex
siblings with glue ear
winter and spring more likely
bottle feeding
day care attendance
parental smoking

Question 13

features of glue ear

Answer 13

peaks at age 2
hearing loss usually presenting feature

secondary problems like speech and language delay, behavioural or balance problems may be seen

Question 14

treatment of glue ear

Answer 14

active observation for 3 months

grommet insertion - allows air to pass through into middle ear - basically do the job of the eustachian tube.
majority stop functioning after 10 months.

adenoidectomy

Question 15

most common causes of deafness

Answer 15

ear wax
otitis media/externa
glue ear
presbycusis - age related sensorineural hearing loss. difficult following convo. audiometry shows bilateral high frequency hearing loss.

otosclerosis - autosomal dominant. 20-40yr old. replaced normal bone by vascular spongy bone.

meniere’s disease
drug ototoxicity

acoustic neuroma

noise damage - heavy industry. bilateral loss - worse at 3000-6000hz

Question 16

features of oterosclerosis

Answer 16

autosomal dominant

replacement of normal bone by vascular spongy bone.

onset usually at 20-40 yrs.

conductive deafness
tinnitus
tympanic membrane - 10% of patients may have a “flamingo tinge” , caused by hyperaemia (excess of blood in vessels)