Paediatric ENT Flashcards
Who does acute otitis media affect most?
young childre.
half of kids have 3 or more episodes by 3 yrs old
causes of otitis media
viral URTI typically precede otitis media.
most secondary to bacteria:
streptococcus pneumonia, Haemophilus influenzae and Moraxella catarrhalis.
pathophysiology of otitis media if viral cause
viral URTI disturb normal nasopharyngeal microbiome
allow bacteria to infect middle ear via estuchian tube
features of otitis media
otalgia (pain in around ear) - kids tug/rub their ear
fever in 50% pts
hearing loss
recent viral URTI sx common (coryza)
ear discharge if tympanic membrane perforates.
possible otoscopy findings for otitis media
bulging tympanic membrane - loss of light reflex
opacification or erythema of tympanic membrane
perforation with purulent otorrhoea.
decreased mobility if using pneumatic otoscope
criteria for diagnosing otitis media
acute onset sx : otalgia or ear tugging
presence of middle ear effusion:
bulging of tympanic membrane or
otorrhoea
decreased mobility on pneumatic otoscopy
inflamation of tympanic membrane eg : erythema
how would you manage otitis media?
self limiting - no abx needed.
analgesia: relieve otlagia.
reattend after 3 days if sx dont resolve.
when should abx be prescribed in otitis media pt?
sx more than 4 days and no improvement
systemically unwell but not admission
less than 2 yrs with bilateral otitis media
otitis media with perforation and/or discharge in canal
immunocompromised/ high risk of comps secondary to heart,lung,kidney,liver/neuromuscular disease
if you were to give an abx for otitis media what would you give and for how long?
5-7 days course
amoxicillin 1st line
if peniciilin allergy, eryhtromycin or clarithromycin.
complications of otitis media
mastoiditis
meningitis
brain abscess
facial nerve paralysis
sequelae of otitis media (after effect)
perforation of tympanic membrane - otorrhoea :
- unresolved otitis media with perforation could lead to chronic suppurative otitis media (CSOM)
hearing loss
labryinthitis
what is CSOM
CHRONIC SUPPURATIVE OTITIS MEDIA
DEVELOPS FROM UNRESOLVED OTITIS MEDIA WITH PERFORATION OF TYMPANIC MEMBRANE
PERFORATION OF TYMPANIC MEMBRANE WITH OTORRHOEA FOR OVER 6 WEEK
What is glue ear?
otitis media with effusion.
(serous otitis media)
common with most kids having it at least once in childhood
risk factors of glue ear
male
siblings with glue ear
bottle feeding
day care attendance
parental smoking
higher chance in winter and spring
features of glue ear
peaks at 2 yrs
hearing loss presenting feature - commonest cause of conductive hearing loss and elective surgery in kids)
secondary problems eg:
speech and language delay
behaviour or balance problems
how would you manage glue ear?
actively observe - for 3 months - do nothing
grommet insetion
adenoidectomy
what does a grommet insertion do?
how long do they last?
allow air to pass through into the middle ear.
do the job of estuchian tube.
most stop working after 10mnths.
tiny tubes into tympanic membrane. allowing air/fluid from middle ear to drain through tympanic membrane to ear canal.
most common causes of deafness
ear wax
otitis media
otitis externa
presbycusis
otosclerosis
glue ear
Meniere’s disease
drug ototoxicity
acoustic neuroma
what is presbycusis?
age related sensorineural hearing loss.
pt may say difficulty following convos.
audiometry shows bilateral high frequency hearing loss.
what is otosclerosis?
autosomal dominant.
replacement of normal bone by vascular spongy bone.
onset 20-40
features:
bilateral conductive deafness
tinnitus
tympanic membrane - 10% of pts may have “flamingo tinge” caused by hyperaemia (excess blood vessels supplying an area)
positive fhx
how can drug ototoxicity cause deafness?
egs:
aminoglycosides like gentamicin
furosemide
aspirin
cytotoxic agents
how can noise damage cause deafness?
workers in heavy industry.
bilateral hearing loss
worse at frequencies of 3000-6000 hz.
briefly explain meniere’s disease
more common in middle aged adults
recurrent vertigo, tinnitus and hearing loss (sensorineural). vertigo prominent
sensation of aural fullness or pressure.
nystagmus
positive romberg test (balance)
minutes to hrs - episode
