Paediatric ENT Flashcards
Pathophysiology of otitis media
common bacterial causes
viral urti typically precede it, most infections are secondary to bacteria: streptococcus pneumonia, haemophilus influenzae, moraxella catarrhalis, staph aureus
viral urti disturb normal nasopharyngeal microbiome.
allow bacteria to infect middle ear via estuchian tube
features of otitis media
otalgia - tug/rub their ear
fever 50% of cases
hearing loss in affected ear.
recent viral urti sx (coryza, sore throat)
ear discharge if TM perforates
if infection affects vestibular system, balance issues and vertigo.
if tm perforated: discharge from ear.
what is otoscopy
possible otoscopy findings of otitis media
visualise TM - PULL PINNA UP AND BACKWARDS.
bulging tympanic membrane - loss of light reflex
opacification or erythema of TM
perforation with purulent otorrhoea
decreased mobility if using pneumatic otoscope
how would you manage otitis media?
usually self-limiting doesnt require abx.
analgesia.
if dont improve after 3 days. then give abx.
younger than 2 with bilateral OM. perforation/discharge in canal, systemically unwell , immunocompromised:
5-7 day 1st line - amoxicillin - if allergy erythromycin/clarithromycin.
sequelae of otitis media
perforation of TM = otorrhoea - unresolved with acute otitis media with perforation develops into chronic suppurative - perforation of tm with otorhoea for over 6 weeks.
hearing loss
labrynthitis
complications of otitis media
mastoiditis
meningitis
brain abscess
facial nerve paralysis
What is glue ear?
risk factors
otitis media with effusion. middle ear gets full of fluid so you get hearing loss
male
siblings with glue ear
winter and spring
bottle feeding
day care
parental smoking
features of glue ear
peak at 2 yrs old
hearing loss presenting feature
secondary problems: speech and language delay, behavioural or balance problems
how would you treat glue ear?
what are grommets?
observe: for 3 months no intervention
refer for audiometry - see extent of hearing loss
grommets : allows air to pass through into middle ear. do the job of estuchian tube. stop working after 10 months . if downs or cleft palate. under general anaesthetic. allows fluid from middle ear to drain through TM to ear canal.
adenoidectomy
what is the estuchian tube
connects middle ear to back of throat.
drains secretions from middle ear.
what will otoscopy show for glue ear?
dull tympanic membrane with air bubbles or visible fluid level.
causes of hearing loss
congenital
perinatal
after birth
congenital :
maternal rubella or cytomegalovirus infection during pregnancy
associated syndromes like downs
genetic deafness - autosomal recessive/dominant
perinatal:
- prematurity
- hypoxia during or after birth
after birth:
- jaundice
- meningitis and encephalitis
- otitis media or glue ear
-chemotherapy
what is the uk newborn hearing screening programme (nhsp)?
hearing test all neonates.
equipment delivers sound to each eardrum individually and checks for response. identifies congenital hearing problems early.
how to manage hearing loss?
speech and language therapy
educational psychology
ent specialist
hearing aids for children who retain some hearing
sign language
what is audiometry?
younger children - under 3 tested by looking for basic response to sound.
older children : test with headphones, specific tones and volume.
results of this recorded on audiogram - help identify and differentiate conductive and sensorineural hearing loss.
