Paediatric ENT Flashcards
What three things must you distinguish when presented with a child who has hearing loss?
Congenital vs acquired
Unilateral vs bilateral
Conductive vs sensorineural
List the subjective assessments of hearing loss
6-18 months: distraction test
12 months - 3 years: visual reinforced audiometry
3-5 years: play audiometry
5 years+ : pure tone audiometry
List the objective assessment of the auditory system
Otoacoustic emissions (all newborns have this screening hearing test)
Auditory brainstem response
Tympanometry (middle ear pressure)
What is the most common cause for hearing loss in children?
Otitis media with effusion
What are the risk factors for OM with effusion?
Infections at day care, smoking, cleft palate, Downs syndrome
What is the treatment for OM with effusion?
Most resolve spontaneously
Hearing aids/grommits and adenoidectomy
What are the signs and symptoms of OM with effusion?
Symptoms - hearing loss, speech delay, behavioural problems, academic decline, imbalance
Signs - dull tympanic membrane, fluid bubbles
What is the cause of OM with effusion?
Eustachian tube failure
Muscular immaturity
Adenoidal hypertrophy
Resolving acute OM
What is otitis externa?
Discharging ear caused by inflammation around the external auditory canal
What is the treatment for otitis externa?
Aural micro suction (drain and clean)
Topical antibiotics
Water precautions (keep it dry)
What are the principle microbes responsible for causing acute OM?
H. influenzae, strep pneumoniae, moraxella catarrhalis
How is acute OM treated?
Co-amoxiclav
Grommets/ Adenoidectomy if recurrent
What are the symptoms of acute OM?
Pain, fever, discharge
What are the complications of acute OM?
Mastoiditis leading to brain abscess
What is chronic OM and how is it treated?
Recurrent/persistent infection of middle ear caused, most commonly, by cholesteatoma.
Treated with mastoidectomy (open antrum and clean out)
What are the clinical features of chronic OM?
Chronic discharge and hearing loss despite grommets in place
What is the normal development time to aeration of the sinuses in children?
Ethmoids/maxillary: 0-4 months
Sphenoid: 3-7 years
Frontal: 8 years to adolescence
When should you be suspicious of a foreign body in the nose?
Unilateral discharge
What is choanal atresia?
Congenital bilateral blockage of the nasal passage
What is the treatment for non-acute tonsillitis?
Viral - symptomatic treatment
Bacterial - 24hrs IV antibiotics if persistent
What is the treatment for acute tonsillitis?
Difficulty to breath requires steroids and IV antibiotics
What complications can occur from tonsillitis?
Peritonsilar abscess (quincy)
What is laryngomalacia?
Congenital condition caused by collapsing of soft immature cartilage of epiglottis so when they breath it obstructs the airway
What is the treatment for larygnomalacia?
Normally maintain saturation and eat well so just let them grow out of it (2/3 years)
