Paediatric ENT

Question 1

What three things must you distinguish when presented with a child who has hearing loss?

Answer 1

Congenital vs acquired
Unilateral vs bilateral
Conductive vs sensorineural

Question 2

List the subjective assessments of hearing loss

Answer 2

6-18 months: distraction test
12 months - 3 years: visual reinforced audiometry
3-5 years: play audiometry
5 years+ : pure tone audiometry

Question 3

List the objective assessment of the auditory system

Answer 3

Otoacoustic emissions (all newborns have this screening hearing test)

Auditory brainstem response

Tympanometry (middle ear pressure)

Question 4

What is the most common cause for hearing loss in children?

Answer 4

Otitis media with effusion

Question 5

What are the risk factors for OM with effusion?

Answer 5

Infections at day care, smoking, cleft palate, Downs syndrome

Question 6

What is the treatment for OM with effusion?

Answer 6

Most resolve spontaneously

Hearing aids/grommits and adenoidectomy

Question 7

What are the signs and symptoms of OM with effusion?

Answer 7

Symptoms - hearing loss, speech delay, behavioural problems, academic decline, imbalance

Signs - dull tympanic membrane, fluid bubbles

Question 8

What is the cause of OM with effusion?

Answer 8

Eustachian tube failure
Muscular immaturity
Adenoidal hypertrophy
Resolving acute OM

Question 9

What is otitis externa?

Answer 9

Discharging ear caused by inflammation around the external auditory canal

Question 10

What is the treatment for otitis externa?

Answer 10

Aural micro suction (drain and clean)

Topical antibiotics

Water precautions (keep it dry)

Question 11

What are the principle microbes responsible for causing acute OM?

Answer 11

H. influenzae, strep pneumoniae, moraxella catarrhalis

Question 12

How is acute OM treated?

Answer 12

Co-amoxiclav

Grommets/ Adenoidectomy if recurrent

Question 13

What are the symptoms of acute OM?

Answer 13

Pain, fever, discharge

Question 14

What are the complications of acute OM?

Answer 14

Mastoiditis leading to brain abscess

Question 15

What is chronic OM and how is it treated?

Answer 15

Recurrent/persistent infection of middle ear caused, most commonly, by cholesteatoma.

Treated with mastoidectomy (open antrum and clean out)

Question 16

What are the clinical features of chronic OM?

Answer 16

Chronic discharge and hearing loss despite grommets in place

Question 17

What is the normal development time to aeration of the sinuses in children?

Answer 17

Ethmoids/maxillary: 0-4 months
Sphenoid: 3-7 years
Frontal: 8 years to adolescence

Question 18

When should you be suspicious of a foreign body in the nose?

Answer 18

Unilateral discharge

Question 19

What is choanal atresia?

Answer 19

Congenital bilateral blockage of the nasal passage

Question 20

What is the treatment for non-acute tonsillitis?

Answer 20

Viral - symptomatic treatment

Bacterial - 24hrs IV antibiotics if persistent

Question 21

What is the treatment for acute tonsillitis?

Answer 21

Difficulty to breath requires steroids and IV antibiotics

Question 22

What complications can occur from tonsillitis?

Answer 22

Peritonsilar abscess (quincy)

Question 23

What is laryngomalacia?

Answer 23

Congenital condition caused by collapsing of soft immature cartilage of epiglottis so when they breath it obstructs the airway

Question 24

What is the treatment for larygnomalacia?

Answer 24

Normally maintain saturation and eat well so just let them grow out of it (2/3 years)

Question 25

What is a branchial cysts?

Answer 25

A cyst formed from epithelial tissue of the lateral neck

Question 26

What is cystic hygroma?

Answer 26

Left posterior triangle of the neck - blockage of lymphatic drainage leading to cyst formation