Paediatric ENT - Laryngology

Question 1

What causes most sore throats? [1]

Answer 1

Tonsilitis

Question 2

Explain the microorganisms causing tonsilitis (bacterial and viral) [2]

Answer 2

If bacterial - Most likely Beta Haemolytic Strep (e.g. Strep Pyogenes)

If Viral - Most likely EBV (Epstein Barr)

Question 3

What are the major complciations of tonsillitis? [2]

Answer 3

Quinsy - A peritonsillar Abscess

Glomerulonephritis - due to strep spread

Question 4

How do we treat quinsy? [2]

Answer 4

Needle aspiration and drainage

Antibiotics

Question 5

How do we treat tonsillitis? [2]

Answer 5

Supportive Care

PENICILLIN V 250mg or ERYTHROMYCIN for 7-10d NEVER give amoxicillin or ampicillin as causes maculopapular rash

Question 6

What makes children more prone to airway issues than adults? [3]

Answer 6

• Short neck
• Narrow Subglottic Issues
• Larger tongue, tonsils and epiglottis relative to rest of airway

Question 7

What would you expect to see in the history of a child with laryngeal airway problems? [4]

Answer 7

• History of Foreign Body
• Recent Illness
• Stridor (Inspiratory)
• Feeding Issues

Question 8

List some issues that can cause paediatric laryngeal problems [3]
What are the types of neck lumps you can see in children [4]

Answer 8

Epiglottitis
Laryngomalacia
Neck Abscess
Lumps:
 - Thyroglossal cyst
 - Branchial Cyst
 - Cystic Hygroma
 - Cervical Lymphadenopathy

Question 9

What is a cystic Hygroma? [2]

Answer 9

Large cyst like cavities [1]of lymphatic tissue, contains lymph [1]

Question 10

How do we manage epiglotitis? [3]

Answer 10

Airway support

IV Abx +/- Steroids

Question 11

What is laryngomalacia? [2]

Cause [1]

Answer 11

Congenital softening of the tissues of the larynx

Cause: Poor/late development of the laryngeal cartilages.

Question 12

How do we handle laryngomalacia? [1]

Answer 12

If its not causing them problems we leave it as the cartilage usually develops eventually.

Question 13

Indications for tonsillectomy [4]

Answer 13

• Sore throats due to tonsillitis (NOT URTIs)
• > 5 episodes tonsillitis/y
• Symptoms have been occurring for at least 1y
• Episodes of sore throat disabling and prevent normal functioning

Question 14

Complications of tonsillectomy
Primary [2]
Secondary [2]

Answer 14

Primary
- haemorrhage in 2-3% (most commonly due to inadequate haemostasis; mx is immediate return to theatre), pain
Secondary:
- haemorrhage (most commonly due to infection; mx is IV abx), pain