Paediatric ENT - Otology

Question 1

What important consideration should we think of when examining an ENT problem?

Answer 1

Always examine all the regions.

If they have through pain dont just examine the throat, do the nose and ears as well

Question 2

What might you pick up on in a kids history that would indicate hearing problems?

Answer 2

• Well…Ear symptoms
• Poor speech development
• Problems at school
• Behavioural Problems

Neonatal infections or maternal infections
Delivery issues such as being a premature baby or anoxia

Question 3

Assessment of hearing lost

Answer 3

Subjective e.g. audiometry

Objective e.g. Otoacoustic Emissions, Auditory brainstem response & tympanometry

Question 4

Children tend not to be compliant with conventional hearing tests.
What subjective tests can we use?

Answer 4

6-18 months = Distraction Test
1-3yrs = Visual Reinforced Audiometry
3-5yrs = Play Audiometry
4+ yrs = Pure tone audiometry like an adult

Question 5

What objective hearing tests can we use on children?

Answer 5

• Otoacoustic Emissions (measures a sound produced by the inner ear during hearing, hearing loss reduces the OAEs)
• Tympanometry (measures inner ear pressure)
• Auditory Brain Stem Response

Question 6

Common Paediatric Otology conditions

Answer 6

• Otitis Media with Effusion (Glue ear)
• Otitis Externa
• Acute Otitis Media
• Chronic Otitis Media

Question 7

What are the peak ages for Glue Ear?

Answer 7

2 and 5 yrs

80% have occured by age 10

Question 8

What are the risk factrs for glue ear?

Answer 8

Day Care
Smoking
Cleft Paalte
Down Syndrome

Question 9

What causes Glue ear?

Answer 9

• Dysfunction of the Eustachian Tube (Either due to messed up skull base or muscular immaturity)
• Adenoid Hypertrophy
• Resolving Acute Otitis Media

Question 10

Presentation of otitis media with effusion

Answer 10

• Hearing Loss
• Speech Delay
• Behavioural Problems
• Academic Decline

Signs on the Tympanic Membrane:

• Dull
• Visible Fluid level
• Bubbles

Question 11

How do we treat otitis media with effusion?

Answer 11

Grommet:

• Most common
• Works itself out in ~1yr as the TM heals over

Autoinflation

Adenoidectomy

Hearing Aid

Question 12

What causes otitis externa and how do we treat it?

Answer 12

Bacterial- Pseudomonas aeruginosa or Staphylococcus aureus

Fungal infection- Candida Albicans/ Aspergillus
Foreign Body
Allergy
Dermatitis

Treat it with:

• Aural Microsuction
• Topical Antibiotics
• Water Precautions (prevent it getting wet)

Question 13

When is acute otitis media most common?

Answer 13

In the 3-18 months

Question 14

How does acute otitis media present?

Answer 14

• Pain
• Fever
• Discharge

Short History of the above

Question 15

What are some complications of acute otitis media

Answer 15

Perforation of the Tympanic Membrane. (keep it dry and treat infection)

Brain Abscess

Question 16

Infective causes of Acute Otitis Media

Answer 16

• Haemophilus Influenzae
• Strep Pneumonia
• Moraxella Catarrhalis

Question 17

How do we treat acute otitis media?

Answer 17

With antibiotics or rest

If its recurrent:
Grommet & Adenoidectomy

Question 18

What causes chronic otitis media?

Answer 18

Usually a Cholesteatoma or a perforated ear drum.

Question 19

How do we treat a cholesteatoma

Answer 19

A mastoidectomy

Involves clearing out some of the mastoid air cells and parts of the middle ear