Paediatric ENT Surgery Flashcards
Definition of otalgia
Ear ache
Definition of otorrhea
Ear discharge
What is the at risk paediatric group for otology symptoms?
S.C.B.U Family history Meningitis Perinatal sepsis - toxoplasmosis - rubella - CMV - Herpes
What are the paediatric hearing tests?
Universal neonatal screening
AOAE test
AABR test
What does the AOAE test stand for?
Automated otoacoustic emission
What does AABR stand for?
Automated auditory brainstem response
What age gets distraction tests?
6 - 18 months
What age gets Visual reforced audiometry (VRA)?
12 months - 3 years
What age gets play audiometry?
3 - 5 years
What age gets pure tone audiometry?
4+ years
How does tympanometry work?
A tympanometer creates a change in pressure in the ear canal
Peak ages to get otitis media with effusion
18/12 years and 4 years
What gender gets otitis media with effusion more?
M > F
At risk groups for OME
Day care Older siblings Parental smoking Cleft palate Downs syndrome
Symptoms of OME
Hearing loss Speech delay Behavioural problems Academic decline Imbalance
What does OME stand for?
Otitis media with effusion
Signs of OME
Dull TM
Fluid membrane
Bubbles
Causes/pathology of OME
Eustachian tube dysfunction - anatomy of skull base - muscular immaturity Adenoidal hypertrophy Resolving AOM
What reduces the risk of OME?
Breast feeding
Treatment of OME
Hearing aids
Grommet insertion
Adenoidectomy
Peak incidence of acute otitis media
3 - 18 months
What gender gets more acute otitis media?
M = F
Symptoms of acute otitis media
Short history Very painful Fever Systemic upset (sleep disturbance) Ear discharge
Causative organisms for acute otitis media
Haemophilus influenzae
Strep pneumonia
Moraxella catarrhalis
Signs of acute otitis media
Often vague
Unwell screaming child
Rubbing the ears
High fever
What is the diagnostic test for acute otitis media?
Otoscopy
Treatment for acute otitis media
Analgesia - calpol vs ibruprofen
Antibiotics - amoxycillin/coamoxiclav, erythromycin second line
How long should antibiotics be taken for in acute otitis media?
5 - 7 days
How long would a long course of antibiotics be for?
4 - 6 weeks
When would you need a long course of antibiotics for in acute otitis media?
Recurrent AOM episodes
Complications of acute otitis media
Acute mastoiditis Mastoid abscess Facial nerve palsy Ossicular/cochlear damage Labyrinthitis Chronic perforation Febrile convulsion Brain abscess Meningitis Sub/extradural empyema
Treatment for recurrent/complicated AOM
Grommet insertion
+/- Adenoidectomy
What examinations are done to investigate nasal symptoms in children?
Nasal speculum
Auriscope / otoscope
Spatula test
Nasal endoscopy
What gender of children gets epistaxis more?
M > F
Treatment of epistaxis
First air- press nose Antibiotic ointments - naseptin - Bactroban Cautery (burning) Nasal packing
Causes of nasal obstruction
Rhinitis
Adenoidal hypertrophy
Foreign body
Types of rhinitis
Allergic
Non-allergic
What would be a feature of nasal obstruction caused by a foreign body?
It would be unilateral
Treatment of nasal obstruction
Decongestants Steroids Nasal hygiene - saline douching Diathermy/reduce turbinates Adenoidectomy Correct choanal atresia
What is there a risk of with periorbital cellulitis?
Intracranial sepsis
Are nasal polyps rare or common in children?
Rare
Causes of nasal polyps in children
Chronic rhinosinusitis
Cystic fibrosis
Angiofibroma
Cause of bacterial tonsillitis
Beta haemolytic `streptococci
Treatment of acute tonsillitis
Penicillin +/- anaerobic cover Antiseptic gargle (difflam) Analgesia Drain tonsillar abscess Tonsillectomy
What antibiotics should be avoided in acute tonsillitis?
Amoxicillin
Ampicillin
What is a complication of acute tonsillitis?
Quinsy
What is a quinsy?
Peritonsillar abscess
Criteria for tonsillectomy
Recurrent tonsillitis 7 episodes >1 year Quinsy >1 Obstructive sleep apnoea Malignancy - rhabdomyosarcoma - lymphoma
Differences in a childs airway than an adults
Relative macroglossia Tonsillar hypertrophy Large epiglottis Short neck High larynx
Where is the narrowest part of a childs airway?
Subglottis
Where is the obstruction when a patient presents with a stertor?
Above larynx
Where is the obstruction when a patient presents with a stridor?
At or below larynx
What is cyanosis an extremely late sign of?
Upper airway obstruction
Causes of acute stridor
Infective (croup / epiglottis)
Foreign body
Causes of chronic stridor
Laryngomalacia
Subglottis stenosis
Vocal cord palsy
What sign on CXR is classically seen in croup?
Steeple sign
What is the commonest cause of paediatric stridor?
Laryngomalacia
Pathology of laryngomalacia
Redundancy of the tissues above the vocal cords
The redundant tissue collapses inwards during inspiration and causes turbulence of inspired air
The turbulence causes stridor
What sign may indicate a peritonsillar abscess?
Uvula deviation
