Paediatric Otorhinolaryngology Flashcards
What are some reasons for hearing loss?
Congenital or acquired
Unilateral vs Bilateral
Conductive or sensorineural
What can be included in the history of child with hearing loss?
Ear symptoms - pain, discharge, loss of function
Speech development and school performance
Behavioural issues, Delivery issues, neonatal infections, growth, passive smoking, bottle feeding
How is a child assessed for hearing loss - subjective assessment of hearing?
Distraction test - 6-18 months
Visual reinforced audiometry - 12 months
Play audiometry - 3-5 years
Pure tone audiometry
How is a child assessed for hearing loss - objective assessment?
Otoacoustic emissions - all children when born
Auditory brain stem responses - looks at nerve function
Tympanometry - checks pressure of middle ear
What are the risk factors of otitis media with effusion/ glue ear?
Day care, smoking, cleft palate and down syndrome
What is the treatment of otitis media with effusion?
Is self limiting - so most improve by themselves
Treat with hearing aids or grommets and adenoidectomy
What the symptoms of otitis media with effusion?
Hearing loss, speech delay, behavioural problems and academic decline
What are the signs of otitis media with effusion?
Dull tympanic membrane
Fluid level and bubbles seen
Describe the aetiology of otitis media with effusion
Eustachian tube dysfunction - anatomy of skull base and muscular immaturity
Adenoidal hypertrophy
Resolving AOM
What is the treatment for otitis externa?
Aural micro-suction
Topical antibiotics
Water precautions
What is the common microbiology for acute otitis media?
Haemophilus influenza
Strep pneumonia
Moraxella catarrhalis
What is the treatment for acute otitis media?
Treat with antibiotics - co-amoxiclav
Grommets and adenoidectomy if recurrent
What is the treatment for chronic otitis media?
Requires mastoidectomy
Also topical steroids
What are the main symptoms of rhinology?
Blocked nose and runny nose
What is included in history of child with blocked/ runny nose?
Nasal symptoms - pain, discharge, loss of function - smell
History of foreign body
Feeding
Snoring and quality of sleep
What examinations are needed for child with blocked or runny nose?
Otoscope
Metal tongue depressor - misting
Rigid endoscopy - older children
What is treatment for rhinitis?
Check if allergic or non-allergic
Allergen tests done (IgE)
Nasal douching, antihistamines and nasal steroids
Describe sinusitis and polyps in children
Is rare. Can think of CF - association
Overlapping symptoms with rhinitis/ large adenoids
Acute sinusitis or chronic
What is epistaxis?
Nosebleeds
Common, more males
Due usually to digital trauma
Consider coagulopathy or haematological abnormality
Where is the most common area for nosebleeds to happen from?
Little’s area
What is the management for epistaxis?
Appropriate first aid
Antibiotic ointments - Naseptin and Bactroban
Cautery - silver nitrate under LA and diathermy under GA
Nasal packing
What symptoms are in laryngology?
Sore throat
Airway issues - stridor
Describe tonsillitis
Inflammation of tonsils
Can be bacterial - strep. B or viral - EBV
Risk of glomerulonephritis
Supportive management and antibiotics for bacterial infection
What are some anatomic and physiological causes for airway obstruction in children?
Large tongue, large tonsils, large epiglottis, short neck, sub glottis narrowest
What is included in history of child with airway issues?
Usually an emergency
Foreign body, recent illness, feeding problems, stridor on inspiratory
What is management for child with airway issues?
Blocks the airway
Need to intubate early
IV antibiotics and steroids
Describe laryngomalacia
Laryngeal cartilages are soft - inward collapse of airways
Don’t usually need to treat
If breathing or feeding problems then can open up cartilages
What are some causes of neck lumps?
Thyroglossal duct cyst
Branchial cyst
Cystic hygroma
Cervical lymphadenopathy
