Paediatric Otorhinolaryngology Flashcards
What conditions are included under the heading otology?
- Hearing loss
- Discharging ear
- Earache
- Tinnitus
- Vertigo
How can hearing loss in children be characterised?
- Congenital vs acquired
- Unilateral vs bilateral
- Conductive vs sensorineural
What ear symptoms may be present with hearing loss?
- Pain
- Discharge
- Loss of function: hearing loss, dizziness, tinnitus
What may there be a history of with hearing loss?
- Ear symptoms
- Problems with speech development and school performance
- Behavioural problems
- Maternal perinatal infections
- Delivery issues (prematurity, anoxia)
- Neonatal infections, drugs, jaundice
- Growth delays, immunisations, passive smoking, breast vs bottle feeding
How is a 6-18 month old subjectively assessed for hearing?
Distraction test
How is a 12 month -3 year old subjectively assessed for hearing?
Visual reinforced audiometry
How is a 3-5 year old subjectively assessed for hearing?
Play audiometry
How is a 4+ year old subjectively assessed for hearing?
Pure tone audiometry
What does objective assessment of the audiometry system include?
- Otoacoustic emissions
- Auditory brain stem response
- Tympanometry
In what age group do 80% of otitis media with effusion cases occur?
Under 10s
When are the 2 peaks in age groups for otitis media with effusion?
- 2 years
- 5 years
What are the risk factors for otitis media with effusion?
- Day care
- Smoking
- Cleft palate
- Down syndrome
How is otitis media with effusion treated?
- Most improve by themselves
- Hearing aids
- Grommets
- Adenoidectomy
What are the symptoms of otitis media with effusion?
- Hearing loss
- Speech delay
- Behavioural problems
- Academic decline
- Imbalance
What are the signs of otitis media with effusion?
- Dull Tm
- Fluid level
- Bubbles
What is the aetiology of otitis media with effusion?
- Eustachian tube dysfunction either due to anatomy of the skull base of muscular immaturity
- Adenoidal hypertrophy
- Resolving A.O.M
How is otitis externa treated?
- Aural microsuction
- Topical antibiotics
- Water precautions
When is acute otitis media common?
3-18 months
How does a child with acute otitis media present?
- Short history
- Pain
- Fever
- Discharge
What is acute otitis media related to/
OME
What is the microbiology of acute otitis media?
- Haemophilus influenza
- Strep pneumonia
- Moraxella catarrhalis
How is acute otitis media treated?
- Antibiotics ( eg Co-amoxiclav)
- Grommets and adenoidectomy if recurrent
When should you suspect chronic otitis media/cholesteatoma in children?
- Chronic discharging ear
- Hearing loss despite grommets
How is cholesteatoma treated?
Mastoidectomy
What conditions are included under the heading rhinology?
- Blocked nose
- Runny nose
How often is normal for a child to present with a blocked/runny nose?
8 episodes per year lasting up to 15 days
What should be discussed in the history of a child presenting with blocked/runny nose?
- Nasal symptoms
- History of foreign body
- Feeding
- Snoring, quality of sleep
What nasal symptoms may be present in a child with blocked/runny nose?
- Pain
- Discharge
- Loss of function: blocked nose, sense of smell
How can rhinitis be classified?
Allergic vs non allergic
How is rhinitis diagnosed?
Allergen tests (IgE)
How is rhinitis treated?
- Nasal douching
- Antihistamines
- Nasal steroids
If a child has large adenoids, what should you check for?
Sleep apnoea
How does a foreign body in the nose present?
Unilateral
What does a foreign body in the nose require?
EUA
How can sinusitis be characterised?
Acute vs chronic
Sinusitis and polyps have overlapping symptoms with…
Rhinitis/large adenoids
What condition is sinusitis and polyps associated?
Cystic fibrosis
What is the incidence of choanal atresia?
1 in 6000-8000 births
How does bilateral choanal atresia manifest?
Unable to breathe
What is the prevalence of epistaxis?
- Common
- M>F
What should be considered with epistaxis?
Coagulopathy/ haematological abnormality
How should epistaxis be managed?
- Appropriate first aid
- Antibiotic ointments
- Cauterise
- Nasal packing
What antibiotic ointments can be used in the treatment of epistaxis?
- Naseptin
- Bactroban
How can cauterisation be carried out for epistaxis?
- Silver nitrate under local anaesthetic
- Diathermy under general anaesthetic
What conditions come under the heading laryngology?
- Sore throat
- Airway issues
What should be discussed in the history of a child with a sore throat?
- Throat symptoms
- Snoring
- Drooling
What throat symptoms may a child with a sore throat present with?
- Pain (odynophagia, ear ache)
- Discharge (cough)
- Loss of function (dysphagia, breathing problems, hoarse voice)
What should be examined when a child presents with a sore throat?
- Throat
- Neck
- Ears and nose
What are the 2 types of tonsillitis?
- Bacterial caused by B haem strep B
- Viral caused by EBV
With tonsillitis , what is there a risk of?
Glomerulonephritis
What is the treatment for tonsillitis?
- Supportive
- Antibiotics
What is a complication of tonsillitis?
Quinsy- peritonsillar abscess
What are the characteristics of a child’s head and neck anatomy?
- Large tongue
- Large tonsils
- Large epiglottis
- Short neck
- Sub glottis narrowest
How does a child with airway issues usually present?
As an emergency but it can be chronic
What is there usually a history of with a child with an airway issue?
- Foreign body
- Recent illness
- Feeding problems
- Stridor particularly inspiratory
What are causes of airway issues in children?
- Foreign body
- Epiglottitis
- Laryngomalacia
What are common neck lumps in children?
- Thyroglossal cyst
- Branchial cyst
- Cystic hygroma
- Cervical lymphadenopathy
