Paediatrics - ENT Flashcards
What are examples of otological conditions?
Hearing loss
Otorrhea
Otalgia
Tinnitus
Vertigo
What are important considerations for diagnosing child with hearing loss cause?
Congenital vs acquired
Unilateral vs bilateral
Conductive vs sensorineural
What is commonly seen in the history of child with hearing loss?
Ear symptoms
Pain
Discharge
Loss of function (hearing loss, dizziness, tinnitus)
Speech development, school performance
Behaviour problems
Maternal perinatal infections
Delivery issues
Neonatal infections, drugs, jaundice
What are common ear symptoms in hearing loss in children?
Ear symptoms
Pain
Discharge
Loss of function (hearing loss, dizziness, tinnitus)
How do you assess the hearing of children of different age groups:
6 to 18 months
12 months to 3 years
3 to 5 years
4 years onwards
6 to 18 months
Distraction test
12 months to 3 years
Visual reinforced audiometry
3 to 5 years
Play audiometry
4 years onwards
Pure tone audiometry
What can an objective assessment of the auditory system be done by?
Otoacoustic emissions
Auditory brain stem responses
Tympanometry
What are examples of conditions that can cause hearing loss?
Otitis media with effusion/glue ear
Autoinflation
Grommet
What is ottitis media with effusion also called?
Glue ear
Ottitis media with effusion - risk factors
Day care, smoking, cleft palate, down syndrome
Ottitis media with effusion - treatment
Most improve by themselves within 3 months time
Treat with hearing aids or grommets
Ottitis media with effusion - aetiology
Eustachian tube dysfunction
Adenoidal hypertrophy
Resolving AOM
Ottitis media with effusion - signs and symptoms
Symptoms
Hearing loss
Speech delay
Behaviour problems
Academic decline
Imbalance
Signs
Dull TM
Fluid levels
Bubbles
What is the most common cause of a child with painful/discharging ear?
Otitis externa
Acute is common for 3-18 months olds
Short history, pain, fever, discharge
Microbiology important, haemophilus influenze, strep pneumonia, Moraxella catarrhalis
Treat with antibiotics (such as co-amoxiclav), also with grommets and adenoidectomy if recurrent
Complication of acute is it becoming chronic
Suspect in children with chronic discharging ear, hearing loss despite grommets
Investigation is CT scan
Requires mastoidectomy
what is Otitis externa treated with?
Treat with antibiotics (such as co-amoxiclav), also with grommets and adenoidectomy if recurrent
Otitis externa - presentation
Short history, pain, fever, discharge
Otitis externa - investigations
Microbiology important, haemophilus influenze, strep pneumonia, Moraxella catarrhalis
What microorganisms most commonly cause otitis externa in children?
Microbiology important, haemophilus influenze, strep pneumonia, Moraxella catarrhalis
Acute otitis externa - treatment
Treat with antibiotics (such as co-amoxiclav), also with grommets and adenoidectomy if recurrent
When should chronic otitis externa be suspected in children?
Suspect in children with chronic discharging ear, hearing loss despite grommets
Chronic otitis externa - investigations
Investigation is CT scan
Chronic otitis externa - treatment
Requires mastoidectomy
What is the study of the ear and diseases called?
Otology
What is the study of the nose and diseases called?
Rhinology = studying the anatomy and diseases of the nose
What are examples of rhinology conditions?
Blocked nose
Runny nose
Sneezing
Reduced sense of smell
Facial pain
What is often seen in the history for child with blocked/runny nose?
Nasal symptoms
Pain
Discharge
Loss of function (blocked nose, sense of smell)
History of foreign body
Feeding
Snoring, quality of sleep
What is the aetiology of child with blocked/runny nose?
Rhinitis
Allergic vs non allergic
Allergen tests (IgE)
Nasal douching, antihistamines, nasal steroids
Large adenoids
Check for sleep apnoea
Foreign body
Unilateral
Needs EUA
Sinusitis and polyps
Overlapping symptoms with rhinitis/large adenoids
Acute vs chronic sinusitis
Associated with cystic fibrosis
Choanal atresia
Uncommon (1 in 6000-8000 births)
Bilateral manifests as unable to breathe
Rhinitis - aetiology
Allergic vs non allergic
Rhinitis - investigations
Allergen tests (IgE)
Rhinitis - treatment
Nasal douching, antihistamines, nasal steroids
Large adenoids - investigations
Check for sleep apnoea
Epistaxis - pathology
Bleeding nose
Epistaxis - epidemiology
(how commen, sex)
Common
Males more than females
Epistaxis - management
Appropriate first aid
Antibiotic ointments
Nasal packing
What should be considered in epistaxis?
Consider coagulopathy/haematological abnormalities
What is the study of the anatomy and diseases of the throat called?
Laryngology = study of the anatomy and diseases of the throat
What are examples of laryngological conditions?
Sore throat
Airway issues
Hoarseness
Dysphagia
What is often seen in the history for a child with a sore throat?
Throat symptoms
Pain (odynophagia, ear ache)
Discharge (cough)
Loss of function (dysphagia, breathing problems, hoarse voice)
Snoring, drooling
Causes of child with sore throat?
Tonsillitis
Bacterial (b haem strep B) or viral (EBV)
Risk of glomerulonephritis
Antibiotics
Complications
Peritonsillar abscess
UVULA
Tonsillitis - most common organisms
Bacterial (b haem strep B) or viral (EBV)
Tonsilitis - treatment
Antibiotics
Tonsillitis - complications
Peritonsillar abscess
UVULA
What is seen in the anatomy and physiology for children with airway issues?
Large tongue
Large tonsils
Large/floppy epiglottis
Short neck
Sub glottis narrowest
What is seen in the history for child with airway issues?
Usually as an emergency
History of foreign body
Recent illness
Feeding problems
Stridor
What are causes of child with airway issues?
Epiglottitis
Laryngomalacia
What are neck lumps in children caused by?
Thyroglossal duct cyst
Branchial cyst
Cystic hygroma
Cervical lymphadenopathy
what is the complication of sinusitis and polyps?
Infection of the tissue around the brain and spinal cord (meningitis)
Infection around the tissue around the eye (orbital cellulitis)
Infection of the sinus bones (osteitis)
what is choanal atresia and who does it affect?
UNCOMMON (1 IN 6000-8000 BIRTHS)
BILATERAL MANIFESTS AS UNABLE TO BREATHE - unilateral may present later in life
