Paediatrics Otorhinolarynology Flashcards
Common presenting complaints seen in paed otology?
Hearing loss
Otorrhoea (discharge from ear)
Otalgia
Tinnitus
Vertigo
Describe what may be found in a history in a child with hearing loss.
Pain
Discharge
Loss of function e.g. hearing loss, dizziness.
May impact school performance and speech development.
Behavioral problems- lack of engagement due to hearing loss.
What are some of the congenital causes of hearing loss?
Maternal perinatal infections e..g rubella
Delivery issues e.g. prematurity, anoxia
What can enlarged adenoids block?
Eustachian tubes
What may blocked Eustachian tubes cause?
Otitis media with effusion
Which test would be done to assess a child with hearing loss if they are 6-18 months old?
Distraction test
Which test would be done to assess a child with hearing loss if they are 12m-3y old?
Visual reinforced audiometry
Which test would be done to assess a child with hearing loss if they are 3-5y old?
Play audiometry
Which test would be done to assess a child with hearing loss if they are >4yo?
Pure tone audiometry
Describe what happens during distraction testing for hearing?
Someone distracting child and then a noise played behind them to see if they turn and react to the sound.
Describe what happens in play audiometry.
When child hears noise, they perform an action e.g. every time they hear a noise, they put a man in a boat
What is an otoacoustic emissions test?
Part of newborn hearing screen
What happens if you fail the otoacoustic emissions test during the newborn hearing screen?
Test auditory brain stem response
What does the auditory brain stem response involve?
Sound played into neonates ears, electrodes placed on skin to test response to sound from the brainstem.
What happens during tympanometry?
Tight seal on eardrum, pump air through and assess how well ear drum is moving.
If there is flat trace on a tympanogram reading, what may this suggest?
Ear drum cannot move, perhaps due to fluid behind eardrum.
What is the most common cause of hearing loss in children?
Otitis media with effusion, commonly known as glue ear
What are some risks factors for otitis media with effusion?
Smoking- second hand
Cleft palate
Down syndrome
Day care- exposed to other children and infections
What is the treatment for otitis media with effusion?
Often resolves by itself
Can be treated by hearing aids, grommet and adenoidectomy
Which anatomical issue may cause otitis media with effusion?
Cleft palate
What are some symptoms of otitis media with effusion in children?
Hearing loss
Speech delay
Behavioral problems
Academic decline
What is a sign of otitis media w effusion?
Dull tympanic membrane
Fluid level- bubbles of gas if more fluid than air
What are some of the causes of otitis media with effusion in children?
Eustachian tube dysfunction
Adenoidal hypertrophy
Resolving acute otitis media
What can be used to help a children to pop their ears if they’re blocked?
Using an otovent for autoinflation
Which bone does a bone-anchored hearing device get attached to?
Temporal bone
How do bone-anchored hearing devices help with hearing loss?
Bone conduction
What are some of the treatments/managements for otitis externa in children?
Aural microsuction
Topical antibiotics
Water precautions
What is a common cause of otitis externa?
Water in the ears- can be known as swimmer’s ear
Which condition can be related to otitis media with effusion?
Acute otitis media
Which microorganisms may cause acute otitis media?
Haem.influenza
Strep pneumonia
Moraxella catarrhalis
What is the treatment for acute otitis media?
Oral antibiotics e.g. amoxicillan
Why may children with otitis media get ear discharge?
Perforation of ear drum
If a child has recurrent acute otitis media, what may be done?
Grommet insertion + adenoidectomy
What is a nasty complication of acute otitis media? It can happen if the eardrum doesn’t burst.
Mastoiditis- infection from fluid has spread into mastoid bone
What can happen if mastoiditis is not treated?
Brain abscess may form
Cholesteatoma?
Skin cells have found themselves into middle ear
What are some symptoms of chronic otitis media/cholesteatoma?
Chronic discharging ear despite treatment
Hearing loss despite grommets
What is the treatment for cholesteatoma?
Mastoidectomy
What are the usual presenting complaints for paeds rhinology?
Blocked nose
Runny nose
Children are more prone to URTI due to child care, mixing with other infections. How many URTis may a child get in a year?
8- considered normal amount
Sinuses are not usually affected in children as they take longer to develop.
Which sinus develops between 0-4months?
Ethmoid sinuses
Maxillary sinuses
Sinuses are not usually affected in children as they take longer to develop.
Which sinus develops between 3y-7y?
Sphenoid sinuses
Sinuses are not usually affected in children as they take longer to develop.
Which sinus develops between 8yrs-adolescent?
Frontal sinuses
Describe what may be found in a history of a child with a blocked/runny nose.
Pain
Discharge
Loss of function e.g. blocked nose, reduced sense of smell
History of foreign body
Feeding problems
Snoring
If there is a foreign body, what are common symptoms?
Nasal discharge on one side
Smelly discharge (foreign body causes infection).
What are some causes of blocked or runny nose?
Allergic rhinitis
Enlarged adenoids
What are some of the allergen tests to determine allergic rhinitis in children.
Skin pricking tests
IgE detection
What needs to be done if a child has a foreign body in their nose?
Removal, especially if a button battery.
If child will not let you take it out of nose, it can be done under anesthetic
If a child has nasal polys, which condition should you check and rule out?
Cystic fibrosis
What are some complications of nasal polys and sinusitis?
What is choanal atresia?
No nasal airway- neonates are nasal breathers so if bilateral, intubation may be required as cannot breathe by themselves
In those with choanal atresia, which investigation needs to be done?
CT to see what is causing it.
Important to note, CT and X-rays are normally avoided in children as exposes them to radiation.
Which children are more likely to get epsitaxis?
M>F
->just think of jmatt getting them more than you
What may cause epsitaxis?
Picking nose- causes constant irritation
Trauma
Underlying coagulopathy/ haematological abnormality
Name a benign tumour of the nose which is common in adolescent males?
Nasopharyngeal angiofibroma
What is the management of nasopharyngeal angiofibroma?
Removal
Which anatomical area does majority of epistaxis come from?
Little’s area
What is the first line treatment of epistaxis?
Pinch nose to stop bleeding
Which treatment can be given to children with epistaxis?
Antibiotic ointments- naseptin
What can be done if a child has continuous epsitaxis?
Cauterization using silver nitrate under local anesthetic
Nasal packing- young children will not let you pack their nose
What are some of the presenting complaints in paeds laryngology?
Sore throat
Airway issues
Describe what may found in the history of a child with a sore throat.
Pain
Cough
Loss of function- difficulty swallowing or breathing
Hoarseness
Snoring
Drooling
In a child presenting with a sore throat, what is particularly important to check upon examination?
Enlarged or swollen lymph nodes
What is tonsillitis caused by?
Mostly viral
Can be bacterial
If a child has bacterial tonsillitis, which microorganisms may be the cause?
Group A beta-haemolytic strep
What is the treatment for viral tonsillitis?
Supportive approach, calpol if required
What is the treatment for bacterial tonsillitis?
Antibiotics
If a child has bacterial tonsillitis, what are they more at risk of?
Glomerulonephritis.
associated w strep. infections
How would you know when to give a child antibiotics for tonsillitis?
If they have other symptoms like fever
What happens if tonsillitis doesn’t get treated properly?
May develop peritonsillar abscess
What is done for those with a peritonsillar abscess?
Drainage of pus
What can cause airway issues in children?
Large tongue
Large tonsils
Large epiglottis
Short neck
Narrowing of airway
What may be found in a history of a child with breathing difficulties?
History of foreign body
Recent illness
Feeding problems
Stridor
Describe what may be seen in a child with epiglottitis.
Quiet, febrile, drooling
Very unwell
What can cause epiglottitis?
Haemophilus influenzae B
If you think a patient has epiglottitis, what should be done?
DO NOT EXAMINE- might cause more swelling and close off airway
Get a senior anesthetist, keep child calm and take to theatre to intubate
Why is epiglottis a lot rarer now?
Due to vaccination against Hemophillus Influenza B
What is laryngomalacia?
Cartilage holding larynx is soft leading to floppy airway
What can cause laryngomalacia?
Prematurity
Which breathing abnormality may a child with laryngomalacia have?
Stridor
What can laryngomalacia lead to?
Feeding difficulties
Failure to thrive
Obstructive sleep apnoea
What can cause neck lumps in children?
Cervical lymphadenopathy
Thyroglossal duct cyst
Branchial cyst
Cystic hyrgoma
Which types of lump in neck can be congenital?
Branchial cyst
Cystic hyrgoma
