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Year 2- Head and Neck > Paediatrics Otorhinolarynology > Flashcards

Paediatrics Otorhinolarynology Flashcards

1
Q

Common presenting complaints seen in paed otology?

A

Hearing loss
Otorrhoea (discharge from ear)
Otalgia
Tinnitus
Vertigo

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2
Q

Describe what may be found in a history in a child with hearing loss.

A

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.

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3
Q

What are some of the congenital causes of hearing loss?

A

Maternal perinatal infections e..g rubella
Delivery issues e.g. prematurity, anoxia

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4
Q

What can enlarged adenoids block?

A

Eustachian tubes

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5
Q

What may blocked Eustachian tubes cause?

A

Otitis media with effusion

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6
Q

Which test would be done to assess a child with hearing loss if they are 6-18 months old?

A

Distraction test

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7
Q

Which test would be done to assess a child with hearing loss if they are 12m-3y old?

A

Visual reinforced audiometry

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8
Q

Which test would be done to assess a child with hearing loss if they are 3-5y old?

A

Play audiometry

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9
Q

Which test would be done to assess a child with hearing loss if they are >4yo?

A

Pure tone audiometry

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10
Q

Describe what happens during distraction testing for hearing?

A

Someone distracting child and then a noise played behind them to see if they turn and react to the sound.

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11
Q

Describe what happens in play audiometry.

A

When child hears noise, they perform an action e.g. every time they hear a noise, they put a man in a boat

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12
Q

What is an otoacoustic emissions test?

A

Part of newborn hearing screen

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13
Q

What happens if you fail the otoacoustic emissions test during the newborn hearing screen?

A

Test auditory brain stem response

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14
Q

What does the auditory brain stem response involve?

A

Sound played into neonates ears, electrodes placed on skin to test response to sound from the brainstem.

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15
Q

What happens during tympanometry?

A

Tight seal on eardrum, pump air through and assess how well ear drum is moving.

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16
Q

If there is flat trace on a tympanogram reading, what may this suggest?

A

Ear drum cannot move, perhaps due to fluid behind eardrum.

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17
Q

What is the most common cause of hearing loss in children?

A

Otitis media with effusion, commonly known as glue ear

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18
Q

What are some risks factors for otitis media with effusion?

A

Smoking- second hand
Cleft palate
Down syndrome
Day care- exposed to other children and infections

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19
Q

What is the treatment for otitis media with effusion?

A

Often resolves by itself
Can be treated by hearing aids, grommet and adenoidectomy

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20
Q

Which anatomical issue may cause otitis media with effusion?

A

Cleft palate

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21
Q

What are some symptoms of otitis media with effusion in children?

A

Hearing loss
Speech delay
Behavioral problems
Academic decline

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22
Q

What is a sign of otitis media w effusion?

A

Dull tympanic membrane
Fluid level- bubbles of gas if more fluid than air

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23
Q

What are some of the causes of otitis media with effusion in children?

A

Eustachian tube dysfunction
Adenoidal hypertrophy
Resolving acute otitis media

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24
Q

What can be used to help a children to pop their ears if they’re blocked?

A

Using an otovent for autoinflation

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25
Q

Which bone does a bone-anchored hearing device get attached to?

A

Temporal bone

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26
Q

How do bone-anchored hearing devices help with hearing loss?

A

Bone conduction

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27
Q

What are some of the treatments/managements for otitis externa in children?

A

Aural microsuction
Topical antibiotics
Water precautions

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28
Q

What is a common cause of otitis externa?

A

Water in the ears- can be known as swimmer’s ear

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29
Q

Which condition can be related to otitis media with effusion?

A

Acute otitis media

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30
Q

Which microorganisms may cause acute otitis media?

A

Haem.influenza
Strep pneumonia
Moraxella catarrhalis

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31
Q

What is the treatment for acute otitis media?

A

Oral antibiotics e.g. amoxicillan

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32
Q

Why may children with otitis media get ear discharge?

A

Perforation of ear drum

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33
Q

If a child has recurrent acute otitis media, what may be done?

A

Grommet insertion + adenoidectomy

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34
Q

What is a nasty complication of acute otitis media? It can happen if the eardrum doesn’t burst.

A

Mastoiditis- infection from fluid has spread into mastoid bone

35
Q

What can happen if mastoiditis is not treated?

A

Brain abscess may form

36
Q

Cholesteatoma?

A

Skin cells have found themselves into middle ear

37
Q

What are some symptoms of chronic otitis media/cholesteatoma?

A

Chronic discharging ear despite treatment
Hearing loss despite grommets

38
Q

What is the treatment for cholesteatoma?

A

Mastoidectomy

39
Q

What are the usual presenting complaints for paeds rhinology?

A

Blocked nose
Runny nose

40
Q

Children are more prone to URTI due to child care, mixing with other infections. How many URTis may a child get in a year?

A

8- considered normal amount

41
Q

Sinuses are not usually affected in children as they take longer to develop.
Which sinus develops between 0-4months?

A

Ethmoid sinuses
Maxillary sinuses

42
Q

Sinuses are not usually affected in children as they take longer to develop.
Which sinus develops between 3y-7y?

A

Sphenoid sinuses

43
Q

Sinuses are not usually affected in children as they take longer to develop.
Which sinus develops between 8yrs-adolescent?

A

Frontal sinuses

44
Q

Describe what may be found in a history of a child with a blocked/runny nose.

A

Pain
Discharge
Loss of function e.g. blocked nose, reduced sense of smell
History of foreign body
Feeding problems
Snoring

45
Q

If there is a foreign body, what are common symptoms?

A

Nasal discharge on one side
Smelly discharge (foreign body causes infection).

46
Q

What are some causes of blocked or runny nose?

A

Allergic rhinitis
Enlarged adenoids

47
Q

What are some of the allergen tests to determine allergic rhinitis in children.

A

Skin pricking tests
IgE detection

48
Q

What needs to be done if a child has a foreign body in their nose?

A

Removal, especially if a button battery.
If child will not let you take it out of nose, it can be done under anesthetic

49
Q

If a child has nasal polys, which condition should you check and rule out?

A

Cystic fibrosis

49
Q

What are some complications of nasal polys and sinusitis?

A
50
Q

What is choanal atresia?

A

No nasal airway- neonates are nasal breathers so if bilateral, intubation may be required as cannot breathe by themselves

51
Q

In those with choanal atresia, which investigation needs to be done?

A

CT to see what is causing it.

Important to note, CT and X-rays are normally avoided in children as exposes them to radiation.

52
Q

Which children are more likely to get epsitaxis?

A

M>F

->just think of jmatt getting them more than you

53
Q

What may cause epsitaxis?

A

Picking nose- causes constant irritation
Trauma
Underlying coagulopathy/ haematological abnormality

54
Q

Name a benign tumour of the nose which is common in adolescent males?

A

Nasopharyngeal angiofibroma

55
Q

What is the management of nasopharyngeal angiofibroma?

A

Removal

56
Q

Which anatomical area does majority of epistaxis come from?

A

Little’s area

57
Q

What is the first line treatment of epistaxis?

A

Pinch nose to stop bleeding

58
Q

Which treatment can be given to children with epistaxis?

A

Antibiotic ointments- naseptin

59
Q

What can be done if a child has continuous epsitaxis?

A

Cauterization using silver nitrate under local anesthetic
Nasal packing- young children will not let you pack their nose

60
Q

What are some of the presenting complaints in paeds laryngology?

A

Sore throat
Airway issues

61
Q

Describe what may found in the history of a child with a sore throat.

A

Pain
Cough
Loss of function- difficulty swallowing or breathing
Hoarseness
Snoring
Drooling

62
Q

In a child presenting with a sore throat, what is particularly important to check upon examination?

A

Enlarged or swollen lymph nodes

63
Q

What is tonsillitis caused by?

A

Mostly viral
Can be bacterial

64
Q

If a child has bacterial tonsillitis, which microorganisms may be the cause?

A

Group A beta-haemolytic strep

65
Q

What is the treatment for viral tonsillitis?

A

Supportive approach, calpol if required

66
Q

What is the treatment for bacterial tonsillitis?

A

Antibiotics

67
Q

If a child has bacterial tonsillitis, what are they more at risk of?

A

Glomerulonephritis.

associated w strep. infections

68
Q

How would you know when to give a child antibiotics for tonsillitis?

A

If they have other symptoms like fever

69
Q

What happens if tonsillitis doesn’t get treated properly?

A

May develop peritonsillar abscess

70
Q

What is done for those with a peritonsillar abscess?

A

Drainage of pus

71
Q

What can cause airway issues in children?

A

Large tongue
Large tonsils
Large epiglottis
Short neck
Narrowing of airway

72
Q

What may be found in a history of a child with breathing difficulties?

A

History of foreign body
Recent illness
Feeding problems
Stridor

73
Q

Describe what may be seen in a child with epiglottitis.

A

Quiet, febrile, drooling
Very unwell

74
Q

What can cause epiglottitis?

A

Haemophilus influenzae B

75
Q

If you think a patient has epiglottitis, what should be done?

A

DO NOT EXAMINE- might cause more swelling and close off airway

Get a senior anesthetist, keep child calm and take to theatre to intubate

76
Q

Why is epiglottis a lot rarer now?

A

Due to vaccination against Hemophillus Influenza B

77
Q

What is laryngomalacia?

A

Cartilage holding larynx is soft leading to floppy airway

78
Q

What can cause laryngomalacia?

A

Prematurity

79
Q

Which breathing abnormality may a child with laryngomalacia have?

A

Stridor

80
Q

What can laryngomalacia lead to?

A

Feeding difficulties
Failure to thrive
Obstructive sleep apnoea

81
Q

What can cause neck lumps in children?

A

Cervical lymphadenopathy
Thyroglossal duct cyst
Branchial cyst
Cystic hyrgoma

82
Q

Which types of lump in neck can be congenital?

A

Branchial cyst
Cystic hyrgoma

83
Q
A

Year 2- Head and Neck (13 decks)

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