Paediatrics Respiratory Flashcards
Side effects of antibiotics
Diarrhoea
Oral thrush
Nappy rash
Allergic reaction
Which age group does Rhinitis most commonly present in children?
5-10 years
In winter months
Management of rhinitis in children
Self-limiting
Review if unsure
Rhinitis is a prodrome to which conditions in children
Pneumonia
Bronchiolitis
Meningitis
Septicaemia
Presentation of otitis media
Erythema
Bulging ear drum
Fever
Pain
Management of otitis media
Self limiting
Analgesia for pain
Two ways otitis media can occur
Primary viral infection
Secondary to Pneumococcal or haemophilus influenza
What is otitis externa?
Inflammation of the external ear canal
Three types of otitis externa
Localised
Diffuse
Malignant
Difference between acute and chronic otitis externa
Acute - lasts around 3 weeks
Chronic- can last more than 3 months
Site of localised otitis externa
Infection of hair follicle - can evolve to boil
Where does diffuse otitis externa occur?
Widespread inflammation of skin and subdermis
Define malignant otitis externa
Infection spreads to mastoid and temporal bones resulting in osteomyelitis
Why is malignant otitis externa described ‘malignant’?
Poor prognosis - not a neoplastic condition
Causes of otitis externa
Bacterial infection
Fungal infection
4 ways bacterial infection giving rise to otitis externa can occur
Blockage of the canal
Absence of cerumen due to excess cleaning
Trauma
Alteration of pH in canal
Risk factors for otitis externa
Hot and humid climates Swimming Older age Diabetes mellitus Narowing/obstruction of canal Over-cleaning Wax build-up Eczema Trauma Radiotherapy to the ear
Symptoms of otitis externa
Pain
itching
Discharge
Hearing loss
Signs of otitis externa on examination
Oedema Erythema Exudate Mobile tympanic membrane Pain on movement of tragus or auricle Pre auricular lymphadenopathy
Differential diagnosis to otitis externa
Acute otitis media with perforation of the TM
Furunculosis (infection of a hair follicle in the cartilaginous part of the ear canal)
Viral infections
Tumours of external auditory canal
Cholesteatoma
Foreign body
Impacted wax
Skin conditions eg. acne, psoriasis, contact dermatitis, seborrhoeic dermatitis
Investigations for otitis externa - failed treatment
Swabs for microscopy and culture
Management of otitis externa
Avoid getting the ear wet use a cap for showering and swimming
Remove any discharge by gently using cotton wool, DO NOT put cotton buds into the ear
Remove any hearing aids and earrings
Use painkillers – paracetamol and ibuprofen
Antibiotic or antifungal ear drops are generally the mainstay of treatment (6). A pope wick can be used to get the drops into the ear if the canal is closed.
If there is cellulitis or lymphadenopathy then oral antibiotics are indicated (4).
In cases of chronic otitis externa, acetic acid and corticosteroid ear drops are used (4).
Complications of otitis externa
Stenosis Abscesses Perforated ear drum Cellulitis Malignant otitis externa
