Paeds ENT

Question 1

What is the most common cause of tonsillitis

Answer 1

-> viral infection : EBV

Question 2

What is the most common cause of bacterial tonsilitis

Answer 2

-> Group A strep (streptococcus pyogenes) : treated with penicillin V for 10 days

Question 3

What is used to estimate the probability that tonsitilits is due to a bacterial infection

Answer 3

FeverPain score

• Fever in previpus 24 hrs
• P : purulence on the tonsils
• A : attened within 3 days of symptom onset
• I : inflamed tonsils
• N : no cough or coryza

4-5 = 62-65% probablility of bacterial tonsilitis

Question 4

What is the most common bacterial cause of otitis media

Answer 4

-Streptococcus pneumoniae

Question 5

How does otitis media commonly present ?

Answer 5

-Ear pain +/- sore throat
-Reduced hearing
-Preceding viral URTI : fever, cough, coryzal symptoms, sore throat
-Otoscopy : red, inflamed, bulging tymopanic membrane +/- perforation

Question 6

What antibiotics can be used in otitis media ?

Answer 6

• Amoxicillin 5 days
• Erythromycin, clarithromycin

Question 7

What is glue ear and how is present and how does does it look when using an otoscopy ?

Answer 7

• > Fluid build up in the middle ear due to blockage of the eustachian tube
• > Reduction in hearing
• > Dull tympanic membrane with air bubbles or visual fluid level

Question 8

What is a complication of tonsilitis

Answer 8

Peritonsillar abscess (quincy)

Question 9

Hx suggest tonsilitis
Uvular deviation
Tonsillar bulge

Answer 9

Quincy
Abx and aspiration

Question 10

What are 2 complications of otitis media

Answer 10

• Acute mastoiditis : tender, boggy swelling behind ear
• Intracranial abscess

Question 11

How would otitis media with effusion present

Answer 11

• Smelly or gunky discharge from the ear + hearing loss
• Grey tympanic membrane
• Loss of cone light reflex
• Visible fluid behind tympanic membrane
  = glue ear, peaks at 2 yrs

Question 12

How is otitis media with effusion managed

Answer 12

• Urgent referral
• Hearing formally tested
• Managed with Grommet insertion

Question 13

what 2 conditions would require urgent ENT referral if they present with recurrent otitis media ?

Answer 13

• Cleft palate
• Down’s syndrome

Question 14

give 5 risk factors for glue ear

Answer 14

male
siblings with glue ear
bottle feeding
nursery
parental smoking

Question 15

How is glue ear managed

Answer 15

Grommet insertion