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YR5 Specialties > Paeds ENT > Flashcards

Paeds ENT Flashcards

1
Q

What is acute otitis media?

A

Acute bacterial infection of middle ear fluid

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2
Q

What is otitis media with effusion?

A

Middle ear fluid that is not infected
Frequently precede AOM or follows its resolution

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3
Q

What is acute suppurative otitis media?

A

complication of AOM: perforation of the tympanic membrane with mucopurulent discharge.

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4
Q

What are 4 symptoms of acute otitis media?

A

Ear pain/ rubbing
Hearing loss
Ear discharge
Fever

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5
Q

What non-specific symptoms may arise in infants with acute otitis media?

A

Fever
Fussiness
Disturbed or restless sleep
Poor feeding/anorexia
D+V

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6
Q

When is the peak incidence of acute otitis media?

A

1-5y

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7
Q

Give 4 intrinsic risk factors for acute otitis media

A

Age <4y: Most occur between 6-24m
Atopic predisposition
Immunosuppression
Conditions affecting ciliary motility: CF, Primary ciliary dyskinesia + Kartagener’s syndrome

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8
Q

Give 4 extrinsic risk factors for acute otitis media

A

Passive smoking
Not receiving pneumococcal vaccination
Nursery
Bottle feeding

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9
Q

What is the pathophysiology of acute otitis media?

A

Secondary to oedema + narrowing of the eustachian tube.
Prevents middle ear from draining, predisposing it to the colonisation of bacteria.
+ Can’t equalise pressure in the middle ear

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10
Q

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

A

Acute otitis media with effusion

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11
Q

What is glue ear?

A

Chronic otitis media with effusion
Characterised by build up of fluid behind an intact TM.
>3/12 duration

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12
Q

What is chronic suppurative otitis media?

A

> 2w discharge
Discharge through perforated tympanic membrane (TM).

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13
Q

What 4 features may be seen on otoscopy in otitis media?

A

Bulging tympanic membrane → loss of light reflex

Opacification or erythema of tympanic membrane

Perforation with purulent otorrhoea

Decreased mobility if using a pneumatic otoscope

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14
Q

What indicates diagnosis of acute otitis media?

A

Bulging of the tympanic membrane- white/ pale yellow
Pus may be seen behind TM
Perforation with purulent otorrhea or bullae

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15
Q

What indicates diagnosis of otitis media with effusion?

A

TM may be retracted/ neutral position
Amber, gray, or blue
Bubbles or air-fluid level may be seen behind TM

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16
Q

What is the management for acute otitis media?

A

Analgesics
Self limiting: 3-7d
Abx don’t make much difference

17
Q

In which patients with AOM are antibiotics prescribed?

A

<2s with bilateral OM
<3/12 with a temp > 38ºC
OM with ear discharge
Systemically unwell
Those at high risk of complication

18
Q

Which antibiotics are used in acute otitis media?

A

1: amoxicillin
2: co-amoxiclav

19
Q

What is the management for otitis media with effusion?

A

self-limiting disease with 50% of cases resolving in 3/12

Watchful waiting for 3/12 with Valsalva manoeuvre.

Grommets +/- adenoidectomy: if hearing loss is present for >3/12, language is delayed, there are craniofacial abnormalities or hx of recurrent AOM with OME.

20
Q

Give 4 complications of AOM

A

Acute mastoiditis
Sensorineural + conductive hearing loss
Facial nerve palsy
Bacterial meningitis

21
Q

What is acute mastoiditis?

A

rare complication of AOM where continued inflammation of the mucosa of the middle ear + mastoid leads to a mastoid abscess.

22
Q

What are 4 signs and symptoms of acute mastoiditis?

A

mastoid pain + tenderness
Post-auricular inflammation: tender boggy, erythematous, fluctuant
Auricle proptosis (abnormal protrusion of the pinna).

23
Q

What is management for acute mastoiditis?

A

IV Abx + fluid resus
Analgesia + antipyrexial agents
CT temporal bone + brain
If failure to improve may require surgical intervention by incision + drainage +/- cortical mastoidectomy +/- grommets

24
Q

What is otitis externa?

A

Inflammation of external ear canal, may also involve the pinna or TM

25
Q

What are the 2 durations of otitis externa?

A

Acute: <3w
Chronic: >3w

26
Q

What is malignant otitis externa?

A

when the infection spreads to the mastoid + temporal bones causing osteomyelitis
(NOT neoplastic)

27
Q

Give the 2 most common causes of otitis externa

A

Pseudomonas Aeruginosa
Staphylococcus Aureus

28
Q

Give 4 symptoms of otitis externa

A

Pain
Itching
Discharge
Hearing loss

29
Q

What are the 2 subtypes of otitis externa?

A

Localised folliculitis: can progress to a boil in the ear canal
Diffuse (aka swimmer’s ear), with widespread inflammation of skin/ subdermis

30
Q

When is the peak incidence of otitis externa?

A

7-12y

31
Q

Describe general management of otitis externa (5)

A

Analgesia
Avoid getting ear wet use a cap for showering + swimming
Remove any discharge by gently using cotton wool, DO NOT put cotton buds into the ear
Remove any hearing aids + earrings

32
Q

What is prescribed for otitis externa?

A

Ciprofloxacin 0.3% w/v (eye drops used in the ear) TOP 5 drops BD 1-2w

33
Q

What investigation should be performed if a child has a long standing hearing problem and no otalgia?

A

Pure tone audiometry

YR5 Specialties (27 decks)

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