Paeds ENT Flashcards
What is otitis media?
- infection of the middle ear
- space between tympanic membrane and inner ear
What does the middle ear contain?
- cochlea
- vestibular apparatus
- nerves
- bacteria enters from eustachian tube
- infection often preceded by viral URTI
Which bacteria cause otitis media?
- MC: strep pneumoniae
- H. influenzae
- Moraxella catarrhalis
- S. aureus
How does otitis media present?
- ear pain
- reduced hearing
- URTI symptoms
- balance issues
- vertigo
- discharge
What is seen on examination in otitis media?
- bulging, red inflamed tympanic membrane
- hole if perforation
- discharge
What does a normal ear look like on otoscope?
- pearly-grey, translucent, shiny membrane
-cone of light reflecting - see malleus
How is otitis media managed?
- most resolve w/out Abx
- simple analgesia
What are some complications of otitis media?
- effusion
- (temporary) hearing loss
- perforated ear drum
- recurrent infection
- mastoiditis
- petrositis
- meningitis
When should Abx be prescribed in otitis media?
- significant co-morbidities
- systemically unwell
- immunocompromised
- <2 years with bilateral otitis media
- otorrhoea
When should a delayed prescription be used in otitis media?
- after 3 days if symptoms have not improved or worsened
Which Abx are prescribed for otitis media?
- 5-7 day course of amoxicillin
- alternatives: erythromycin
- clarithromycin
When should children with otitis media be referred for specialist assessment?
- <3 mo and temp >38ºC
- 3-6mo and temp >39ºC
What is mastoiditis?
- infection spread from middle ear in otitis media
- abscess formation in mastoid air spaces in temporal bone
- leads to post auricular swelling and mastoid tenderness
What are grommets?
- tiny tubes inserted into tympanic membrane
- allows fluid to drain from middle ear to ear canal
What is glue ear?
- otitis media with effusion
- middle ear filled with fluid
What is the Eustachian tube?
- connects middle ear to back of throat
- helps to drain fluid
- buildup if blocked
What is the main symptom of glue ear?
- hearing reduction or loss
- main complication is otitis media
How is glue ear investigated and what is seen?
- otoscopy
- dull tympanic membrane
- filled with air bubbles or fluid
How is glue ear managed?
- referral for audiometry
- conservative management: resolves within 3 months
What is the most common cause of tonsillitis?
- Group A strep (Strep pyogenes)
- Strep pneumoniae
Which tonsils most commonly get infected in tonsillitis?
- palatine
- either side of back of throat
How does tonsillitis present?
- fever
- sore throat
- painful swallowing
- poor oral intake
- headache
- vomiting
What is seen on examination of tonsillitis?
- red, inflamed, enlarged tonsils
- with or without white patches
Which age groups does tonsillitis affect?
- 5-10 years
- 15-20 years
How is tonsillitis managed?
- safety net
- paracetamol/ibuprofen
- Penicillin V 10 days
- clarithromycin if allergic
What frequency is indication for a tonsillectomy?
- 7+ episodes in a year
- 5+ episodes per year in 2 years
- 3+ episodes per year in 3 years
What is the FeverPAIN score?
- Fever during past 24hrs
- Purulence
- Attended within 3 days of symptom onset
- Inflamed tonsils
- No cough
- score of 4-5 gives 62-65% probability of bacterial tonsillitis
What is the Centor criteria?
- Fever >38
- tonsillar exudates
- absence of cough
- lymphadenopathy
- age <15
- score ≥3 is 40-60% probability of bacterial tonsillitis
What are congenital causes of hearing loss?
- maternal rubella or CMV
- genetic deafness
- associated conditions e.g. Down’s
What can cause deafness after birth?
- jaundice
- meningitis and encephalitis
- otitis media/glue ear
- chemotherapy
How does hearing loss present in children?
- ignoring calls or sounds
- frustration or bad behaviour
- poor speech and language development
- poor schooling
How is hearing screened for?
- newborn hearing screening programme
- testing in neonates
- checks eardrums individually
What is an audiogram?
- document the volume at which they can hear different tones
- each ear tested separately
- tests air and bone conduction
How is hearing loss managed?
- MDT
- SALT
- ENT specalist
- educational psychology
What is audiometry?
- children <3 tested for basic response to sound
- older children tested with headphones and tones
