Paeds ENT Flashcards
When child presents with ear pathology what are imp questions to ask?
pain, bleeding, discharge, fever, systemic unwell, hearing loss, communication/speech difficulty, school problems., foreign bodies? Do they need to be able to go swimming? (grommets- recommend kept dry).
how do you assess hearing in children and newborns?
Newborns-
Children-
How do you differentiate snoring and sleep apnoea?
How is OSA managed in kids?
all patients with OSA snore but not all those who snore have OSA. OSA cannot be transient i.e. only occurring when person is congested due to URTI.
OSA: cessation of breathing for a minimum of 6 seconds (10 in adults) occurring during sleep causing patient to wake/ O2 desaturation. OSA results from the collapse of the upper airways due to muscle paralysis during REM sleep. Blood O2 levels drop because gas exchange cannot occur and once they reach a critical level, a central mechanism is activated causing patient to wake slightly to take a deep breath to overcome the obstruction.
snoring: noise produced in sleep due to vibration of the soft tissues of the pharynx e.g. soft palate or tongue base.
OSA is managed with adentonsillectomy which is curative for 80% kids (snoring may still be present but is improved).
What features of the history/examination are imp in a child presenting with snoring?
Snoring persistent? i.e. not just when they have a cold/ flu
Do they have periods where the snoring stops for some time, they take a deep breath and the snoring restarts?
Are they drowsy during the day? Has anyone at school mentioned this?
Do they have regular tonsillitis?
Do they have trouble breathing through their nose?
To examine: Tonsils, Nose- adenoids, turbinates, Tongue (big?).
When a patient presents with nasal obstruction/ discharge what are imp questions to ask?
atopy colour of discharge and consistency fluctuation of obstruction, uni/bilateral facial pain sneezing smell sense breathing through nose snoring Examination: misting of both sides of nose (may be choanal atresia), hypertrophied turbinates, adenoids, tonsils.
What is periorbital cellulitis? What is it a complication of? How must a patient with this suspected be investigated? How must it be managed?
complication of acute rhinosinusitis (earlier presentation is severe frontal headache that worsens on bending over). Sight and life may be threatened in short time period. Must be treated aggressively with broad spectrum abx and decongestants but if signs that it has progressed- surgical drainage is req.
investigations: colour vision, eye movements (painful/restricted?), diplopia, proptosis- i.e. exopthalmos unilateral, visual acuity. CT scan to id if any intraorbital abscess is present.
What are the common/imp causes of stridor/ airway obstruction in kids?
laryngomalacia- congenital abnormality of the laryngeal cartilage leading to collapse of supraglottic structures during inspiration causing airway obstruction. v common cause of stridor in kids. resulting in omega shaped epiglottis.
epiglottitis (thickened ariepiglottic folds and epiglottis) due to infection w/ Haemophilius influenza B. Can follow normal URTI. Shorter hx than croup. Suspicious if child is having difficulty swallowing. Change in voice- to hot potato, drooling. Immediate action is required. DO NOT LIE PATIENT DOWN and keep them CALM. NO oral exam, NO XR. IV Abx, laryngeal examination to confirm and intubation.
choanal atresia- congenital closure of the posterior choanae in the nasal cavity by bone/ membranous tissue. can be uni/bilateral.
Croup- acute laryngotracheobronchitis. usually viral in origin. Can follow normal URTI which progresses with temp, stridor, general deterioration. IV Abx req.
Vocal cord palsy- congenital nervous system abnormality e.g. hydrocephalus, iatrogenic: post surgery, weak, muffled voice/ cry
What are the guidelines for tonsillectomy in kids?
suggested for kids who have had 7 or more cases in 1 year, 5 cases each year for 2 years, or 3 cases each year for 3 years.
What are the RF for congenital hearing loss?
syndromes e.g. due to first Branchial arch abnormalities, or associated with kidney pathology.
craniofacial anomalies.
intrauterine infections e.g. Rubella can cause inner ear damage
perinatal hypoxia/ anoxia, rhesus incompatibility can cause congenital hearing loss.
prematurity, low birth weight, ototoxic medications e.g. chemo. head trauma.
fhx of deafness, long stay in NICU, neurodegenerative diseases e.g. Charcot Marie tooth,
