Paeds - ENT

Question 1

what is otitis media?

Answer 1

acute infection of the middle ear

Question 2

how common is otitis media, what age is it common in ?

Answer 2

most children will have at least one episode

most common in age 6-12 months

Question 3

what children are prone to otitis media?

Answer 3

the ones who have short, horizontal or poorly functioning Eustachian tubes

Question 4

what are the symptoms of otitis media?

Answer 4

pain in the ear
fever
bright red and bulging tympanic membrane with loss of normal light reflexion
occasionally there is acute perforation of the ear drum with pus visible in the external canal

Question 5

what pathogens cause otitis media?

Answer 5

RSV
rhinovirus
pneumococcus 
non-tapeable H.influenzae 
mortadella catarrali

Question 6

what are the complications of otitis media?

Answer 6

mastoiditis

meningitis

Question 7

when should antibiotics be prescribed in children with otits media?

Answer 7

Antibiotics should be prescribed immediately if:
Symptoms lasting more than 4 days or not improving
Systemically unwell but not requiring admission
Immunocompromise or high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease
Younger than 2 years with bilateral otitis media
Otitis media with perforation and/or discharge in the canal

amoxicillin
or erythromycin/clarithromycin

Question 8

what can recurrent ear infections lead to ?

Answer 8

otitis media with effusion. (OME or glue ear or serous otitis media)

Question 9

how does glue ear present?

Answer 9

hearing loss is the presenting feature

secondary problems such as speech and language delay, behavioural or balance problems may also be seen

Question 10

how is glue ear diagnosed?

Answer 10

the ear drum will be dull and retracted, often with fluid level visible
conformation of glue ear can be gained by a flat trace on tympanometry, in conduction with evidence of a conductive loss on pure tone audiometry

Question 11

how is glue ear treated

Answer 11

usually resolves spontaneously
however insertion of ventilation tubes (grommets) can be beneficial
adenoidectomy can offer long term effects

Question 12

what is the most common cause of hearing loss in children>

Answer 12

glue ear

Question 13

what hearing tests do children have?

Answer 13

Newborn - Otoacoustic emission test (all newborns)

• if the otoacoustic emission is abnormal then do auditory brainstem response test (newborn and infants)

6-9 months - distraction test

18 months - 2.5 years - recognition of familiar objects

> 2.5 years - performance testing

> 2.5 years - speech discrimination tests

> 3 years - pure tone audiometry

Question 14

what is periorbital cellulitis?

Answer 14

infection of the peri-orbital skin

children are often systemically unwell with fever, erythema and tenderness over the affected area.

Question 15

what causes peri-orbital cellulitis?

Answer 15

usually due to an infection either b s.aureus or H.influenzae type B
may occur secondary to paranasal or dental abscess in older children.

Question 16

how do you treat peri-orbital cellulitis ?

Answer 16

admission to hospital for IV antibiotics

Question 17

what are the complications of peri-orbital cellulitis?

Answer 17

it may develop into orbital cellulitis with evolving ocular proptosis, limited ocular movement and decreased visual acuity.

Question 18

what are the risk factors for orbital cellulitis?

Answer 18

Childhood
Previous sinus infection
Lack of Haemophilus influenzae type b (Hib) vaccination
Recent eyelid infection/ insect bite on eyelid (Peri-orbital cellulitis)
Ear or facial infection

Question 19

how does orbital cellulitis present?

Answer 19

Redness and swelling around the eye
Severe ocular pain
Visual disturbance
Proptosis
Ophthalmoplegia/pain with eye movements
Eyelid oedema and ptosis
Drowsiness +/- Nausea/vomiting in meningeal involvement (Rare)