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Questions > Paeds ENT > Flashcards

Paeds ENT Flashcards

1
Q

What differentiates chronic and acute Otitis Externa

A

<3 weeks is acute

>3 months is chronic

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2
Q

What is malignant OE?

A

this is when the infection spreads from the ear canal to the temporal and mastoid bone causing osteomyelitis.

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3
Q

causes of OE?

A
  1. bacterial infection (psuedomonas aeruginosa or staph A) which enters via -
  • blocked ear canal
  • excessive cleaning
  • trauma
  • change in pH
  1. fungal infection
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4
Q

epidemiology and risk factors associated with OE?

A
  • swimming
  • summer
  • girls
  • atopy
  • diabetes
  • 1% of population get it a year
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5
Q

history and examination of OE?

A

history -

  • hearing loss
  • itch
  • discharge
  • pain

examination -

  • erythema
  • oedema
  • poorly mobile tympanic membrane
  • exudate
  • preauricular lympahdenopathy (behind the ear lad)
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6
Q

what are some differential diagnosis you should consider with OE?

A
  1. viral infection
  2. acute infection with rupture of timpani membrane
  3. cholesteatoma
  4. tumour in external ear canal
  5. foreign body
  6. otitis media
  7. Furunculosis
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7
Q

management of OE?

A

general -

  • don’t get ear wet (use cap)
  • clean exudate and gunk with cotton swabs
  • painkillers
  • remove earrings and hearing aids

specific -

  • antibiotics or anti fungal into ear canal (pope wick)
  • if suspected cellulitis give orally
  • if chronic, treat with acetic acid and corticosteroids
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8
Q

complications of OE?

A
  1. abcess
  2. malignancy (osteomyelitis)
  3. otitis media/interna
  4. perforation
  5. cellulitis (which will require oral antibiotics)
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9
Q

what is mastoiditis and a subperiosteal abscess?

A

this is when the infection in the air cells in the mastoid process which com from the adits to mastoid antrum begins to collect pus in the tube, this increase in pressure due to blocking and pus leads to necrosis. this spread can lead to subperiosteal access, commonly found -

  • macewans triangle (posterior to pinna)
  • zygomatic bone (superior)
  • squamous temporal boen (very superior)
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10
Q

Clinical features of mastoiditis

A

history -

  • recurrent history of otitis media problems
  • otalgia
  • hearing loss
  • irritability in child
  • pyrexia

examination -

  • pinna pushed forward
  • swelling behind pinna
  • oedema in ear canal
  • exudate
  • tenderness behind ear (macewans triangle)
  • Tympanic membrane rupture
  • cholesteoma
  • lethargic

do a neurological examination and if signs of distress = advanced disease -

  • CN6 (abducens)
  • CN7 (facial/bells)
  • CN5a (ophthalmic branch of trigeminal nerve can cause pain)
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11
Q

what can periorbital cellulitis lead to

A

orbital access

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12
Q

what are other causes of periorbital cellulitis

A
  • dental infection
  • dacrocytosis
  • endophthalmitis
  • foreign bodies
  • trauma
  • skin infections (IMPETIGO)
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13
Q

what is periorbital cellulitis?

A

infection of the eyelids and eye socket characterised by oedema and erythema. can result in -

  • death
  • blindness
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14
Q

epidemiology of periorbital cellulitis

A
  • age 0-15 (mostly at 10)
  • mostly in boys
  • in line with sinusitis cases (winter)
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15
Q

Pathology of periorbital cellulitis

A

Staph A, H. influenza or stretococcal infections get into the peri-orbital area (pre/post septum) and migrate into the periosteum. it is usually through the ethmoidal sinus. infection can also come from -

  • endophthalmitis
  • dacrocytosis
  • foreign body
  • dental bacteria
  • trauma
  • skin infection
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16
Q

clinical features of periorbital cellulitis?

A

history of URTI or sinusitis in the last couple of weeks. pre orbital -

  • no eye involvement
  • oedema
  • erythema

Chandler Classification

1) pre-orbital cellulitis (as above)
2) orbital cellulitis (low degree of proptosis, loss of eye movement, vision loss, conjunctival chemosis)
3) subperiosteal abcess - increased level of symptoms above but due to collection of pus in cavity wall
4) Intraorbital abcess - full collection of pus in the orbital socket
5) Cavernous sinus thrombosis -

4 + bilateral oedema in eyelids anf cranial nerve involvement of 3,5,6 with potential -

  • sepsis
  • mental state alteration
  • N/V

Orbital apex syndrome -

  • loss of vision
  • loss of motility
  • oedema
  • optic neuralgia (Va)
  • proptosis
17
Q

Where do the palatine tonsils sit?

A

in the tonsils capsule made up of the anterior and posterior tonsils pillars

18
Q

what age group is most likely to get peritonsilar access and what is the causative agent?

A

10-20 (fusobacterium necrophorum)

30+ (GAS)

19
Q

what is a peritonsilar access?

A

complication associated with tonsillitis –> peritonsilar abscess-> retropharyngeal/parapharyngeal abscess

20
Q

give benzylpenicillin for tonsillitis

A

Benzylpenicillin

Questions (8 decks)

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