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3a paeds > Paeds ENT + Ophthalmology > Flashcards

Paeds ENT + Ophthalmology Flashcards

1
Q

What is otitis media?

A

infection in the middle ear

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2
Q

What are the hearing tests

A
  • Otoacoustic emission test (birth)
  • Auditory Brainstem Response test –> if otoacoustic abnormal
  • Distraction test (6 - 9months)
  • Pure tone Audiometry (>3y)
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3
Q

What is Rinne +

A

a patient who hears the tuning fork loudest when it is placed 1cm from the external auditory meatus

air > bone
(Sensorineural hearing loss)

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4
Q

What is Rinne -

A

a person who hears loudest when placed over the mastoid process has a negative Rinne test.

bone > air

(conductive hearing loss)

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5
Q

What is weber test results in Sensorineural hearing loss

A

sound is heard louder on the side of the intact ear.

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6
Q

What is weber test results in conductive hearing loss

A

sound is heard louder on the side of the affected ear.

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7
Q

what is an audiogram

A

measures hearing inn dB
bigger = worse hearing

normal = 20dB

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8
Q

What are non congenital causes of hearing loos

A

OM + OE + earwax
cholesteatoma, meniere’s, acoustic neuroma, otosclerosis,

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9
Q

Where is the middle ear?

A

the space that sits between the tympanic membrane (ear drum) and the inner ear

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10
Q

How does bacteria enter the middle ear to cause otitis media?

A

bacteria enter from the back of the throat through the eustachian tube

bacterial infection of the middle ear is often preceded by a viral upper respiratory tract infection.

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11
Q

WHat is the most common bacterial cause of otitis media and other ENT infections?

A

streptococcus pneumoniae.

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12
Q

How does otitis media present?

A

ear pain - tugging on ear
fever
poor feeding
hearing loss
ear discharge if tympanic membrane perforates

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13
Q

What are possible otoscopy findings of otitis media?

A

Bulging tympanic membrane –> loss of light reflex
perforation

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14
Q

What are RF for otitis media

A

immature eustachian tube
daycare
cleft lip
downs
breastfeeding
low birth weight

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15
Q

How is otitis media managed?

A

usually self limitied but if persist >4 days then 5 day course of amoxicillin/erythromycin

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16
Q

What are complications of otitis media

A

mastoiditis, meningitis, CN7 palsy, abscess

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17
Q

what is glue ear?

A

Otitis media with effusion.

The middle ear becomes full of fluid, causing a loss of hearing in that ear.

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18
Q

what causes glue ear?

A

blocked eustachian tube

eustachian tube connects ear to back of throat and drain secretions

when blocked causes fluid build up in middle ear

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19
Q

What is the main symptom of glue ear?

A

reduced hearing

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20
Q

what is the main complication of glue ear

A

otitis media

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21
Q

What is otitis externa

A

S. Aureus ear canal infection associated with swimming, daycare

itchy and thick discharge

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22
Q

How is otitis externa diagnosed

A

otoscopy eczematous, erythemotous ear canal with normal tympanic membrane

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23
Q

How is otitis externa treated

A

topical fluclox drops + steroid drops

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24
Q

what is complication of otitis externa

A

malignant OE

infection spreads to surrounding masto-temporal bone

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25
How is glue ear treated?
observe for 3 months referral to audiometry to establish diagnosis and extent of hearing loss lasts >3 months --> referral for myringotomy grommets +/- adenoidectomy
26
What are grommets
tiny tubes inserted into the tympanic membrane by an ENT surgeon allows fluid from the middle ear to drain through the tympanic membrane to the ear canal.
27
How long for grommets last?
majority stop functioning after 10 months
28
What are congenital causes of deafness
maternal rubella or cytomegalovrius infections during pregnancy genetic deafness associated syndromes eg Downs
29
What are perinatal causes of hearing loss
prematurity hypoxia during/after birth
30
What are causes of deafness after birth
jaundice meningitis/encephalitis otitis media/glue ear chemotherapy
31
how does deafness present?
UK newborn hearing screening programme (NHSP) tests hearing in all neonates. or parental concerns or behavioural changes
32
how can deafness manifest behaviourally?
Ignoring calls or sounds Frustration or bad behaviour Poor speech and language development Poor school performance
33
What are two types of deafness
conductive and sensorineural hearing loss
34
How is conductive and sensorineural hearing loss differentiate
by audiometry testing are recorded on an audiogram air and bone conduction tested separately
35
how does conductive hearing loss present on audiogram
bone conduction readings will be normal (between 0 and 20 dB), however air conduction readings will be greater than 20 dB conductive hearing loss = sound an travel through bones but not air due to pathology
36
how does sensorineural hearing loss present on audiogram
both air and bone conduction readings will be more than 20 dB
37
how is hearing loss managed?
Speech and language therapy Educational psychology ENT specialist Hearing aids for children who retain some hearing Sign language
38
What is mastoiditis
infected mastoid bone usually secondary to otitis media untreated
39
What are symptoms of mastoiditis
* otalgia (pain behind ear) * the external ear may protrude forwards * fever * swelling, erythema and tenderness over the mastoid process
40
How is mastoiditis treated
IV Abx Piperacillin and tazobactam
41
what is squint
misalignment of the visual axes/eyes Also known as strabismus
42
What are the two types of squint
concomitant (common) and paralytic (rare)
43
what is concomitant squint
Due to imbalance in extraocular muscles Convergent is more common than divergent
44
What is MC convergent squint caused bu
hypermetropic eye (long vision)
45
when is red reflex checked and what for?
on NIPE cong cataracts + retinoblastoma
46
what is paralytic squint
Due to paralysis of extraocular muscles
47
What is the pathophysiology of squint?
- In childhood, as the eyes have not fully established their connections with the brain, the brain copes with this by reducing the signal from the less dominant eyes. - This results in one dominant eye and one eye which will be ignored (lazy eye) - When left untreated, this lazy eye becomes more and more disconnected from the brain and the problem worses - this is known as amblyopia
48
What is diff between tropia & phoria squint
tropia is when the eyes are always misaligned phoria is when the eyes are sometimes misaligned
49
What is esotropia squint
- inward position squint -> affected eye deviated towards the nose MC
50
what is exotropia squint
outward position quint -> affected eye deviated towards the ear
51
what is hypertropia squint
upward moving affected eye
52
what is hypotropia squint
downward moving affected eye
53
What causes squint
- Idiopathic - Hydrocephalus - Cerebral palsy - Space occupying lesion e.g retinoblastoma - Trauma
54
How is squint investigated?
Eye movements and inspection - Cover test - Fundoscopy - Visual acuity - Hrischberg’s test -
55
What is the cover test
- ask the child to focus on an object - cover one eye - observe movement of uncovered eye - cover other eye and repeat test
56
What is Hrischbergs test?
aka corneal light reflection test holding a light source 30cm from the child's face to see if the light reflects symmetrically on the pupils for px who cannot do cover test
57
How is squint managed?
- Treatment must start before 8 years of age - Occlusive patch on good eye - Atropine drops used in the good eye causing blurry vision
58
What is complication of untreated squint
lazy eye (amblyopia)
59
What is periorbital cellulitis? (inc symptoms)
eyelid infection by S. Aureus lacrimation, eyelid and periorbital oedema, non painful eye movement, minimal vision change, no chemosis (white part of eyeball swelling) non parenchymal
60
What is orbital cellulitis? (inc symptoms)
eye infected by S. Aureus miosis, chemosis, lacrimation, pain on movement, vision changes parchymal
61
what are risk factors of periorbital cellulitis?
- young boys - Previous sinus infection - Lack of Hib infection - Recent eyelid injury
62
how does periorbital cellulitis present?
Swelling, redness and hot skin around the eyelids and the eye
63
how is periorbital/orbital cellulitis investigated?
- Clinical examination - Full blood count - WBC elevated, raised inflammatory markers. - CT sinus and orbits with contrast will help to differentiate between periorbital and orbital (GS) - Blood culture and microbiological swab to determine the organism
64
how if periorbital / orbita; cellulitis managed?
Peri = PO Orb = IV fluclox stat
65
what’s hertz tuning for is used in rhinnes and weber
512
66
In patients with conductive hearing loss what are results of rhinnes and webers
Rinne’s test is negative (indicating bone conduction is better than air conduction) on the affected ear Weber’s test localises to the affected ear.
67
In sensorineural hearing loss what are results of rinnes and webers
Rinne’s test is positive (indicating air conduction is better than bone conduction) and Weber’s is heard in the unaffected ear.

3a paeds (12 decks)

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