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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
Q

How is glue ear treated?

A

observe for 3 months
referral to audiometry to establish diagnosis and extent of hearing loss

lasts >3 months –> referral for myringotomy grommets +/- adenoidectomy

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26
Q

What are grommets

A

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.

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27
Q

How long for grommets last?

A

majority stop functioning after 10 months

28
Q

What are congenital causes of deafness

A

maternal rubella or cytomegalovrius infections during pregnancy
genetic deafness
associated syndromes eg Downs

29
Q

What are perinatal causes of hearing loss

A

prematurity
hypoxia during/after birth

30
Q

What are causes of deafness after birth

A

jaundice
meningitis/encephalitis
otitis media/glue ear
chemotherapy

31
Q

how does deafness present?

A

UK newborn hearing screening programme (NHSP) tests hearing in all neonates.

or parental concerns or behavioural changes

32
Q

how can deafness manifest behaviourally?

A

Ignoring calls or sounds
Frustration or bad behaviour
Poor speech and language development
Poor school performance

33
Q

What are two types of deafness

A

conductive and sensorineural hearing loss

34
Q

How is conductive and sensorineural hearing loss differentiate

A

by audiometry testing are recorded on an audiogram
air and bone conduction tested separately

35
Q

how does conductive hearing loss present on audiogram

A

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
Q

how does sensorineural hearing loss present on audiogram

A

both air and bone conduction readings will be more than 20 dB

37
Q

how is hearing loss managed?

A

Speech and language therapy
Educational psychology
ENT specialist
Hearing aids for children who retain some hearing
Sign language

38
Q

What is mastoiditis

A

infected mastoid bone usually secondary to otitis media untreated

39
Q

What are symptoms of mastoiditis

A
  • otalgia (pain behind ear)
  • the external ear may protrude forwards
  • fever
  • swelling, erythema and tenderness over the mastoid process
40
Q

How is mastoiditis treated

A

IV Abx Piperacillin and tazobactam

41
Q

what is squint

A

misalignment of the visual axes/eyes

Also known as strabismus

42
Q

What are the two types of squint

A

concomitant (common) and paralytic (rare)

43
Q

what is concomitant squint

A

Due to imbalance in extraocular muscles
Convergent is more common than divergent

44
Q

What is MC convergent squint caused bu

A

hypermetropic eye

(long vision)

45
Q

when is red reflex checked and what for?

A

on NIPE

cong cataracts + retinoblastoma

46
Q

what is paralytic squint

A

Due to paralysis of extraocular muscles

47
Q

What is the pathophysiology of squint?

A
  • 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
Q

What is diff between tropia & phoria squint

A

tropia is when the eyes are always misaligned

phoria is when the eyes are sometimes misaligned

49
Q

What is esotropia squint

A
  • inward position squint -> affected eye deviated towards the nose

MC

50
Q

what is exotropia squint

A

outward position quint -> affected eye deviated towards the ear

51
Q

what is hypertropia squint

A

upward moving affected eye

52
Q

what is hypotropia squint

A

downward moving affected eye

53
Q

What causes squint

A
  • Idiopathic
  • Hydrocephalus
  • Cerebral palsy
  • Space occupying lesion e.g retinoblastoma
  • Trauma
54
Q

How is squint investigated?

A

Eye movements and inspection
- Cover test
- Fundoscopy
- Visual acuity
- Hrischberg’s test -

55
Q

What is the cover test

A
  • ask the child to focus on an object
  • cover one eye
  • observe movement of uncovered eye
  • cover other eye and repeat test
56
Q

What is Hrischbergs test?

A

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
Q

How is squint managed?

A
  • Treatment must start before 8 years of age
  • Occlusive patch on good eye
  • Atropine drops used in the good eye causing blurry vision
58
Q

What is complication of untreated squint

A

lazy eye (amblyopia)

59
Q

What is periorbital cellulitis? (inc symptoms)

A

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
Q

What is orbital cellulitis? (inc symptoms)

A

eye infected by S. Aureus

miosis, chemosis, lacrimation, pain on movement, vision changes

parchymal

61
Q

what are risk factors of periorbital cellulitis?

A
  • young boys
  • Previous sinus infection
  • Lack of Hib infection
  • Recent eyelid injury
62
Q

how does periorbital cellulitis present?

A

Swelling, redness and hot skin around the eyelids and the eye

63
Q

how is periorbital/orbital cellulitis investigated?

A
  • 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
Q

how if periorbital / orbita; cellulitis managed?

A

Peri = PO
Orb = IV
fluclox stat

65
Q

what’s hertz tuning for is used in rhinnes and weber

A

512

66
Q

In patients with conductive hearing loss what are results of rhinnes and webers

A

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
Q

In sensorineural hearing loss what are results of rinnes and webers

A

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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