Pediatric ENT Flashcards
cholesteatoma
trapped epithelial tissues grows beneath surface of tympanic membrane
white, cystic mass w/in or behind TM, pearly and irregularly shaped
progressive HL
needs to be surgically removed or will erode mastoid bone, ossicles, inner ear and potentially the cranium
can occur across the lifetime
HL prevention
prevent erythroblastosis fetalis, hyperbilirubinemia, congenital rubella
avoid ototoxic antibiotics like aminoglycosides when possible
avoid exposure to loud noise - earbuds, firecrackers, cap pistol shots
AOM overview
acute otitis media
suppurative infection of the middle ear cavity
most prevalent in kids btwn 6-24 mos of age
80% of kids with AOM get better w/o antibiotics
AOM pathogens - bacterial
streptococcus pneumoniae, morexella catarrhalis, haemophilus influenze, strep pyogenes (less common)
AOM pathogens - viral
respiratory syncytial virus, rhinovirus, influenza, adenovirus, parainfluenza virus
more common than bacteria
AOM risks
non-modifiable - down syndrome, craniofacial anomalies, kids eustachian tubes are more horizontal/ level than adults
modifiable- day care, second hand cigarette smoke, formula-fed infants with feeding position (formula perfect for growth and flows back into eustachian tube)
AOM presentation
follow URI by 1-7 days, presents with pain a/o irritability, fever, nasal congestion
AOM Dx requirements
recent, abrupt onset of illness
presence of middle ear fluid or effusion
s+s of middle ear inflammation
severe AOM
moderate+ otalgia OR
otalgia > 48 hrs OR
Temp > 102.2
AOM tx plan
tx all kids 6-23 mos w/ antibiotics
tx kids 2+ with antibiotics or observation with clear follow-up plan
AOM antibiotics
if no amoxicillin in past 30 days - give amoxicillin 80-90 mg/kg/day for 10 days
if high risk or recent amoxicillin or tx failure in 48-72 hrs,
give augmentin (amoxicillin-clavulanate), cefuroxime axetil, ceftriaxone
AOM follow up
fluid persist for 4-6 wks after AOM
NO prophylactic antibiotics to reduce AOM in kids w/ recurrent AOM
tympanostomy tubes
3 episodes of AOM in 6 mos 4 episodes in 1 year w/ 1 in past 6 mos serous fluid for > 12 wks complicated AOM that could lead to meningitis, mastoiditis, etc fall out in 2-6 mos naturally
AOM prevention
promote breast-feeding for 6 mos after birth
decrease exposure to passive tobacco smoke
avoid bottle propping
prevnar decreases deadly, difficult strains of AOM infecteion
otitis externa etiology/ s+s
inflammation of skin in ear canal from trauma
often caused by water trapped in canal from swimming in lakes or pools
pathogens - staphylococcus aureus, psuedomonas aeruginosa
symptoms - pain with external ear tugging
OE tx
combo - antibiotic + corticosteroid
- cortisporin otic, cipro HC, floxin otic (topical)
ear wicks used in severe cases to get meds in ear
manage pain
OE prevention
let canal heal
avoid q tips
try mack’s earplugs
homemade solution after swimming - 1 part rubbing alcohol to one part white vinegar ( dries canal + some bacteriostatic)
choanal atresia
congenital nasal obstruction
b/l or u/l
bony (90%) or membraneous
b/l - presents at delivery with severe respiratory distress and paradoxical cyanosis, emergent surgery with possible incubation needed
u/l - asymptomatic besides unilateral nasal discharge
paradoxical cyanosis
cyanosis relieved by crying and worse when at rest
epistaxis
common in winter
most commonly due to nose picking
can be caused by cocaine - septal defect (longtime use)
epistaxis tx
digital pressure and no nose blowing
phenylephrine spray or silver nitrate cautery
may need nasal packing
epistaxis prevention
humidity, lubrication, cut nails, discontinue irritants
r/o underlying bleeding disorder if sever/recurrent
septal hematoma
collection of blood in the septum rare cause of epistaxis can cause permanent septal defect, ruin septum tx - immediate I&D usually due to blow to the nose
allergic rhinitis
inflammation of nasal and sinus passages
seasonal, perennial, episodic
sneezing, runny nose, congestion, itchy eyes
20-30% of all kids, 75% of those with asthma
important hx - Fhx, home, pets, smokers, seasonal “triggers”
PE - allergic shiners, allergic salute
atopic triad
asthma/ allergy/ atopic dermatitis
AR tx
remove offending agent - pets, smoke, dust, mold, insects - dust mites, cockroaches
oral:
OTC - loratadine, cetirizine, fexofenadine, diphenyhydramine
Rx - desloratadine, monteleukast
topical
steroids ( best if used regularly) - fluticasone, triamcinolone (nasocort - OTC), mometasone, budesonide
antihistamines - azelastine HCl
Viral URI
common in any age esp, 6 mos - 6 years
7-10 days
nasal congestion, coryza, sneezing, mild conjunctivitis, sore throat, hoarseness, cough, fever for 2-3 days that is low grade
cure - rest, fluids, time, saline nasal drops, oral cough and cold meds - supportive care and do not shorten duration ( be careful with psuedophedrine with little kids)
NO antibiotics
coryza
rhinitis
psuedophedrin
not approved for kids < 4 yo (prefer not until 6)
side effects
sinus formation
sphenoid forms by 5 yo
frontal - by 7-8 yo present, not complete until late adolescence
ethmoid, maxillary present at birth
acute bacterial sinusitis (ABS)
consider if URI symptoms for 7-10 days w/ no signs of improvement
presents by following URI
symptoms - purulent nasal discharge, headache, foul breath, toothache, facial pain and fever at times
ABS pathogens
s. pneumoniae, h. influenzae, m. catarrhalis
diagnostic criteria of ABS
persistent illness for > 10 days w/o improvement
worsening course of illnes
sever onset - fever > 102/39 OR purulent nasal discharge for at least 3 days
DON’T image unless concerned for orbital or CNS complications (kids have growing bones!)
ABS tx
antibiotic theraphy OR additional outpt abservation *3 days
- amoxicillin 80-90 mg/kg/day w/ or w/o clavulanate for 10+ days
- recurrent cases - tx for 21 days
ENT foreign bodies
ear: pain, drainage, HL
nose: unilateral purulent rhinitis, persistent sinusitis, blocked nasal passage on exam
don’t blindly probe - remove only if visible with forceps, curette, foley
cleft lip and palate etiology
1 in 1,000
M:F ratio is 3:2
risks - fetal exposure to alcohol, tobacco, certain drugs
sometimes associated w/ recognizable syndrome or genetic abnormalities
cleft lip
failure of maxilary and medial nasal processes to fuse
anywhere from a small notch to a complete cleft that extends to base of nose
worry about feeding difficulties
correct at 2-10 weeks of life
cleft palate
midline fissure of the palate incomplete
concern about speech difficulty, otits media
surgery: 6-18 months
hand, foot and mouth disease
usually coxsackie A16 virus
under 5 yo
incubation 5-7 days usually late summer and fall
painful oral ulcers, low grade fever, gray-red vesicles on palms and soles
tx - supportive - fluid and pain relief
pharyngitis
usually viral esp under 2 yo
bacterial more commonly group a strep
identify and treat - reduce symptoms, prevent acute rheumatic fever development, prevent local suppurative complications, prevent transmission
viral vs. group A strep
viral - gradual onset, sore throat, rhinorrhea, cough, and conjunctivitis, sometimes laryngitis, diarrhea, or fever
bacterial - sore throat, headache, fever, nausea, tonsillar exudates, petechiae on soft palate, beefy red throat, sandpaper rash over groing and torso - scarlet fever, has a fetted, sweet small
strep diagnosis and tx
diagnosis: rapid strep antigen testing a/o throat culture, follow neg. with culture if sick <24 hrs
tx: penicillin or amoxicillin, erthyromycin if allergic
tonsillectomy
documented sore throat-
1. 7+ episodes in 12 months
2. 5+ episodes in each of 2 prior years
3. 3+ episodes in each of 3 prior years
PLUS one of following: fever, tonsillar exudate, or positive culture
- if criteria not met, watchful waiting
- indicated for evidence of sleep-disordered breathing aND comorbid conditions that would benefit - growth retardation, poor school performance, enuresis, behavioral problems
epiglottitis
usually group a strep
rapid onset of sore throat, muffled voice, high fever and drooling - kids look awful
thumb sign on x-ray
assume critical airway and don’t examine oropharynx unless able to intubate STAT
mononucleosis
strep present in at least 25% of pts
ampicillin may cause a rash, don’t use, use macrolide
peritonsillar abscess
unilateral walled of inside of tonsil, can get very large
more common 10+ yo
compl of group a strep pharyngitis
high fever, muffled voice, drooling, dyspnea, pain
tx - early diagnosis, I&D, antibiotic (hospitalization common)
retropharyngeal abscess
posterior pharynx - cannot see
more common <6 yo
pathogens - staph aureus and anaerobes
high fever, muffled voice, drooling, toxic looking - look gray and worried
tx - early diagnosis, I&D, antibiotic (hospitalization common)
cervical adenitis
inflammation of cervical lymph nodes via group A strep or staph aureus
symptoms - neck pain and dysphagia
signs - unilateral red, tender, swollen LN with fever
tx - PO, IM, IV antibiotic, strep test and possible PPD
