Pediatric ENT

Question 1

Cholesteatoma

Answer 1

• Consists of trapped epithelial tissue that grows beneath the surface of tympanic membrane
• Appears as a white, cystic mass within or behind the TM
• Causes progressive hearing loss
• If not surgically removed, can erode mastoid bone, ossicles, inner ear, and even cranium

Question 2

Prevention of hearing loss

Answer 2

• Prevention of erythroblastosis fetalis, hyperbilirubinemia (high bilirubin can effect hearing loss), and congenital rubella
• Avoidance of ototoxic antibiotics when possible (i.e. aminoglycosides)
• Reduction of exposure to loud noise in environment, including music (headphones), firecrackers, and shots from cap pistols

Question 3

Acute Otitis Media (AOM)

Answer 3

suppurative infection of middle ear cavity 
80% get better without antibiotics 
ear tugging is not a reliable sign 
TM won't luff, will see pus
often follows an URI

Question 4

severe AOM

Answer 4

o Moderate or severe otalgia, or
o Otalgia at least 48 hours, or
o Temperature ≥39ºC (102.2ºF)

Question 5

non-severe AOM

Answer 5

o Mild otalgia for less than 48 hours

o Temperature ‹39ºC (102.2ºF)

Question 6

AOM antibiotic treatment

Answer 6

amoxicillin
90mg/kg/day for 10 days
or augmentin, ceftin or rocephin

Question 7

when to offer tubes

Answer 7

o 3 episodes in 6 months, OR
o 4 episodes in 1 year, with 1 in past 6 mos
o Serous fluid > 12 weeks
o Complicated AOM
• Got mastoiditis or meningitis, had to be admitted

Question 8

AOM Prevention

Answer 8

promote breast-feeding for at least the first 6 months of life
• Decrease modifiable risk factors
o Eliminate exposure to passive tobacco smoke
o Avoid “bottle-propping”
• Prevnar (Pneumococcal vaccine) –
o Dosed at 2,4,6, and 12-15 months
o Early data suggests deadly strains decreased, but overall incidence of AOM unchanged

Question 9

otitis externa definition and cause

Answer 9

inflammation of the skin in the ear canal

commonly caused by water trapped in canal from swimming in lakes for pools

Question 10

Otitis externa pathogens

Answer 10

staphlycoccus aureus

pseudomonas aeruginosa

Question 11

otitis externa symptoms

Answer 11

pain, tugging of external ear
can get green discharge
no cold symptoms

Question 12

OE treatment

Answer 12

combo drops: antibiotic/corticosteroid

Question 13

choanal atresia

Answer 13

nasal obstruction, 90% are bony

Question 14

allergic rhinitis triad

Answer 14

asthma, allergy, atopic dermatitis

Question 15

allergic rhinitis physical exam pearls

Answer 15

allergic shiners – collection of blood below eyes

allergic salute – line across nose

Question 16

acute bacterial sinusitis pathogens

Answer 16

• S. pneumoniae
• H. influenzae
• M. catarrhalis

Question 17

acute bacterial sinusitis diagnostic criteria

Answer 17

o Persistent illness >10 days without improvement or
o Worsening course (cough, nasal d/c, new fever) or
o Severe onset (fever ≥39ºC or purulent nasal discharge at least 3 days)

Question 18

hand foot mouth disease virus

Answer 18

coxsakie A16 virus

Question 19

Ethmoid development

Answer 19

at birth

Question 20

maxillary development

Answer 20

at birth

Question 21

sphenoid development

Answer 21

5 years

Question 22

frontal development

Answer 22

7-8 years

Question 23

cleft lip definition

Answer 23

failure of the maxillary and median nasal processes to fuse
feeding difficulties
repair at first 2-10 weeks of life

Question 24

cleft palate

Answer 24

midline fissure of the palate, failure of 2 to fuse
speech difficulty, otitis media
repair at 6-18 months

Question 25

why want to indentify and treat strep throat

Answer 25

1. reduce symptoms
2. prevent sequela of acute rheumatic fever
3. prevent locally suppurative complications
4. prevent transmission to others

Question 26

epiglottitis

Answer 26

group a strep
rapid onset of sore throat
drooling and fever
do not examine the oropharynx