Pediatric Oto Flashcards
What is the most common disorder seen by otolaryngologists and peds?
Otitis media
Foreign bodies usually get placed where in the ear by kids?
What problems can this cause?
- LATERAL part of External auditory canal
2. damage to middle or inner ear; SNHL, dizzy
If a kid puts something in their nose, this can result in what type of rhinorrhea?
UNILATERAL, foul-SMELLING, purulent rhinorrhea
What may happen if a kid swallows batteries and it gets lodged in the esophagus?
can leak caustic fluid and result in serious burns –> fatal perforation with mediastinitis
When are tonsillectomies performed on adults and peds patients today?
- recurrent or chronic tonsillitis
- obstructive sleep apnea
- asymmetric tonsils
- peritonsillar abscess.
When is tonsillectomy indicated in kids with recurrent tonsillitis?
7+ infections per year, 5/year for the past 2 years, or 3/year for the past 3 years
What are some mitigating factors of kids with recurrent tonsillitis?
- recurrent severe infections requiring hospitalization
- complications of infection (peritonsillar abscess, periodic fever, aphthous stomatitis, pharyngitis and adentitis (PFAPA) or Lemierre’s syndrome (thrombophlebitis of the internal jugular vein)
- multiple antibiotic allergy/intolerance
- family history of rheumatic heart disease
- numerous repeat infections in a single household (“ping-pong spread”).
How is chronic tonsillitis different than recurrent tonsillitis?
Chronic low-grade infection of the tonsils can occur in older children, adolescents, and adults. These patients often have large crypts, or spaces within the tonsils that collect food and debris (chronic halitosis), that are difficult to treat with antibiotics.
Neck LN usually inflammed
What is the typical history of patients with chronic tonsillitis?
Chronic halitosis (bad breath) Sore throat that gets better on abx but comes back as soon as they stop meds
What is common cause of Obstructive sleep apnea in kids? Tx?
Enlarged tonsils and adenoids
Tonsillectomy and adenoidectomy curative.
What is common cause of Obstructive sleep apnea in adults?
increased amount of soft tissue in the pharynx and hypopharynx.
Symptoms of OSA?
Daytime lethargy, obstructive symptoms, growth retardation, behavioral problems, including poor school performance and hyperactivity, and nocturnal enuresis
In what population does severe sleep apnea occur?
Kids with Down Synd.
Kids
What causes asymmetric tonsils?
Is it more likely to be malignant in kids or adults?
recurrent scarring from infections, but they may harbor tumors (such as lymphoma) and should be removed for pathologic examination.
Adults
Where does a peritonsillar abscess (or quinsy) collect?
In the potential space between the pharyngeal constrictors and tonsil itself.
Classic history and signs of pt w/peritonsillar abscess?
recent sore throat that has now become significantly worse on one side.
Classic signs: fullness of the anterior tonsillar pillar, deviated uvula, “hot-potato voice” (somewhat muffled sound to voice), and severe dysphagia.
How to tx peritonsillar abscess?
I&D, high does Abx
If pt has 2+ episodes, do tonsillectomy
Where are adenoids located?
posterior pharyngeal wall and roof of the nasopharynx just behind the soft palate and adjacent to the torus tubarius (eustachian tube openings)
What symptoms may occur if adenoids are enlarged?
Airway compromise arise, such as nasal obstruction, chronic mouth breathing, and snoring.
What can adenoiditis result in?
secondary eustachian tube dysfunction, and the proximity of a bacteria reservoir within the adenoid tissue can be an underlying cause of otitis media and sinusitis in children.
If older children have recurrent acute otitis media or chronic otitis media with effusion, especially if effusion has returned after tympanostomy tube extrusion, what can be done?
Adenoidectomy
When do adenoids atrophy typically?
Puberty
What is the term for a high-pitched, noisy respiration emanating from the larynx or upper trachea? What is this a sign of?
- Stridor
2. Respiratory obstruction
Which 3 causes of stridor can be life threatening in kids?
- Acute epiglottitis
- Croup
- Foreign body aspiration
Acute epiglottitis is an infection of the SUPRA/SUBglottic (above the vocal cords) structures that causes swelling of the portion of the larynx above the vocal cords. The swelling can become so severe that it blocks the airway
SUPRA
What organisms typically cause acute epiglottitis?
Why is acute epiglottitis dec in incidence lately?
H influenza type B.
HiB Vaccines have dec incidence of this dz
What are the cardinal signs of acute epiglottitis?
stridor, leaning forward in a tripod posture, and drooling because it hurts to swallow.
Croup: no pain to swallow and no drooling
A. 3-6mo - 3 yo not septic
B. 3-6yo Septic
Which describes Acute epiglottitis and which describes croup?
A = croup B = acute epiglottitis
T/F If a child w/acute epiglottitis obstructs acutely, the airway can almost always be maintained with a bag and mask, but DO NOT lie down
T
What is approp therapy for H influenza type B and S aureus (double and singe drug therapy)
- ceftriaxone and oxacillin
2. Cefuroxime
Croup or laryngotracheobronchitis is a viral infection of the upper airway causing swelling in the SUPRA/SUBglottic area and stridor
SUBglottic (below the vocal cords)
What is this syndrome?Stridor is high pitched, biphasic (with both inspiration and expiration), and associated with a “barking” cough—often sounding like a seal.
Croup
What is the classic radiologic finding for croup? For epiglottitis?
Steeple sign
Thumb sign
Tx for croup?
Humidity, oxygen and if necessary racemic epinephrine tx or steroids
Most common cause of stridor?
foreign body that has been aspirated into the tracheobronchial tree
Presentation of foreign bodies in airway?
PAROXYSMAL coughing and stridor that may or may not resolve, followed by wheezing.
History of choking!
May refuse to eat and will drool
RECURRENT BOUTS OF PNEUMONIA
If a small object is swallowed, where can it end up?
Hypopharynx or esophagus.
What is the problem with aspiration of peanuts?
the oil and salt produce a chemical inflammation that causes the bronchial mucosa to swell, making removal difficult.
Foreign body aspiration can cause bronchial ball valve obstruction which will hypo/hyperinflate one lung
Hyper
Why is subglottic stenosis becoming more common cause of stridor?
NICU with long-term tube placement scars the endotracheal tube and eventionally the subglottic area.
Is stridor biphasic or monophasic with subglottic stenosis?
Biphasic (same with croup - makes sense bc both subglottic but croup due to infection.
Tx for severe subglottic stenosis? Mild?
- Tracheotomy (butmay delay speech and get plugged w/mucus)
- Laryngotracheal reconstruction (rib cartilage grafted into cricoid cartilage and upper tracheal rings)
- Mild - laser plus balloon dilation
Sublgottic hemangiomas can cause stridor and occur at ___ age range. When will spontaneous involution occur?
- 2-4 month bc rapid growth phase.
2. 12-24mo.
___% of pts w/subglottic hemangiomas have other associated head and neck hemangiomatas on skin
50
Tx of hemangiomas?
Laser, systemic steroids and interferon. Off label propranolol
Why do vascular rings (embroyologic phenomenon) cause stridor in kids?
Artery (e.g. double-arched aorta or innominate a) may Compression of the trachea.
How do you definitively diagnose vascular rings?
Tx?
- CT scan or MRI of chest.
2. ligation and division of the offending vessel or rerouting.
Most common cause of persistent stridor in infants?
What does the epiglottis look like?
Laryngomalacia (floppy SUPRAglottic airway –> high-speed airflow)
Omega sign
T/F • If there is no history of respiratory distress (apnea, cyanosis, retractions) and the patient is gaining weight well, tx for larngomalacia is simply observation, because these children will usually grow out of the condition.
T
If a pt w/larynggomalacia has apneic episodes or desaturates, then what can be done to the supraglottic tissues?
What are other indications for surgery?
can be trimmed or a tracheostomy can be performed.
poor wt gain or failure to thrive.
Laryngomalacia and what condition are associated?
GERD. In symptomatic children, empiric treatment of GERD may result in improvement.
T/F neck masses in kids are most likely to be malignant?
F - benign
What are 3 congenital causes of neck masses in kids?
- lymphangioma/cystic hygroma
- branchial cleft cyst
- thyroglossal duct cyst
What are 6 infectious causes of neck masses in kids?
- tonsillitis
- pharyngitis
- cat-scratch disease
- atypical mycobacterial infection
- TB
- retropharyngeal cellulitis or abscess
What are 3 malignant neck masses seen in kids?
- Salivary gland malignancy
- tumors of thyroid gland –> mets to LN
- Lymphoma (Hodgkins) - presents as cervical lymphadenopathy
common congenital neck masses due to lymphatic malformation –> immediate intubation at birth
lymphangioma/cystic hygroma
Where are branchial cleft cysts typically found?
Tx?
Anterior border of SCM
Abx but recur
Where do thyroglossal duct cysts typically occur?
Tx?
midline, usually over the thyrohyoid membrane. They are usually associated with the hyoid bone and move with swallowing Sistrunk operation (remove midportion of hyoid bone)
Most common reason for enlarged LN in kid?
Tonsillitis or pharyngitis
What organisms infect LN of kids with tonsillitis or pharyngitis?
Presentation?
Staph or strep
Febrile, nodes tender and may suppurate
Kid who presents with suppurative adenitis WITHOUT associated constitutional symptoms (fever, malaise, and localized tenderness) may have?
Cat scratch disease
Atypical mycobacterial infection is occasionally a cause of swollen lymph nodes in children. Generally, this is confined to what levels of the neck?
1 and 2
What condition classically presents as a collection of matted LN?
TB
What is this condition? Cervical adenitis that occurs in the space behind the pharynx and may have inflammation on the anterior spinal ligament and base of the skull (stiff neck and fever)
Retropharyngeal cellulitis or abscess
Xray shows thick retropharyngeal space anterior to the spine
How do you treat retropharyngeal cellulitis vs abscess?
Cellulitis: abx (covering S aureus, anaerobes, H influenza)
Abscess: surgical I&D through mouth or neck
Since retropharyngeal cellulitis/abscesses may affect the meninges, a drug that penetrates the CSF should be used. What are these drugs?
Cefuroxime
Ticarcillin
Clavulanate
Vancomycin for resistant orgs (e.g. penicillin-resistant S pneumonia)
Name of congenital mass bw eyes and over bridge of nose.
Cause?
Nasion
dermoid cyst or a congenital herniation of the intracranial tissues (encephalocele or meningoencephalocele)
Kids with tongue tie have a short what? They have trouble saying what letter?
- short lingual frenulum that limits tongue mobility.
2. L
Rhinosinusitis is most commonly viral or bacterial? How does this impact tx?
Viral
Don’t need abx even though parents insist
When might you prescribe abx for rhinosinusitis
Children that have persistent illness that lasts for weeks or months and is associated with fever. These patients may benefit from antibiotics directed toward common pathogens.
Where might rhinosinusitis spread and what symptoms might occur?
peri- and intraorbital tissues and result in visual change, proptosis, or loss of normal eye movement
