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Yr 5 - ENT > Revision - Otitis Media & Tonsillitis > Flashcards

Revision - Otitis Media & Tonsillitis Flashcards

1
Q

What age is a risk factor for otitis media?

A

<4 y/o

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2
Q

What 2 genetic disorders can predispose to otitis media?

A

1) Primary ciliary dyskinesia

2) Kartagener’s syndrome

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3
Q

Lack of what vaccination can contribute to development of otitis media?

A

Pneumococcal

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4
Q

Is bottle or breastfeeding a risk factor for otitis media?

A

Bottle feeding

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5
Q

Give the 4 most common bacteria causing otitis media

A

1) Strep. pneumoniae

2) Haemophilus influenzae

3) Moraxella catarrhalis

4) Staph. aureus

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6
Q

What is the most common cause of hearing impairment in children?

A

Otitis media w/ effusion

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7
Q

What are the 2 types of chronic OM?

A

1) Chronic OM with effusion (‘glue ear’)

2) Chronic suppurative

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8
Q

How long must OM be present for to support a diagnosis of ‘chronic’?

A

> 3 months

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9
Q

Is acute or chronic OM with effusion more likely to cause hearing impairment?

A

Chronic

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10
Q

What is chronic suppurative OM?

A

Presents with persistent ear discharge through a perforated tympanic membrane (TM).

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11
Q

How long must discharge be present for in chronic suppurative OM to support a diagnosis?

A

> 2 weeks

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12
Q

What is often the management of acute OM?

A

Most cases of OM will self resolve without antibiotics and instead use simple analgesia.

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13
Q

When are Abx considered in OM?

A

A prescription for antibiotics may be given with the advice to take:

a) in 3 days if symptoms do not being to improve

b) or the patient becomes systemically unwell

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14
Q

Which groups is it recommended to prescribe Abx?

A

1) children <2 y/o with bilateral OM

2) children <3m with temp >38

3) OM with ear discharge (otorrhoea)

4) systemically unwell

5) high risk of complications

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15
Q

1st line abx in OM?

A

Amoxicillin (5-7d)

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16
Q

2nd line abx in OM?

A

Erythromycin or clarithromycin

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17
Q

Management of acute and chronic otitis media with effusion (glue ear)?

A

1) Conservative management & observation for 6-12 weeks

2) Pure tone audiometry

3) Referral to 2ary care if:
- There is concern with the child’s development
- The hearing loss persists after other symptoms have resolved
- There is severe hearing loss
- The child has Down’s syndrome or cleft palate

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18
Q

In what 2 conditions would you refer to 2ary care in chronic OM with effusion (glue ear)?

A

1) Down’s sydnrome

2) Cleft palate

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19
Q

Management options in 2ary care of chronic otitis media with effusion (glue ear)?

A

1) hearing aids –> offered to patients with persistent bilateral symptoms

2) Eustachian tube autoinflation –> blowing up a balloon with the nostrils several times a day

3) Surgical –> myringotomy with grommet insertion

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20
Q

How long are grommets usually in for?

A

They are ordinarily a temporary measure lasting around 12 months.

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21
Q

Perforations in what area of TM are more likely to lead to mastoiditis?

A

Upper portion of drum

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22
Q

What is mastoiditis usually the result of?

A

Infection of the middle ear –> OM

It most commonly occurs in children of school age following an UNTREATED episode of acute otitis media or after RECURRENT episodes of otitis media.

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23
Q

What are the most common pathogen causing OM/mastoiditis in young children prior to vaccination?

A

Haemophilus influenzar

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24
Q

What are the most common pathogen causing OM/mastoiditis in children of school age?

A

Strep. pneumoniae

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25
Q

What pathogen can cause OM or mastoiditis in diabetics?

A

Pseudomonas aeruginosa

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26
Q

What is there often a history of in mastoiditis?

A

Recurrent or chronic OM

27
Q

Abx of choice in mastoiditis?

A

1st line –> Cephalosporins e.g. ceftriaxone

If allergic to penicillins / beta-lactams –> vancomycin, gentamicin

28
Q

What branch of the facial nerve runs through the middle ear?

A

The corda tympani branch of the facial nerve.

29
Q

Risk factors for chronic suppurative OM?

A

poor hygiene, malnutrition, and exposure to polluted environments.

30
Q

Is tonsillitis more likely to be viral or bacterial?

A

Viral

31
Q

What tonsils are involved in tonsillitis?

A

Palatine tonsils

32
Q

What is the most common virus causing viral tonsillitis?

A

Rhinovirus

33
Q

3 most common viruses causing viral tonsillitis?

A

1) rhinovirus

2) covid

3) parainfluenza virus

34
Q

What is the most common bacterial cause of tonsillitis?

A

GAS (S. pyogenes)

35
Q

What is the 2nd most common cause of bacterial tonsillitis?

A

Strep. pneumoniae

36
Q

What Centor score indicates it is acceptable to offer abx?

A

≥3

37
Q

What 4 aspects make up the centor criteria?

A

1) fever >38

2) absence of cough

3) tender cervical lymphadenopathy

4) tonsillar exudates

Higher score = more likely to be bacterial cause

38
Q

Does a cough indicate that a viral or bacterial cause of tonsillitis is more likely?

A

Viral

39
Q

Where are the tonsillar lymph nodes located?

A

Just below the angle of the mandible (jaw bone)

40
Q

In which circumstance are investigations done in tonsillitis?

A

If confirmation of group A streptococcal (GAS) infection is required e.g. immunosuppression, very old/young, severe symptoms

41
Q

When it is indicated, what test is used for the confirmation of group A streptococcal (GAS) infection in tonsillitis?

A

1) Rapid antigen test for GAS

2) If negative –> throat culture

42
Q

What Abx is indicated in tonsillitis caused by group A streptococcus (Streptococcus pyogenes)?

A

Penicillin V (phenoxymethylpenicillin) 10d course

43
Q

Describe the FeverPAIN score

A

Fever >38 degrees in past 24h

P - purulence on tonsils
A - attended rapidly (<3d from symptom onset)
I - inflamed tonsils
N - no cough/coryza

44
Q

What are the NICE indications for Abx in tonsillitis?

A

1) features of marked systemic upset 2ary to the acute sore throat

2) unilateral peritonsillitis

3) history of rheumatic fever

4) an increased risk from acute infection (such as a child with diabetes mellitus or immunodeficiency)

5) patients with acute sore throat/acute pharyngitis/acute tonsillitis when 3 or more Centor criteria are present

45
Q

What FeverPAIN score would you consider prescribing Abx? What Centor score?

A

Centor –> ≥3

FeverPAIN –> ≥4

46
Q

1st line Abx in tonsillitis in penicillin allergy?

A

Clarithromycin

47
Q

Complications of tonsillitis?

A

1) peritonsillar abscess (quinsy)

2) rheumatic fever

3) scarlet fever

4) otitis media

5) post-strep glomerulonephritis

6) post-strep reactive arthritis

48
Q

What is the most common bacterial cause of a quinsy?

A

GAS

49
Q

Management of a quinsy?

A

1) Refer to hospital under ENT

2) Needle aspiration OR surgical incision & drainage to remove pus

3) Abx before and after surgery

50
Q

Choice of Abx in quinsy?

A

Co-amoxiclav (broad spectrum)

51
Q

How does a cholesteatoma present?

A
  • Recurrent ear discharge that may be foul smelling
  • Hearing loss
  • Pain (if there is an associated infection)
52
Q

What is a 1ary (or reactionary) haemorrhage post-tonsillectomy?

A

most commonly occurs in the first 6-8 hours following surgery

53
Q

Management of wound bleeding in the first 6-8 after tonsillectomy?

A

Immediate return to theatre

54
Q

What is 2ary haemorrhage post-tonsillectomy?

What is it associated with?

A

Occurs between 5-10 days after surgery.

Often associated with wound infection.

55
Q

Management of 2ary haemorrhage post-tonsillectomy?

A

Admission & abx

56
Q

When should a child with recurrent glue ear be referred to ENT?

A

If they have persisting significant hearing loss on TWO separate occasions (usually 6-12 weeks apart).

57
Q

management of otitis externa?

A

topical antibiotic or a combined topical antibiotic with a steroid

58
Q

Management of acute OM with perforation?

A

Oral Abx (amoxicillin) for 5-7 days

59
Q

What are 3 key complications of mastoiditis?

A

1) facial nerve palsy

2) hearing loss

3) meningitis

60
Q

Inheritance of otosclerosis?

A

Autosomal dominant

61
Q

What type of hearing loss does ototoxicity associated with medications typically cause?

A

Sensorineural

62
Q

Immediate management of bleeding post-tonsillectomy 5 days ago?

A

Refer immediately to ENT –> all post-tonsillectomy haemorrhages should be assessed by ENT

63
Q

What does unilateral glue ear in an adult need to be investigated for?

A

Posterior nasal space tumour

64
Q
A

Yr 5 - ENT (4 decks)

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