W7: ENT Paeds, Allergy, Rhinology, Radiology Flashcards
Common presentations of ENT in Children
Hearing loss
Pain
Discharge: watery = ext. / pus = middle ear
Changes in school performance
Sore throat
Tinnitus
ENT Paeds: OTITIS MEDIA
Conductive hearing loss, presenting w/ behavioural, social
RF: <10Y/O ~5y/o peak (adenoid); day care, cleft palate
*self-resolve
> Hearing aids
Grommets tube
Adenoidectomy
Autoinflation
ENT Paeds: ACUTE OT. MEDIA
Common pres. w/ pain, fever, discharge
*H. influenza, strep pneumon., moraxella cataarrhalis
> co-amoxiclav
!progress to mastoiditis when mastoid air cells become infected
!progress to intra-cranial infection = MENINGITIS
Investigating hearing loss in ENT paeds
TYMPANOMETRY: middle ear pressure + patency
OTOACOUSTIC EMISSION: children screening. cochlear emission recieved
AUDITORY B.STEM RESPONSE: nerve stimulation sensory
ENT Paeds: OTITIS EXT.
Infective nature OR inflamm = dermatitis (swimmer’s ear)
> aural microsuction
> topical abx
> water precautions
ENT Paeds: CHRONIC OT. MEDIA
Persistent hearing loss + chronic discharge
+?CHOLESTEATOMA
> Mastoidectomy
Rhinology
RHINITIS = blocked/runny nose
think allergy, IgE
recurrent URTI
large adenoid = sleep apnoea
!bilateral blocked nose = FOREIGN BODY
SINUSITIS + POLYPS: association with CF; lesss common; acute vs chronic sinusitis
CHOANAL ATRESIA = bilateral inability to breathe (congenital narrowing)
Complications of Sinusitis
PERI-ORBITAL CELLULITIS = eye inflamm, oedema, proptosiis
+abscess
ENT Paeds: Epistaxis
common, M>F
- digital trauma
- mucosal irritation
- coagulation pathology: hereditary hemorrhagic telangiectasia (arteriovenous malformations in face esp)
- Little’s Area: most septal part w/ major anastamoses
> First Aid
Abx ointment
Cautery: silver nitrate
Nasal packing
Common hereditary disorder associated with epistaxis
hereditary hemorrhagic telangiectasia (arteriovenous malformations in face esp)
ENT Paeds: SORE THROAT
TONSILLITIS
- B haem strep
- EBV
> Abx
QUINSY: pus-filled swelling in the throat that develops infrequently as a complication of acute tonsillitis
- acute worsening of sore throat (unilateral), swelling
- trismus = lockjaw
ENT Peds: AIRWAY ISSUES
Think: foreign body, and STRIDOR
LARYNGOMALACIA: congenitl soft cartilage = narrowing
EPIGLOTTITIS: Haemophilus influenza type b (Hib) bacteria
> IV abx
>intubation
ENT Paeds: NECK ABSCESS
d/t lymphadenotitis = firm swelling, cyst
?dental infection
*USS
> drainage & aspiration
Define allergy
Type 1 IgE mediated response upon re-exposure comprising of MAST CELL degran. producing immediate and late symptoms.
Summarize the factors that produce allergic reactions including eczema, asthma and food allergies
Host: hereditary, race, age
Env: exposure to. infectious disease + pollution, dietary changes, HYGIENCE HYPOTHESIS
Occupational: flour, latex, wood dust
describe diagnostic tests including skin tests, RAST and blood tests
- SKIN TEST*
- RAST: detection of IgE presence and levels
- Hx and PMG
- ImmunoCAP Specific IgE blood test: finger prick blood =
Allergic Rhinitis Classifiction
INTERMITTENT: <4d/w
PERSISTENT: >4d/w AND >4 consecutive weeks
MILD: normal sleep and no impairment
MODERATE: Disturbances and impairment
*seasonal and per-annual nature
Management of Allergies
Pt education = avoiding any future triggers
> Anti-histamines
> Topical steroid spray
> Na Chromoglicate = masst cell destab.
> Anti IgE
______
ImmTherapy = promote immune tolerance and graaadual increase (IgG blocking IgE mediation)
Sx
Non-Aallergic Rhinitis
Granulomatous
Vasomotor = irritants
Infectious
Hormonally-induced (preg.)
Drug-induced (contraception, NSAIDs, decongestants, phosphodiesterase inhibitors)
Describe standard nasal examination techniques.
NASAL ENDOSCOPY
Bloods: fbc, ANCA, ESR, ACE, RAST
CT Scan: turbinates
MRI
Skin test
Rhinomanometry
- NASAL ALLERGEN CHALLENGE * gold standard but rarely used
Describe Acute and Chronic Rhinosinusitis and treatment modalities for these.
acute = onset of <4w
* S. pneumonia, H influenz.
> symptomatic relief - self limit
topical steroids
abx + topical (rare): penicillins, cephalosporin, clarithromycin
chronic = at least 12 consecutive weeks
*CT
> Sinus sx via endoscope
daily saline irrigation with topical cortical steroid therapy
systemic steroids
Describe how to assess and manage a patient with a nasal fracture.
- nasal haematoma following trauma = swelling
- can progress to a septal abscess
> drain
Describe diagnosis and management of Nasal Polyps
1º = chronic inflamm, NS dysf., genetic predisposition
asthma, recurring infection, allergies, drug sensitivity or certain immune disorders
2º = CF, AFS (alleg. fungal sinusitis), Churg-Strauss Syndrome (vasc. inflamm)
- sweat
- nasal smear = micro., eosinophils, neutrophils
- endoscopy
> oral and nasal steroids
aspirin desens.
tx of co-existing allergic rhinitis/asthma
dietary changes
> Sx: polypectomy
Be aware of the criteria used to assess of patient with Epistaxis.
assessment of vital signs, mental status, and airway patency.
Pott Puffy Tumour
Presents as a frontal sinusitis
Pott puffy tumor is a forehead swelling due to frontal bone osteomyelitis with associated subperiosteal abscess. PPT is a rare complication of sinusitis, but can also occur due to trauma
> long-term antibiotics, with surgical drainage, debridement and reconstruction
if resistant to abx = frontal sinus surgery
Ethmoidal Mucocele
Presents as: diplopia, Oculomotor Nerve Paralysis
> FESS (functional endoscopic sinus surgery)
Commonest causes of epistaxis in adults
- INFECTION: rhinitis, nasopharyngitis, sinusitis
- TRAUMA
- Allergy
- HT and atherosclerotic vasc. disease
- Hereditary hemorrhagic telangiectasia
Nasal Packs indications and CI
For resistant epistaxis.
CI:
Significant facial/nasal bone fractures. Basilar skull fracture. Hemodynamic instability or airway compromise requiring emergency blood transfusion or intubation
Sx Tx of Epistaxis
> endoscopic sphenopalatine artery ligation
> ethmoidal ligation
HHT:
laser coag.
> embolisation
Benign and Non-benign causes of epistaxis
Angiofibroma
> embolisation and sx
malignant sinonasal melanoma: presents with hearing loss
>RT
> Sx
> Combined Rx
