ENT + eyes

Question 1

Adenotonsillar hypertrophy CF

Answer 1

• Nasal obstruction - mouth breathing, recurrent pharyngeal/chest infection, chronic sinusitis, snoring, OSA
• Eustachian tube dysfunction - recurrent AOM, OME, chronic suppurative OM

Adenoids enlarged + pale o/e

Question 2

Deafness

Answer 2

• Sensorineural: uncommon in UK, usually present at birth, irreversible. Mostly genetic, can also be from antenatal/perinatal infection, post-meningitis/head injury, aminoglycoside/furosemide. Amplification with hearing aids, may need cochlear implant, need to ensure S+L development. At school sit at front so can see teacher + gestures
• Conductive: more common, usually mild-moderate. E.g. OME, ET dysfunction (in T21, cleft palate). M-decongestant, Abx, remove nasal allergies, grommets (tympanostomy tubes), adenoid removal, hearing aids

Question 3

Glue ear

Answer 3

Otitis media with effusion - serous/mucoid fluid in middle ear cavity, without features of acute infection. Often causes CHL, in some cases can affect development if not picked up

Higher risk in T21 and cleft palate

CF include repeated ear infection/pain, healing loss, recurrent URTI, behavioural/education problems, tinnitus. Dull appearance of TM with radial vessels visible (dark blue/grey colour or TM), immobilise TM, retracted ear drum

Monitor for 3m before considering intervention which would be grommet insertion +/- adenoidectomy

Steroids, Abs, antihistamines etc not recommended

Question 4

Conjunctivitis

Answer 4

Allergic or infective (often bacterial with a type of H influenza)

CF: gritty feeling to eyes (itchy if allergic), purulent/mucoid/watery discharge, eyelashes stuck together on waking, transient blurring of vision (dc on cornea) cleared with blinking, diffuse hyperaemia over sclera + inner eyelids

M: topical Abx drop/ointment e.g. chloramphenicol, not sharing towels etc

Comp: Keratoconjunctivitis: photophobia + pain indicates corneal involvement

Question 5

Peri orbital cellulitis

Answer 5

C: extension of infection from sinuses/face/haematogenouus, e.g. H influenza, S pneumonia, Staph

CF: acute swelling of orbital tissues, proptosis, oedema, limited eye movement

Comp: cavernous sinus thrombosis (cf-neuro signs, visual loss, muscle paresis, papilloedema), orbital bone erosion leading to abscess + meningitis

M: treat empirically, hot compress to help localise inflammatory reaction, surgical drainage if suppurative

Question 6

Cataracts

Answer 6

• Congenital: TORCH infection, hereditary – should detect in NIPE with absent red reflex (checked again at 6w)
• Developmental: genetic, metabolic e.g. galactokinase deficiency
• Acquired: traumatic, radiotherapy

CF: leucocoria (pupil looks white/cloudy spots), amblyopia (if not correcteD), loss of binocular function, squint (usually convergent, because of loss of binocular function), light sensitivity