ENT - Paediatrics Flashcards by Peter Savage

What are the most commonly presenting ear problems in children?

Hearing loss
Otorrhea
Otalgia
Tinnitius
Vertigo

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How do hearing problems typically manifest in children?

Behavioural issues

Speech and language therapy

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What is conductive hearing loss?

Issue with Outer or middle ear, sound not being CONDUCTED through to the cochlea

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What is sensorineural hearing loss?

Issue with the nerve or the cochlea

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What is the common history of a child with hearing loss?

Ear symptoms
Speech/school/behaviour issues
Maternal perinatal infection
Delivery issues
Neonatal infections

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How are the ears of a child typically examined?

Otoscope > endoscope - much more comfortable

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What are the different age groups and tests performed for children with hearing loss?

6-18mo: Distraction tests
12mo-3yr: Visual Reinforced audiometry
3-5yr: Play audiometry
4yrs+: Pure tone audiometry

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What are the direct assessments of the auditory system?

Otoacoustic emissions
Auditory Brain stem responses
Tympanometry

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What is tympanometry?

Test for pressure behind the tympanic membrane

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What are the results of tympanometry and what do they mean?

Type A - normal tympanogram

Type B - FLAT tympanogram (fluid in middle ear)

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What does auditory brain stem response measure?

Test to see if auditory nerve is working

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What is glue ear?

Otitis media with effusion - fluid in middle ear

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What are the peak ages of otitis media with effusion to occur?

80% before 10y

2yrs and 5 years

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What are the risk factors for otitis media with effusion?

Day care
Smoking
Cleft palate
Down’s syndrome

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What is the management for otitis media with effusion?

Observe for 3 months
Hearing aids
Grommets
Autoinflation

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What are the symptoms of otitis media with effusion?

Hearing loss
Speech delay
Behavioural problems
Academic decline
Imbalance

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What are the signs of otitis media with effusion?

Dull tympanic membrane
Fluid level behind TM
Bubbles behind TM

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What is the cause of otitis media with effusion?

Eustachian tube dysfunction
Adenoidal hypertrophy
Resolving Acute Otitis media

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Why are children at increased risk of otitis media with effusion?

Eustachian tubes are straight in children

Adenoids are larger, apply more pressure

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How long do Grommets last?

6-18mo

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What type of hearing aids are used in children with hearing loss?

BAHA - bone anchored hearing aid

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Why are BAHAs more useful in children?

Nothing has to be put inside the ear

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What additional treatment is needed with cochlear implant?

Speech and language therapy to understand how to use the implant

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What are the most common causes of ear pain/discharge in children?

Otitis externa
Acute otitis media
Chronic otitis media
Cholesteatoma

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How is otitis externa managed in children?

Aural microsuction with cleaning Topical antibiotics Water precautions

What are the most common pathogens in acute otitis media?

Haemophilius influenza Strep pneumonia Moraxella catarrhalis

Acute otitis media is most common in which age group?

3-18mo

How does acute otitis media present?

``` Short history Pain Fever Discharge Bulging tympanic membrane Perforation ```

How is acute otitis media treated?

Antibiotics | co-amoxiclav

How is recurrent otitis media treated?

Grommets | Adenoidectomy

What is a dangerous complication of acute otitis media?

Mastoiditis

What is the biggest risk associated with mastoiditis?

Brain abscess

How is mastoiditis treated?

Mastoidectomy

How does chronic otitis media present?

Chronic discharging ear | Hearing loss DESPITE grommets

How does chronic otitis media/cholesteatoma damage hearing?

Eating away of ossicles in middle ear

How is Chronic otitis media investigated?

CT Scan

How is Chronic otitis media treated?

Mastoidectomy

When do the ethmoid sinuses develop?

0-4months

When do the maxillary sinuses develop?

0-4 months

When do the sphenoid sinuses develop?

3-7yrs

When do the frontal sinuses develop?

8yrs - adolescence

Always enquire for what in children with blocked/runny noses

POSSIBILITY OF FOREIGN BODY

What factors must be enquired to for a child with a blocked/runny nose?

``` Pain Discharge Loss of function Feeding issues Snoring/quality of sleep ```

How would you examine a child with a blocked nose?

Suspected foreign body - Examination under anaesthesia Otoscope Cold spatula test

What is the cause of a blocked/runny nose?

``` Foreign body Rhinitis Large adenoids Sinusitis Polyps Choanal atresia ```

Large adenoids commonly present with what?

Sleep apnoea

How is rhinitis treated?

Test for allergen first (IgE) Nasal douching Antihistamines Nasal steroids

When will a child benefit from the removal of adenoids?

Unknown - perform sleep studies

Sinusitis and polyps are associated with what?

Cystic fibrosis

When are nasal polyps removed?

Very large causing obstruction of breathing

Why is sinusitis so high risk in children?

Can pass through the thin sinus walls to eyes

What is the management for sinusitis spreading to the eye?

CT scans observing for evidence of abscess and compression -- SURGERY

What is choanal atresia?

One side of rear nasal passage is unopened

Bilateral choanal atresia presents with what?

Inability to breathe

What is the occurence rate of choanal atresia?

1 in 6-8000

What must be considered in epistaxis?

Digital trauma | Coagulopathy

Bleeding in epistaxis typically comes from where?

Little's area/Kiesselbach's plexus

How is epistaxis managed?

Lean forward and pinch Antibiotic ointments Cauterising Nasal packing

What are the possible processes for cauterising epistaxis?

Silver nitrate under LA | Diathermy under GA

What is the common presenting history for a child with a sore throat?

Pain (swallowing, ears) Discharge Loss of function (dysphagia, hoarseness) Snoring/drooling

What are the causes of tonsillitis?

Bacterial (B haem Strep B) | Viral (EBV)

Tonsillitis has a risk of progressing to what?

Glomerulonephritis

When are antibiotics indicated in childhood tonsillitis?

Systemic unwellness

What is a common complication of tonsillitis? How is it treated?

Peritonsillar abscess | Needs to be drained

What structural differences in children can lead to airway issues?

Large tongue/tonsils Short/floppy epiglottis Short neck Narrow sub-glottis

Cause of airway issues in children?

Foreign body Epiglottitis Laryngomalacia

Airway issues in children normally present how?

Stridor Feeding problems History of foreign body Recent illness

How is epiglottitis managed?

Conservative treatment ?Airway support IV Antibiotics Observe overnight

How are foreign body airway issues managed?

Removal | Overnight observation

How does laryngeomalacia present?

'unusual' crying | Can breathe well when prone

What are the most common causes of neck lumps in children?

``` Thyroglossal duct cyst Branchial cyst Cystic Hygroma Cervical lymphadenopathy Abscess ```

How is a neck abscess managed?

Clear infection Give antibiotics Drain abscess

ENT - Paediatrics Flashcards

(72 cards)