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Flashcards in Otolaryngology Deck (17)
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What would you look for in a history of a child with hearing loss?

Ear symptoms
Loss of function- hearing loss, dizziness, tinnitus
Speech development, school performance
Maternal perinatal infections
Maternal drugs/alcohol
Delivery issues (prematurity, anorexia)
Neonatal infections, drugs, jaundice
PMH, Growth, immunisations, passive smoking, breast vs. bottle feeding


Explain the subjective assessment of hearing in children

6-18 months: Distraction test
12 months-3 years: Visual reinforced audiometry
3-5 years: play audiometry
4+ years: Pure tone audiometry


Describe the objective assessment of the auditory system in children with hearing loss

Otoacoustic Emissions
Auditory brain stem response

These usually require a quiet baby and testing environment so are carried out when the baby is asleep or under anaesthetic


What is tympanometry?

Allows you to assess the pressure of the middle ear

Is it filled with fluid?


How to you test Otoacoustic emissions?

Check if the active hair cells move with putting a tiny microphone in the ear and listening for the otoacoustic emissions in response to a click sound

If presence then cochlea healthy


What is auditory brain response audiometry?

Measure the electrical activity of the acoustic nerve and the brain in response to sounds


What is the commonest cause of conductive hearing loss in children?

Otitis media with glue ear

It effects children around 2 and 5 years old and resolves by itself in the majority.
If it persists more than 3 months and causes hearing loss give hearing aids or put grommets in (removing adenoids also)


Who is otitis externa common with?
How do you treat?

Patients who have eczema in the ears, swimmers
Not a very common cause of discharging ear in children

Treat with:
-Aural microsuction
-Topical antibiotics
-Water precautions


A child presenting with painful discharging ear probably has what?

What is the clinical presentation

Acute otitis media

Unwell - fever
Irritable - pain
Child pulling at ears with discharge if the ear drum bursts


What is the microbiology and treatment of acute otitis media?

-Haemophilus influenza
-Strep pneumonia
-Moraxella catarrhalis

Treat with antibiotics (co-amoxiclav)

Grommets and adenoidectomy if recurrent


What are the complications of acute otitis media?

Infection may spread back causing mastoiditis (needs draining)

If it spreads upwards it can cause meningitis or even cerebral abscess


Children with chronically discharging ears or unexplained hearing loss you may suspect what?

A more serious but rare condition, cholesteatoma

This is the presence of squamous epithelium in the middle ear cleft causing infections and bony erosions.
This requires surgery - mastoidectomy


Describe the conditions you consider with a child presenting with blocked/ runny nose

Most common = Rhinitis (allergic or non-allergic)
Check for specific IgE for allergens
Treat with:
-Reducing allergen load (avoidance and saline irrigation)
-Reducing body reaction (antihistamines and nasal steroid spray)

Large adenoids can mimic
Check for sleep apnoea


How can you distinguish rhinosinusitis?

Foul smelling nasal discharge


What are the complications of sinusitis?

In acute sinusitis the infection can spread to the soft tissues causing periorbital cellulitis and sometimes into the orbit

This is an emergency (get an ophthalmologist)


What features are you looking for in a child which presents with a sore throat?

Pain (odynophagia, ear ache)
Discharge (cough)

Loss of function (dysphagia, breathing problems, hoarse voice) may display as:
-Snoring or drooling


How do you suspect streptococcal infection in a child presenting with a sore throat?
How does the treatment vary from most other sore throats?

Chances increase if they are young, Have exudate, lymphadenopathy, fever and absent cough

Need antibiotics
Almost invariably viral and will resolve on its own