Paediatric ENT

Question 1

Screening for deafness in children

Answer 1

all infants screened shortly after birth with automated ABR (auditory brainstem response)

Question 2

what type of deafness is most common in permanent deafness

Answer 2

sensorineural

Question 3

prevalence of deafness in children

Answer 3

1/1000 born w moderate or worse hearding imparied

1/1000 deveopo moderate hearing impairment by 8yrs

Question 4

how are acquired causes of deafness classified

Answer 4

prenatal

perinatal

postnatal

Question 5

causes of prenatal deafenss 3 examples

Answer 5

toxoplasma

rubella

CMV

Question 6

causes of perinatal deafness 3

Answer 6

SCBU babies (special care baby unit)
-from things like
-jaundice (kernicteus)
-hypoxia
-aminoglycoside ABx

Question 7

causes of post natal deafness 3

Answer 7

menigitis -HEARING TEST SHOULD BE ARRANGED AT DISCHARGE

head injury

ototoxic drugs

Question 8

examples of ototoxic drugs 3

Answer 8

cisplatin

aminoglycosides -gentamicin, amikacin, tobramycin, neomycin, and streptomycin

furosemide

Question 9

how are congenital causes of deafness split

Answer 9

syndromic 1/3

nonsyndromic - 2/3

Question 10

syndromic causes of congenital deafness 5

Answer 10

Ushers

Pendreds

Brachio-oto-renal

Jervell & Lange-Nielsen

sticklers

Question 11

nonsyndormic cuases of congenital deafness 1

Answer 11

any condition where deafness is an isolated feature

-most are autosomal receessive due to mutation in connexin 26 gap junction protein gene

Question 12

treatement options for hearing rehabilitation

Answer 12

moderate
-bilateral,digital, behind the ear hearing aids

sever-profound hearing impairment
-cochlear implantation (direct stimulation of tehcochlear nerve)
-produces excellent hearing and speech

Question 13

another name for otitis media with effusion

Answer 13

glue ear

Question 14

cause of otitis media with effusion

Answer 14

mucus in the middle ear space

Question 15

what can cause otitis media with effusion 2

Answer 15

effusion in middle ear v common after a URTI or an episode of otitis media

Question 16

when is otitis media with effusion conisdered pathological

Answer 16

has to have been there for at least 3 months

-usually short lived

Question 17

appearance of tympanic membrane with otitis media with effusion

Answer 17

dull and retracted

may have yellow or grey colour

prominent blood vessels on surface running radially

Question 18

how is otitis media with effusion diagnosed

-what is the prevalence of glue ear in kids

Answer 18

daignosed w otoscopy
-tympanometry 9middle ear pressure testing) will demonstrate ear fluid
-*signs of infection are absent

20% of 2 yo have it on any given day

80% have had at least a three month episode

Question 19

symptoms of otitis media with effusion 1

Answer 19

most minimal

few are severely afected with persistnet conductive hearing impairment

Question 20

how does persistent conductive hearing impairment usually present

Answer 20

as speech delay

Question 21

why is hearing testing essential in otitis media with effusion

Answer 21

to exclude a more serious sensorineual hearing loss cause

Question 22

managemnt of otitis media with effusion 2

Answer 22

most watch and wait

small minority - grommets
-small ventilation tubes inserted into tympanic membrane
-v effective at clearing fluid and improving hearing

Question 23

what can be done to prevent reccurence of otitis media with effusion 1

Answer 23

removal of adenoids from the nasopharynx

-alos improves health of ears in the long term

Question 24

classical presentation of tonsilitis 5

Answer 24

sore throat lasting more than a few days

tonsillar exudate

fever

cervical lymphadenopathy

malaise

Question 25

what is the cut off for episodes of tonsilitis where tonsilectomy would be considered

Answer 25

more than 5 per year over 2yo or 7 in a year *also reasonable to watch and wait as many children will outgrow the problem

Question 26

what is nasal obstruction in pre-school children likely due to -what syx are often associated with this 2

Answer 26

physiological hyperthrophy of the adenoids (nasopharyngeal lymphoid tissue) -ofeten associated with snoring and rhinoorhea

Question 27

how to manage obstructive adenooids in kids 3

Answer 27

shrink sponaneously by 6yo so can just leave adenoidectomy can be considered in severe cases saline nasal douches can be helpful for milder cases

Question 28

what is nasal obstruction more common in for children of school age -what are the syx 2

Answer 28

allergic rhinitis sneezing and clear rhinorrhoea

Question 29

treatment for allergic rhinitis 2

Answer 29

topical nasal steroids spray + oral non-sedating antihistamines

Question 30

what is the most important aspect of the history regarding nasal obstruction 1

Answer 30

sleep quality

Question 31

what is the most common cause of obstructive sleep apnoea in children

Answer 31

physiological hypertrophy of the tonsils and adenoids therefore common in 2-7yo

Question 32

management of obstructive sleep apnoea

Answer 32

adenoidectomy and tonsillectomy curative in majoriyu of cases

Question 33

daignoiss of obstructive sleep apnoea

Answer 33

good hisotry can do sleep studies (overnight pulse oximetry or full 12 cahllen polysomnography)

Question 34

aspects of a sleep history of a child 8

Answer 34

* Does he/she get a good night’s sleep? * Does he/she snore? * Have you ever noticed him/her stop breathing/ hold their breath during the night? * Does he/she wake during the night? * Is he/she restless or sweaty at night? * Is he/she difficult to wake in the morning? * Does he/she have night terrors? * Does he/she wet the bed?

Question 35

most common cause of chronic stridor

Answer 35

laryngomalacia

Question 36

differnrtials for acute stirdor 4

Answer 36

inhaled foreing body CROUP epliglottis anaphylaxis

Question 37

causes of chronic stridor 4

Answer 37

laryngomalacia sobglottic stenosis airway haemangioma tracheal stenosis

Question 38

if a child presents with stridor what is an important aspect of their care

Answer 38

every child needs a diagnosis -that means some kind of airway endoscopy

Question 39

what cancers of the neck are kids at the main risk of 2

Answer 39

lymphoma rhabdomyosarcoma