Paediatric ENT Flashcards
(32 cards)
Name two important congenital conditions to rule out in children
Moebius syndrome (bilat VI, bilat VII with uni or bilateral XII N palsies) Hemifacial microsomia (unita VII with microtia, hemifacial hypoplasia)
What are the causes for congenital hearing loss?
associated with external or middle ear abnormalities most common anomaly is is dysplasia/aplasia of membranous labyrinth intrauterine infections (rubella) can cause inner ear damageperinatal hypoxia/anoxia, Rhesus incompatibility are RFs
How is neonatal hearing screening carried out?
automated otoacoustic emission (AOAE) test (A small soft-tipped earpiece is placed in your baby’s ear and gentle clicking sounds are played.
When an ear receives sound, the inner part (called the cochlea) responds. This can be picked up by the screening equipment. Automated auditory brainstem response (AABR) test (The AABR test involves placing three small sensors on your baby’s head and neck. Soft headphones are placed over your baby’s ears and gentle clicking sounds are played.
What are the hearing methods used in children?
Visual reinforcement audiometry (VRA) - young babies (7months - 2.5years) Play audiometry (2-5 years) Pure tone audiometry (older children, before they start school) Bone conduction test (device passes into inner ear) Tympanometry (tests how flexible the ear drum is) Speech perception test (test child's ability to recognise words)
What are the different types of otitis media?
suppurative otitis media secretary otitis media otitis media with effusion (OME) glue ear (eustachian tube dysfunction) chronic otitis media (inactive/active with cholesteatoma/active with no cholesteatoma) recurrent acute otitis media
What should you remember to ask in children presenting with hearing loss?
young children may give few us any localising signs - look for pyrexia and systemic upset
What is otitis media?
inflammation of the middle ear which is characterised by the formation of an effusion which can be sterile (glue ear) or infective (acute otitis media)
How does chronic otitis media (perforation) occur?
repeated attacks of acute suppuration can lead to weakening of the ear drum and eventually a non-healing perforation
What are the different types of chronic otitis media?
inactive - dry perforation
active - otorrhoea -> non cholesteatoma (safe)
active - otorrhoea -> cholesteatoma (unsafe)
What are the symptoms of otitis media?
hearing loss pain otorrhoea pyrexia systemic upset
How is otitis media (infection) treated?
antibiotics and simple analgesia
ear must be kept dry if there is a perforation
discharging ear maybe by treated with a combination of antibiotic and steroid drops
How is OME treated?
If glue ear does not resolve over 3 months and if it is symptomatic treatment is required
current mainstay of treatment is insertion of grommets which provides a different route for middle ear ventilation
Identify the different types of OM on examination
LOOK UP IMAGES
Which ear perforations (CSOM) are considered to be safe and which are considered to be unsafe?
safe - a central pars tense perforation - tubotympanic
safe - a subtotal perforation (central) - tubotympanic unsafe - a marginal pars tensa perforation - attico-antral unsafe - a attic/pars flaccida - tubotympanic
What are the symptoms of CSOM?
hearing loss
otorrhoea - intermittent; mucoid/mucopurulent
How is CSOM treated?
depends on treatment
steroid and antibiotic drops and keeping ear dry will help settle active infection
surgical repair of the ear drum will help prevent reinfection no symptoms - no treatment
What is a cholesteatoma?
a cyst or sac of keratinising squamous epithelium (skin) leads to foul smelling discharge from the ear (infection), conductive hearing loss, attic retraction filled with squamous debris
cholesteatoma is able to erode bone and damage important structures of the middle ear
What is the treatment of cholesteatoma?
cholesteatoma usually requires surgical removal or radical mastoidectomy is it extends to mastoid bone
when do complications of otitis media occur?
occur when infection spreads outside the inner ear/ involves bone and blood
What are the extracranial complications of otitis media?
mastoiditis - mastoid air cells fill with pus facial nerve palsy labryinthitis - spread of infection to inner earpetrositis
What are the intracranial complications of otitis media?
temporal lobe abscess cerebellar abscess sigmoid sinus thrombosis meningitis jugular vein thrombosis otitis hydrocephalus
Where are thyroglossal cysts found?
present in the midline of the neck and move upwards if the patient sticks out their tongue, due to the attachment of the tract to the hyoid and tongue base
Where do branchial cysts present?
present before the age of 30 lump in the neck situated in the middle third of the SCM painful if infected
What are dermoids?
These are defects of fusion in the embryo, elements of the skin become trapped subcutaneously and develop into cysts
