What important consideration should we think of when examining an ENT problem?
Always examine all the regions.
If they have through pain dont just examine the throat, do the nose and ears as well
What might you pick up on in a kids history that would indicate hearing problems?
- Well…Ear symptoms
- Poor speech development
- Problems at school
- Behavioural Problems
Neonatal infections or maternal infections
Delivery issues such as being a premature baby or anoxia
How do we categorise hearing tests?
Subjective e.g. audiometry
Objective e.g. Otoacoustic Emissions
Children tend not to be compliant with conventional hearing tests.
What subjective tests can we use?
6-18 months = Distraction Test
1-3yrs = Visual Reinforced Audiometry
3-5yrs = Play Audiometry
4+ yrs = Pure tone audiometry like an adult
What objective hearing tests can we use on children?
- Otoacoustic Emissions (measures a sound produced by the inner ear during hearing, hearing loss reduces the OAEs)
- Tympanometry (measures inner ear pressure)
- Auditory Brain Stem Response
Common Paediatric conditions
- Otitis Media with Effusion (Glue ear)
- Otitis Externa
- Acute Otitis Media
- Chronic Otitis Media
What are the peak ages for Glue Ear?
2 and 5 yrs
80% have occured by age 10
What are the risk factrs for glue ear?
What causes Glue ear?
- Dysfunction of the Eustachian Tube (Either due to messed up skull base or muscular immaturity)
- Adenoid Hypertrophy
- Resolving Acute Otitis Media
What does Otitis media with effusion look like?
- Hearing Loss
- Speech Delay
- Behavioural Problems
- Academic Decline
Signs on the Tympanic Membrane:
- Visible Fluid level
How do we treat otitis media with effusion?
- Most common
- Works itself out in ~1yr as the TM heals over
What causes otitis externa and how do we treat it?
Treat it with:
- Aural Microsuction
- Topical Antibiotics
- Water Precautions (prevent it getting wet)
When is acute otitis media most common?
In the 3-18 months
How does acute otitis media present?
Short History of the above
What are some complications of acute otitis media
Perforation of the Tympanic Membrane. (keep it dry and treat infection)
What causes Acute Otitis Media
- Haemophilus Influenzae
- Strep Pneumonia
- Moraxella Catarrhalis
How do we treat acute otitis media?
With antibiotics or rest
If its recurrent:
Grommet & Adenoidectomy
What causes chronic otitis media?
Usually a Cholesteatoma or a perforated ear drum.
How do we treat a cholesteatoma
Involves clearing out some of the mastoid air cells and parts of the middle ear