Yr4 ENT - Study Points

Question 1

Define:
- Tonsillectomy?
- Throat infection?
- Obstructive sleep-disordered breathing (oSDB)?
- Obstructive sleep apnea (OSA)?

Answer 1

Obstructive sleep apnea (OSA) is diagnosed when oSDB is accompanied by an abnormal polysomno-graphy (PSG) with an obstructive apnea-hypopneaindex (AHI). It is a disorder of breathing during sleep characterized by prolonged partial upperairway obstruction and/or intermittent completeobstruction (obstructive apnea) that disrupts normal ventilation during sleep and normal sleep patterns.

Question 2

Tonsillectomy Guidelines: STATEMENT 1. WATCHFUL WAITING FOR RECURRENT THROAT INFECTION
- How long should they wait?

Answer 2

STATEMENT 1. Watchful waiting forrecurrent throat infection: Clinicians should recommend watchful waiting for recurrent throat infection if there have been:
- <7 episodes in the past year
- <5 episodes per year in the past 2 years
- <3 episodes per year in the past 3 years.

Question 3

What are the 2 most common indications for Tonsillectomy?
- What impact do these conditions have on patients & on the healthcare system?
- What is the prevalence of oSDB?
- What behavioural features might a child with oSDB exihibit?
- Impact of oSDB on quality of life?

Answer 3

Question 4

Outline the Evidence for Benefits of Tonsillectomy for Throat Infections & OSA.

Answer 4

Question 5

Outilne the Harms/Adverse Effects of Tonsillectomy.

Answer 5

Question 6

Describe the Structure and Function of the Tonsils.
- What tissue are they formed of?
- At what ages is greatest immunologic activity of the tonsils is found?
- Epithelium? Cells?
- Function?
- Which immunoglobulin isotypes can they produce? Which is most important here?

Answer 6

Question 7

What are the Effects of Tonsillitis and Tonsillectomy on Immunity?

Answer 7

Question 8

What are the recommendations regarding:
- polysomnography in children with obstructive sleep-disordered breathing (oSDB)?
- tonsillectomy for children with OSA?
- education to caregivers regarding persistent or recurrent oSDB?

Answer 8

Question 9

What are the guidelines regarding:
- perioperative pain counseling for tonsillectomy?
- Perioperative antibiotics?
- Intraoperative steroids?
- Inpatient monitoring forchildren after tonsillectomy?
- Postoperative pain relief?
- Outcome assessment for bleeding & Bleeding rate?

Answer 9

Question 10

Outline the Role of polysomnography in Assessing High-Risk Populations before Tonsillectomy for oSDB and the rationale behind it?

Answer 10

Question 11

• Patient Information: Post-tonsillectomy Pain Management for Children — Education for Caregivers?
• Tonsillectomy and oSDB Caregiver Counseling?

Answer 11

Question 12

Provide a clinical practice guideline algorithm for Tonsillectomy in children?

Answer 12

Question 13

What Is OME?

Answer 13

What Is OME?
- OME, or ear fluid, occurs in the middle ear. The middle ear is an air-filled space just behind the eardrum.
- When mucus or liquid builds up in this area, it is called OME. OME is different from an ear infection (which is sometimes called acute otitis media).
- Ear infections and OME both have fluid in the middle ear, but with OME, the fluid is not infected and usually there is little to no pain. Many times a child with OME will not have any symptoms. If there are symptoms, the most common are a feeling of fullness in the ear, mild hearing problems, and mild discomfort.
- A child can have OME in one ear or both. OME is so common in children that almost all will have it at least once by the time that they reach school age.

Question 14

When Should I Worry about OME?
- What is ear fluid & how common is it?
- How does ear fluid differ from an ear infection?
- If my child gets ear fluid, how can I tell?
- What causes ear fluid?
- Should I worry if my child has ear fluid?
- What is the best way to manage ear fluid?

Answer 14

Most cases of OME will go away on their own within 3 months. Repeated cases of OME or OME that lasts more than 3 months can be a problem. These long-lasting or repeated cases of OME may be linked to hearing loss, balance problems, middle ear disease, poor school performance, or behavioral issues.

Question 15

Ear Fluid and Newborn Hearing Screening
- How many babies who fail their newborn hearing screening will really have hearing loss?
- How common is middle ear fluid in children who fail a screening test?
- If my child gets ear tubes, how long will it take before the fluid’s effect on hearing resolves?
- Are some babies more likely to have problems with middle ear fluid compared to others?
- If my baby seems to hear normally, can the tests be wrong?

Answer 15

Question 16

Otitis Media with Effusion
- What Causes OME?
- How Is OME Diagnosed?
- Why are children more prone to OME than adults?

Answer 16

Question 17

Otitis Media with Effusion
- When should a hearing test be ordered?
- Who is in the at-risk group? (7)

Answer 17

The doctor should order a hearing test if ear fluid lasts more than 3 months or if your child is in an at-risk group.

Question 18

Otitis Media with Effusion
- What Treatments Are Available?
- Role of antibiotics, antihistamines, and decongestants?
- Surgical options?

Answer 18

• OME usually goes away on its own. If your child is not in an at-risk group, your doctor will typically recommend watchful waiting (not taking any medical action) for 3 months, starting when OME is diagnosed.
• Your health care provider may discuss surgery to insert ear tubes if your child still has ear fluid after 3 months, repeated long periods of OME, hearing loss, or other related health problems. Ear tubes are placed into the eardrum to allow air into the middle ear space and prevent constant middle ear fluid.
• For children 4 and 12 years of age, an additional procedure called adenoidectomy to remove tissue from the back of the nose may be recommended.
• Studies show that medicines such as antibiotics, allergy medications (antihistamines), and decongestants are not helpful for treating OME and should not be used for this purpose.

Question 19

Otitis Media with Effusion
- How Can I Make My Child More Comfortable?
- What can I do at home to help the fluid go away?
- Will medications or other therapies help the fluid to go away?
- Do I still need to follow up with my doctor even if my child seems fine?
- Does the fluid cause hearing loss?

Answer 19

Question 20

Otitis Media with Effusion
- How Can I Help my child hear better?
- Will the fluid turn into an ear infection?
- Can my child travel by plane if ear fluid is present?
- List 5 Findings that Suggest Delayed Speech development in a child.
- List 5 Findings that Suggest Delayed Language development in a child.

Answer 20

Question 21

OME Guidelines
- How should an OME in a child be diagnosed?
- Which symptoms should suggest OME in a child?
- What investigation should be sought in uncertainty?
- What should clinicians tell parents if their child fails a newborn hearing screening test?
- When should at-risk children be screened?
- Do we routinely screen for OME in all children?
- How long for watchful waiting?
- Use of steroids?

Answer 21

Question 22

OME Guidelines
- Use of antibiotics?
- Use of antihistamines?
- When should a hearing test be sought?
- Impact of OME on speech & language development?
- When should tympanostomy tubes be advised?

Answer 22

Question 23

Adult Sinusitis
- What Is Sinusitis?
- What Causes Adult Sinusitis?
- What are the sinuses?
- How can I tell if I have acute sinusitis?
- How can I tell if my sinusitis is caused by bacteria or viruses? Why is that important?

Answer 23

A sinus infection is typically caused by a viral upper respiratory infection, like a cold. A viral infection does not get better from taking antibiotics. Acute bacterial sinus infections are caused by a bacterial infection. Some people with bacterial infections can benefit from the use of antibiotics, although antibiotics are not necessary for everyone.

Question 24

Adult Sinusitis
- What Can You Do?
- How is it diagnosed?

Answer 24

What Can You Do?
You should see a healthcare provider soon after symptoms occur. Early diagnosis may help avoid misdiagnosis or delayed treatment and worse results. There are several types of sinus infections, so it is important to get the correct diagnosis for proper treatment. Treatment options should be discussed with the healthcare provider after diagnosis. Antibiotics do not work for viral sinus infections. Antibiotics are not recommended for all types of bacterial infections.

Question 25

**Adult Sinusitis** - What treatments are available for a viral sinus infection? - for an acute bacterial sinus infection? - For a chronic sinus infection? - How long will it take before I feel better? - Is there anything I can do for symptomatic relief? - Is there anything I should not do?

Answer 25

Question 26

**Adult Sinusitis** - If I have ARBS, do I have to take antibiotics? - Is there downside to using antibiotics? - How is watchful waiting done? - If I use an antibiotic, for how many days should I take it?

Answer 26

Question 27

**Allergic Rhinitis (Nasal Allergies or Hay Fever)** - What is it? - Symptoms? - What causes it? - What can you do?

Answer 27

- Allergic rhinitis or nasal allergies is often called “hay fever.” - Allergic rhinitis is swelling inside of the nose caused by allergies. - Allergic rhinitis is common in both children and adults.

Question 28

**Allergic Rhinitis (Nasal Allergies or Hay Fever)** - How is it diagnosed? - What treatments are available?

Answer 28

Question 29

What is the most common acute mono-neuropathy, or disorder affecting a single nerve? - Definition? - Overview? - Onset? - How common is bilateral? - Cause? - Other causes? - Course? - Epidemiology?

Answer 29

**Bell’s Palsy** = Acute unilateral facial nerve paresis or paralysis with onset in less than 72 hours and without an identifiable cause.

Question 30

Define: - Bell's Palsy? - EMG? - ENoG? - Facial paralysis? - Facial paresis? - Idiopathic?

Answer 30

Question 31

**Bell's Palsy** - Epidemiology: Age group with the highest incidence? Gender? - 6 Risk Factors? 6 Signs & Symptoms?

Answer 31

**Risk Factors for Bells Palsy** 1. Pregnancy 2. Severe preeclampsia 3. Obesity 4. Hypertension and chronic hypertension 5. Diabetes 6. Upper respiratory ailments

Question 32

**Bell's Palsy** - Explain the suspected aetiology & pathophysiology? - List 19 causes of facial paralysis & the associated clinical features?

Answer 32

Question 33

**Bell's Palsy** - Diagnosis? - What to look for on examination? - 6 Diagnostic tests to consider? - House-Brackmann facial nerve grading scale?

Answer 33

**Grading of Facial Paresis** Literature cited throughout this guideline often uses the House-Brackmann facial nerve grading scale. This commonly used scale, designed to systematically quantify facial nerve functional recovery after surgery that puts the facial nerve at-risk, has been used to assess recovery after trauma to the facial nerve or Bell’s palsy. It was not designed to assess initial facial nerve paresis or paralysis of Bell’s palsy.

Question 34

**Bell's Palsy** - Treatment? - Prognosis? - Sequelae: Short term & Long term?

Answer 34

**Prognosis of Bell's Palsy** Most patients with Bell’s palsy show some recovery without intervention within 2 to 3 weeks after onset of symptoms and completely recover within 3 to 4 months. Moreover, even without treatment, facial function is completely restored in approximately 70% of Bell’s palsy patients with complete paralysis within 6 months and as high as 94% of patients with incomplete paralysis; accordingly, as many as 30% of patients do not recover completely.

Question 35

**Clinical Practice Guidelines: Bell's Palsy** - List the 11 statements? - Statement 1: Why should clinicians assess the patient using history and physical examination to exclude identifiable causes of facial paresis or paralysis in patients presenting with acute-onset unilateral facial paresis or paralysis?

Answer 35

Question 36

**Clinical Practice Guidelines: Bell's Palsy** - Statement 2: Should clinicians order tests, when & which ones? - Statement 3: Routine imaging?

Answer 36

Question 37

**Clinical Practice Guidelines: Bell's Palsy** - Statement 4: Oral steroids? - Statement 5A: oral antiviral therapy? - Statement 5B: combination antiviral therapy?

Answer 37

Question 38

**Clinical Practice Guidelines: Bell's Palsy** - Statement 6: Eye care? - Statement 7A: Electrodiagnostic testing for incomplete paralysis? - Statement 7A: Electrodiagnostic testing for complete paralysis?

Answer 38

Question 39

**Clinical Practice Guidelines: Bell's Palsy** - Statement 8: Surgical decompression? - Statement 9: Acupuncture? - Statement 10: Physical therapies? - Statement 11: Which specialist to refer to?

Answer 39

**STATEMENT 11. PATIENT FOLLOW-UP: Recommendation** Clinicians should reassess or refer to a facial nerve specialist those Bell’s palsy patients with (1) new or worsening neurologic findings at any point, (2) ocular symptoms developing at any point, or (3) incomplete facial recovery 3 months after initial symptom onset.

Question 40

Provide an algorithm of clinical guideline key action statements for Bell's Palsy.

Answer 40