ENT
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- chronic OME definition and treatmetn
- 3 months of OME. Do audiogram. if hearing loss present refer for drainage. After failing Abx
- parotitis diff dx
- paraflu, flu, otehr viruses. recurrent juvenile parotitis 3-7days 2-4 times a yr.Bacterial parotitis is very ill, febrile, exquisitely tender, red, warm.
- tongue tie
- rare. Nothing to do if breastfed normally and able to push tongue out past central teeth.
- cleft palate associations
- other congenital anom. more common to have associations as compared with cleft lip or lip/palate.
- clefting recurrence
- cleft palate and lip+palate are unique. 3-5% recurrence risk of that one only.
- dental abscess sx
- fever, nonerythematous swelling below the jaw
- treatment of facial nerve paralysis from AOM
- Abx, tmphancentesis or tubes placed quickly
- congenital causes of hoarseness
- vocal cord paralysis, laryngeal web, anatomic malformations of vocal cords, papillomas. But not midline throglossal duct cysts.
- acquired hoarseness
- URI, vocal nodules (calluses on vocal cords from vocal abuse. 75% of chronic acquired hoarsness. visualize chords if persists 2-3 weeks.
- most likely bacteria to cause treatment failure in AOM
- non typable H. flu. Moraxella as well but less common.
- most common site for atypical TB lymphadenitis
- unilat submandibular or ant cerv chain, weak positive or nonreactive PPD. true TB, kids are sick, bilat or multiple nodes involved, contact PPD strongly positive.
- most common GAS infection in infants and toddlers
- protracted serous nasopharyngitis
- number of cases of tonsillitis before removing
-
5 episodes in one year or
3 episodes /yr in 3 successive years - Obstructive sleep apnea sx
-
snoring in all positins, apneic spells.
daytime tiredness, poor school, growth failure. - finding places at risk for hypernasal voice after T & A
- palpable notch in post bony palate and soft palate.
- basilar skull fracture sites
- bottom of frontal, ethmoid, sphenoid, temporal, or occipital bones.
- midline cystic mass under tongue of infant
- ranula. large mucocele causing obstruction of sublingual gland ducts. surgical exision to prevent feeding problems.
- Options for treatment failure in AOM
- sx should improve in 3 days. if failed augmentin either ceftriaxone or tympanocentesis needs to be done.
- sx of cyclic neutropenia
- aphthous stomatits and fever recurrent
- peritonsillar abscess
- school age. unilateral tonsillar enlargement, trismus (pain on mouth opening), sore throat
- Rx of AOM with intratemporal complications
-
facial nerve paralysis, perf of TM, mastoiditis.
Treat with ceftriaxone and tympanocentesis. - otalgia with nl exam adn no fever
-
dental or periodontal disease (dental abscess)
refer to dentist - infectious causes of hearing loss
- menintitis, measles, mumps
- chronic OME
- middle ear fluid for >3mo
- cholesteatoma
- chornic otorrhea that does not resovlve with abx. perforation orf retraction pocket with retained squamous debris. can erode bone.
- first choice of abx for AOM if on chronic abx for UTI prophylaxis
- Augmentin or ceftriaxone.
- cause of chronic suppurative otitis media
- perforated TM with otorrhea. Often with cholesteatoma, needs ENT referral
- EBV incubation
- 30-50 days
- 3 findings with suybmucous cleft palate
- bifid uvula, muscular diastasis, notching of post border of hard palate.
- submucosal cleft palate associated with
- eustachian tube malformation, increased incidence of otits media.
- when does otitis externa need systemic therapy
- patient with diabetes or other immunesupression
- congenital ear defects seen, look for...
- renal defects
- Battle sign
- bruising behind auricle. basal skull fx
- hereditary hearing loss and nephritis
- Alport S
- Goldenhar S
- assymetric faces, eyes, vertbral change, ear abnormalitis
- sensorineural hearing loss and retinitis pigmentosa
- Usher S.
- flat face, cleft, eye findings, eustacian tube dysfxn from palatal abnormal
- Stickler
- recurrent signifiacnt epistaxis with nl cbc, PT, PTT. what lab test
-
factor VIII fxn including coagulation, antigenic, ristocetin cofactor activity..
Screen for von Willebrands - midline neck mass differential
-
cervical dermoid cyst
thyroid anomalies - ant cervical triangle masses
- branchial cysts, dermoid cysts, thymic gland anom.
- most common finding in child with unilateral recurrent epistaxis
- prominent nasal septal inflammation or excoriation. prominent blood vessels
- epistaxis recurrent with findings of telangiectasias in mouth, lips. nose
-
Rendu-Osler-Weber S.
heredeitary hemorrhagic telangiectasia. - nasal septal hematoma complication
- abscess. causes severe nasal deformation. Exam septum in all cases of nasal trauma. If swelling present refer to ENT.
- diff dx vertigo in child
- AOM, seizures, migraines, benign paroxysmal vertigo, vestibular neuronitis
- vestibular neurononitis
- inflammatory process of vestibula. severe vertigo sudden onset, nystagmus. subsides over days to weeks.
- Meniere disease
- recurrent vertigo, hearing loss, aural fullness. rare in kids.
- cholesteotoma presentation and path
-
squamous epithelial cyst from chronic neg pressure or OME with retraction pocket.
purulent otorrhea and conductive hearing loss - red mobile mass on TM in child with bloody otorrhea and hx of PE tume
- tympanostomy tube granuloma.
- isolaed preauricular pits, work up
- No need for renal ultrasound. Do family hx, if positive or other findings present, consult genetics.
- bacteriology of AOM in neonate
- same as older kids. Strep pneumo. non typable H. flu, moraxella
- percent of cases of spontaneously resolving AOM in 2 weeks.
- 80%.
- percent of kids with effusion following AOM
-
70% at 2 wks
40% at 1 mo
20% at 2 mo
10% at 3mo (chronic OME) - management of cholesteatoma
- tympanomastoidectomy
- bacteriology of chronic supporitive otorrhea
- pseudomonas. rarely S. aureus. Treat with anti-pseudomonal
- treatment of chronic supporitive otitis media.
- topical ofloxacin or cipro. 90% will respond. If fails surgery required.
- recurrent AOM or chronic OME look for
- submucosal cleft palate.
- OME 6 weeks after AOM, management
- repeat exam in 6 more weeks. If effusion still present do audiogram to determine if tubes need to be placed.
- most common intracranial complication of AOM
- meningitis
- Rx of auricular hematoma
- as with nasal septal hematoma. Requires rapid decompression to prevent abscess formation and deformation
- bacteriology of acute mastoiditis
-
same as AOM, S. pneumo, H flu.
chronic mastoiditis: s. aureus, pseudamonas. - recurrent severe epistaxis in teen male
- juvenile nasopharyngeal angiofibroma. benign fibroma in post of nose. do ct to plan surgery. slowly grows causing mass effect problems, facial nerve palsy, nasal obstruction.
- nasal signs of cocain abuse
- septal perf. teen. mucoid rhinorrhea, hyperemia.
- Nasal polyps, sx dx
- rarely before 10yrs. can be in atopic patients. associated with CF and immotile cilia. sudden onset of nasal sx worsening steadily, unusual for allergy. rfailrue of respoond to sinusitis rx or allergy rx. May not be visible in ant. nose.
- pharyngitis, conjunctivitis, fever cause
- adenovirus
- retropharyngeal abscess
- <4yrs old as lymphoid tissue in retropharyngeal space atrophies after 4yrs. illness several days earlier suddenly worsens. hyperextended neck for comfort. back of throat pushed forwards. red pharynx. fever, toxic, drooling.
- peritonsillar abscess initial treatment
- penicillin, I&D
- treatment of ranula
- excision. Can occur at all ages. Blockage of submandibular ducts
- actue parotitis sx, rx
- often follows dehydration or illness. Staph, EBV, HIVmumps, preauricular pain, tenderness, swelling. Stenson duct red, pus expressable. Rehydrate, sialgogs (lemon drops), massage. Staph Abx.
- feeding method for complete cleft palate
- compressible bottle.
- isolated cleft palate significance
- least signifaicnt. surgery at 10 months. velopharyngeal insufficiency is teh main problem (nose and mouth not separated). nasal sounding speech, articulation issues50% cleft palate patients have syndrome.
- ear problems with cleft palate
- effusions always present. AOM common. sensineurol loss is not common.
- when is it too late for teeth.
- 18mo. XR to look for teeth. GH deficiency and hypopituitarism are most common causes
- Pott puffy tumor
- frontal sinusitis complication. erosion antieriorly through frontal bone forming abscess. surgical drainage.
- periorbital cellulitis
- complication of sinusistis. ethmoid or maxillary. <5yrs. sudden lid and periorobital swelling. usually unilateralj .
- periorbital cellulitis from hematogenous spread
- rapid onset and fulminent course. high fever, <1yr, S. pneumo, Hib bacteremia.
- periorbital cellulitis from adjacent infection
- 50% of periorgbital cellulitis have no sinusitis or bacteremia. recent trama to orbit or nearby face with break in skin. >5yrs S aureus, GAS
- orbital cellulitis
- usually spread from ethmoid sinusitis or facial infection. more toxic, more ill than periorbiatl. eyemovement is painful. significant swelling. proptosis, CT. subperiosteal abscess or deteriorating exam requires surgery. with ethmoidectomy.
- cleft palate freq
- 1 in 2000
- tonsil progression
- enlarge over first 10yrs then regress
- tonsillitis most common agents
- GAS, adeno, coxackie, EBV
- exam features separating tonsillitis agents
-
GAS: fever, HA, palatal petiechiae, ant nods, abdom pain
EBV: malaise, feber, exudateive tonsillits, gen adenop, splanomaeg.
adeno: conjuncitivitis, nonexudative taonsillar inflam
coxsackie: yellow ulcers - setup for peritonsillar abscess
- EBV treated with steroids.
- tonsillar lymphoma
- asymmetrically enlarged tonsil withoiut infection. examine cervical and other nodes. bx if enlarging.
- trismus, think
- pertonsillar abscess, pyterigoid muscle inflammed limits mouth opening.
- peritonsillar abscess organisms
- GAS, Staph.
- retropharyngeal abscess radiography
- lat neck in extension shows prevert space larger than one vert body. CT may be used to determine if drainage req.
- parapharyngeal abscess
- lateral neck space abscess infant and young children. toxic with high fevers. similar present to retro[pharyngeal. torticollis, bending toward affected side tender anterolateral swelling. Displaced tonsil