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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
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
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.
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
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
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
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

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