Week 1 - EENT Problems in Children

What are Lea Symbols used for?

Equivalent of a snellen chart to evaluation visual acuity in kids

What are best practices for evaluation of the eye?

Assess visual acuity for ALL eye complaints

What is conjunctivitis?

inflammation of the conjunctiva presenting with redness, edema, pain, blurry vision, watery discharge

What are the different types of conjunctivitis?

viral, bacterial, allergic

What is the MCC of infectious conjunctivitis?

Viral Conjunctivitis

What is viral conjunctivitis?

A highly contagious inflammation of conjunctiva

What are the clinical manifestations of viral conjunctivitis?

- preauricle lymphadenopathy

- URI symptoms

- May begin unilaterally and spread within 24-38 hrs

What is the most common pathogen of viral conjunctivitis?

Adenovirus

What is the management for viral conjunctivitis?

- Symptomatic/Supportive care (cold compresses)

- Typically can return to school after 3-7 days

What is bacterial conjunctivitis?

How does it present?

A very contagious inflammation of the conjunctiva caused by strep Pneumoniae, Haemophlius influenzae or Moraxella catarrhalis,

How does bacterial conjunctivitis present?

Present with presents with thick mucopurlent discharge, persistent throughout day

eye “stuck shut”

red, irritated eye (unilateral)

What is the treatment for bacterial conjunctivitis?

-self limited

-Topical Antibiotics (speed resolution)

- Warm compresses

- Improvement in 1-3 days and return to school 24 hrs after Ab tx

What is allergic conjunctivitis?

Inflammation of the conjunctiva in response to an allergen (hypersensitivity reactions to environment) *not contagious

How does allergic conjunctivitis present?

Presents with bilateral redness, watery discharge, ocular itching, allergic shiners and cobblestone papillae

What is the management for allergic conjunctivitis?

- Conservative Care (cool compresses, artificial tears, allergen avoidance)

- Topical antihistamines

- Not contagious so can attend school/daycare

What is ophthalmia neonatorum?

conjunctivitis occurring within the first 28 days of life

What does opthalmia neonatorum present with?

Redness, swelling, discharge, photophobia, corneal haze (in severe or HSV) and systemic signs like fever.

How is ophthalmia neonatorum diagnosed?

- Gram stain and culture

- PCR testing

- Fluorescein staining

How is opthalmia neonatorum prevented?

- Prophylactic eye drops/ointment

- Prenatal screening and treatment

- Cesarean delivery

What are the causes of ophthalmia neonatorum?

- Chemical

- Gonorrhea

- Chalmydia

- HSV

What is the treatment for ophthalmia neuonatorum caused by Chlamydia?

Oral Erythomycin

What is the onset of ophthalmia neonatorum?

Typically appears 5-14 days after birth

What is the treatment for ophthalmia Neonatorum caused by gonorrhea?

MEDICAL EMERGENCY - Hospital admission + Iv Ceftriaxone or Cefotaxime

How can Opthalmia Neonatorum caused by Gonorrhea be prevented?

Erythromycin prophylaxis

Key takeaways for Ophthalmia Neonatorum caused by Gonorrhea?

- Rapidly progressive and potentially blinding

- Warrants emergent intervention and systemic Abs

What are the potential complications of ophthalmia neonatorum caused by HSV

- Vision loss

- Life threatening/death

What are characteristic clinical features of ophthalmia neonatorum caused by HSV?

Vesicular skin lesion on eyelids, periorbital area or face

What is the Tx for ophthalmia neonatorum caused by HSV?

IV acyclovir

What should be done anytime an infant under 3 months old presents with fever?

SEPSIS WORKUP + EMPIRIC ANTIBIOTICS

What is a corneal abrasion?

disruption of the superficial epithelium of the cornea caused by trauma, foreign bodies, chemical exposure, eye rubbing or forceps delivery (neonatal causes)

What is the clinical presentation of corneal abrasion in infants?

- Fussiness or crying

- Blephrospasm

How are corneal abrasions diagnosed?

- Visual inspection

- Fluroscein staining

- Pupillary Exam

What is the management for corneal abrasions?

- Topical antibiotics or drops

- Lubricating eye drops/ointment

- Pain Management

What is cloudy cornea?

Refers to loss of corneal clarity and transparency, which appears as haze, whiteness or opacity

What is the etiology of cloudy cornea?

Congenital glaucoma - presents between 3-9 months of age presenting with light sensitivity and large, cloudy cornea

What is the clinical presentation of cloudy cornea in neonates?

- Excessive tearing, photophobia, eye rubbing

- Enlarged eyes (buphthalmos)

What is the management for cloudy cornea?

Referral to pediatric opthalmologist

What is congenital cataracts?

clouding of the lens that is present at birth presenting with absent/abnormal red light reflex and leukocoria (white pupil)

How is congenital cataracts diagnosed?

- Refer to ophtho

- Ocular US

- Systemic workup

What is dacryostenosis?

Congenital nasolacrimal duct obstruction presenting with chronic tearing, matting of eyelashes, palpation of lacrimal sac causing tear reflux

What is the management of Dacryostenosis?

Lacrimal sac massage/compression performed 2-3/day

What is a dacrocystocele?

Cystic distention of the lacrimal sac usually present shortly after birth, that presents will bluish, tense swelling

What is the management of dacrocystocele?

Urgent referral to Peds Ophtho

What is dacrocystitis?

infection of the lacrimal sac presenting with painful swelling, erythema and warmth

How is dacrocystitis managed?

- Acute: Systemic Ab + urgent ophthal referral

- Chronic - Probing and dacrocystorhinostomy (DCR)

What is preseptal cellulitis?

Infection arising within or near the eyelid itself

What is the M/C/C of preseptal cellulitis?

Infected insect bites

What are the clinical manifestations of preseptal cellulitis?

- No limitation of EOM, proptosis or chemosis

- Generally, no fever

How is preseptal cellulitis diagnosed?

CT scan of the orbits

What is orbital cellulitis?

serious infection of orbital muscles and fat behind eye that is a ophtho emergency

What are the clinical manifestations of orbital cellulitis?

- Unilateral ocular pain

- Chemosis

- Fever

- Proptosis

- impaired EOm and pain with eye movement

How is orbital cellulitis diagnosed?

Cultures

How is orbital cellulitis treated?

IV antibiotics (Vancomycin plus 3rd gen cephalosporin)

What is retinopathy of prematurity (ROP)?

A vasoproliferative disorder of the retina that occurs in premature infants with low birth weights, that can lead to retinal detachment and permanent blindness.

What are the causes of ROP?

- Prematurity - infants born prior to 31 weeks gestation

- Low birth weights

What are the complications of ROP?

Retinal Detachment and blindness

What is retinoblastoma?

Most common primary intraocular malignancy of childhood, typically dx in children under 5.

What is the clinical presentation of Retinoblastoma?

Leukocoria (white pupillary reflex)

What is a tropia (strabismus)?

An ocular alignment disorder this is constant or intermittent eye turn (one eye drifts off when both are open)

What is phoria?

Hidden misalignment that only appears when binocular vision is disrupted (like covering one eye)

What is pseudostrabismus?

The false appearance of crossed eyes

What is amblyopia?

Poor vision of one eye due to poor visual development that is commonly dx'ed before age 7

What is the M/C/C of conductive hearing loss?

Cerumen impaction

What is otitis externa?

inflammation of external auditory canal aka "swimmer's ear", that presents with tenderness with palpation of tragus or pinna (tug test)

What is the treatment for otitis externa?

- Ear Drops

- NSAIDS for pain management

What is eustachian tube dysfunction?

Middle ear disease that is most commonly caused by URIs, allergies, large adenoids

What are clinical manifestations of Eustachian tube dysfunction?

- Muffled hearing

- Difficultly equalizing pressure

- Retracted ear drum on PE

What is acute otitis media (AOM)?

infection of the middle ear that presents with purulent fluid accumulation in middle ear, bulging appearance, temporary conductive hearing loss

What is them most common reason for antibiotic use in children?

AOM

What are the Acute Otitis Media (AOM) treatment guidelines?

- Children less than 6 months: always treated

- Children under 2 w/ severe AOM: 10 days of Ab tx

- Children 2-5 with mild to moderate AOM: 7 days of Ab tx

- Children over 6 with mild to moderate AOM: 7 days of Ab tx

What is the treatment for AOM?

amoxicillin - 1st time

Augmentin - If 1st line failed

Azithromycin - if pcn allergy

What are the indications for myringotomy with Tympanostomy Tube placement?

- Middle ear effusion persistent for >3 month

- Recurrent AOM

- >/= 3 episodes of AOM in 6 months

- >/= 4 episodes of AOM in 12 months

What are complications of AOM?

Cholesteatoma

With is otitis media with effusion?

Fluid present in the middle ear presenting with muffled hearing, temporary conductive hearing loss and serous fluid (bubbles)

What is the management for otitis media with effusion?

- Conservative tx

- Do not give Ab if no signs of infection

What is a tympanic membrane perforation?

hole in the tympanic membrane

What are the clinical manifestations of Tympanic Membrane Perforation?

- Otalgia

- Hearing loss

- Bloody Otorrhea

What is the management for tympanic membrane perforation?

- Majoritity heal spontaneously w/o visible scars

- No swimming/bathing (water precautions)

What is cholesteatoma?

A white mass or debris that may erode/destroy ear bones

What is Mastoiditis?

Inflammation/infection of the mastoid process that presents with redness and swelling of mastoid process and fever.

How is mastoiditis dx?

- Gram stain and culture purulent fluid via myringotomy or tympanocentesis

- CT scan of temporal bone

How is mastoiditis treated?

Hospital admission with ENT consult + Empiric Antibiotics

What is conductive hearing loss?

Problems with sound transmission in the outer or middle ear, often temporary and treatable

What is sensorineural hearing loss?

hearing loss caused by damage to the cochlea or auditory nerve often permanent

What is acute cervical adenitis?

Inflammation of the cervical lymph nodes that is the most commonly caused cause of neck swelling in children

How do benign and malignant lymph nodes differ?

Benign - tender, mobile, soft, enlarged nodule

Chronic - non-tender, hard, fixed and enlarged

What is the most common congenital cyst of the neck?

thyroglossal duct cyst

Where are branchial cleft cysts located?

anterior to SCM

What is rhinosinusitis?

Inflammation of the paranasal sinuses and nasal cavity (ethmoid and maxillary sinus infections)

What is allergic rhinitis?

hay fever - type I IgE mediated reaction presenting with allergic shiners, allergic salute, pale/boggy turbinates

How is allergic rhinitis treated?

-remove offending agent

-intranasal corticosteroids (2 weeks to reach full relief)

-antihistamines

What is epitaxis?

Nose bleeds

How is epitaxis treated?

- Pinching

- Nasal packing

What is acute viral rhinitis?

The common cold! It is a viral upper respiratory infection

How is acute viral rhinitis treated?

treat symptoms

What are foreign bodies?

Foreign objects impacted in patient's orifices that can present with nasal d/c

How are foreign bodies treated?

Removal of the object

What are aphthous ulcers (canker sores)?

Ulcerative lesion of oral mucosa that presents with round ulcers with gray centers and red halos

How are aphthous ulcers treated?

- No definitive tx

- Pain control

What is herpes gingivostomatitis?

Common viral infection caused by HSV-1 that is most commonly in children aged 6 months to 5 years.