Peds E2- ENT

What is mild hearing loss?

25-40dB; difficulty w/ whisper, misses up to 50% speech; 3-5 yo at dx

What is moderate hearing loss?

41-55dB; struggle w/ convo at home, misses 50-100% speech; poor voice and speech quality

What is moderate-severe hearing loss?

56-70dB; barely hear vacuum cleaner, loud shout heard as whisper; needs education interventions

What is severe hearing loss?

71-90dB; barely hear garbage disposal; difficulty w/ hearing aids

What is profound hearing loss?

>90dB; barely hear motorcycle @25 ft; feels vibration only, relies on vision for communication

What are RF for hearing loss?

pre-term birth, low birth wt, low APGAR, in utero TORCH infxn, postnatal infxn, chemo, etc

What is the MC type of hearing loss in pediatrics?

conductive

What is the MCC of acquired & conductive hearing loss?

Middle ear effusion

What is the MC congenital infxn causing sensorineural HL?

CMV

What is the MC acquired infection causing sensorineural HL?

meningitis

What medication is most commonly associated with acquired sensorineural hearing loss?

Aminoglycosides (gentamicin)

What is the MC genetic sensorineural HL?

Connexin 26 gene defect

When does the AAP/NIH recommend universal screening for hearing loss be done?

by 1 month

Screening test for hearing loss to determine:

"Can baby hear?"

Otoacoustic emission (OAE)

Screening test for hearing loss to determine:

"How well can baby hear?"

Brainstem Auditory Evoked Response (BAER)

What audiometry behavioral test:

For children < 6 mos, look for changes in child's reflexive behavior

Behavioral observation audiometry

What audiometry behavioral test:

Sound are played through headphones and child is instructed to perform a simple task

Conditioned play audiometry

What audiometry behavioral test:

Ask the child to play a task in response to sound

Conventional audiometry

What audiometry behavioral test:

Allows you to distinguish between conductive hearing loss and sensorineural hearing loss

Visual reinforcement audiometry

What is key to tx hearing loss?

early intervention

What are the 4 D's of an ear exam?

Discharge, Displacement of pinna, Discoloration, Deformity

What is the medical term for "Swimmer's ear"?

Acute otitis externa

What are the MC organisms that cause acute otitis externa?

Pseudomonas, Strep, Staph

What is the biggest RF for AOE?

swimming

How does AOE present?

pain, pruritic, canal erythema, thick/white discharge, pulling on pinna & pressing on tragus elicits pain

What is the 1st line tx for acute otitis externa?

> 6 mo = Ciprodex drops; > 2 yo = Cortisporin drops

*if TM ruptured or unsure use systemic

What usually precedes AOM?

viral URI

What are the MC bacterial causes of AOM?

S. pneumo, H. influenzae, M. catarrhalis

What are RF for AOM?

exposure to cigarette smoke, sick contacts, immunodeficiency, high risk in < 6mo d/t horizontal Eustachian tube

How does AOM present?

TM bulging/retracted/perforated and erythematous, hearing may be dec

At what age can Ibuprofen be given for symptom relief in patients w/ AOM?

6+ months

What is the tx for AOM?

Amoxicillin

When do you tx AOM w/ Augmentin instead?

Amoxicillin is not working in 48-72 hrs OR recent tx with other beta-lactam w/in 30 days OR concomitant purulent conjunctivitis

What is the tx for AOM in patient with Type 1 allergy to PCN?

(anaphylaxis/angioedema)

Macrolide (Azithromycin)

What is the tx for AOM in patient with Non-Type 1 allergy to PCN?

Cephalosporin (cefdinir)

You should refer a patient with > ____ AOM episodes in < 6 mos

3

You should refer a patient with > _____ AOM episodes in a 12-month period with resolutions in between

4

When should you consider tympanostomy tubes?

> 4 OM in 1 yr

How does Serous otitis media present?

clear grey or yellowish colored fluid behind the eardrum

Treat or don't treat:

AOM with bulging TM

YES- abx!

Treat or don't treat:

Serous otitis media (OME) with opacification of TM or air-fluid level

No!

What is the tx for chronic recurrent otitis media?

Tympanostomy tubes

Chronic recurrent otitis media is common in young children with what conditions?

facial hypoplasia or deformities (Cleft palate & Down syndrome)

What is one of the most serious lesions of the ear drum?

-consists of trapped epithelial tissue growing beneath the surface of the membrane

Cholesteatoma

What is the tx for Cholesteatoma?

surgical removal

What is the MCC of aural polyps?

Old, retained tympanostomy tube

What is the tx of Granulomas and polyps?

surgical removal + abx if infxn

What are the MC organisms that cause mastoiditis?

S. pneumo, S. pyogenes, Staph aureus

Mastoiditis associated with recurrent OM/recently treated with abx is d/t what pathogen?

Psuedomonas

How does Mastoiditis present?

pain, edema, erythema, tenderness behind ear; pinna may be displaced

What is the most reliable exam for diagnosis of mastoiditis?

CT scan

What is the tx for mastoiditis without recurrent AOM/recent abx (>6 mos)?

IV Unasyn

What is the tx for mastoiditis with recurrent AOM/recent abx (<6 mos)?

IV Zosyn

What is the tx for mastoiditis with severe PCN allergy?

IV Vanco (or Linezolid) + Metronidazole

How long are infants obligate nose breathers (can lead to a URI/nasal congestion)?

first 1-3 months

What is Choanal atresia?

blockage of the nasal opening

How does bilateral Choanal atresia present?

noisy breathing, cyanosis that worsens w/ feeds and improves w/ crying

How does unilateral Choanal atresia present?

later in life, nasal discharge or obstruction

What is the definitive study for diagnosis of choanal atresia?

CT scan

Which form of choanal atresia is an emergency --> Place an oral airway?

Bilateral

What is the definitive tx of bilateral choanal atresia?

surgical repair

What should any child presenting with nasal polyps should be evaluated for?

CF and asthma

How does a Displaced nasal fracture present?

Crepitus evident on palpation of nasal bridge; ecchymoses under both eyes, obvious nasal deformity

What can cause saddle nose deformity?

untx septal hematoma

When does the sphenoid sinus cavity mature?

5 yo

What does the frontal sinus cavity mature?

> 7 yo (avg 10-11)

Which sinuses are present at birth?

ethmoid & maxillary

What is the MCC of sinusitis?

Viral URI/Allergic rhinitis

What are the bacterial causes of sinusitis?

S. pneumo, H. flu, M. catarr

How does Sinusitis present?

Prolonged URI for 7-10 days with halitosis

What is the tx for sinusitis?

Augmentin

What is a Pott Puffy tumor?

complication of sinusitis with frontal bone osteomyelitis associated with subperiosteal abscess

How does a Pott Puffy tumor present?

erythematous forehead swelling that’s exquisitely tender, HA, fever

What is the dx test & tx for a Pott Puffy tumor?

Dx: head CT

Tx: surgical drainage & broad spec IV abx

What is an Epidural abscess?

complication of sinusitis with erosion through the posterior wall of the frontal bone

How does an Epidural abscess present?

high fever, AMS, and signs of toxicity

What is the dx test & tx for an Epidural abscess?

Dx: MRI
Tx: IV abx; neurosurgery consult if drainage needed

What are complications of sinusitis?

periorbital or orbital cellulitis, intracranial abscess, subdural empyema, meningitis

What is Periorbital cellulitis?

skin and soft tissue infection around the eye ant. to the orbital septum; more common in children

How does Periorbital cellulitis present?

Unilateral, bright erythema, tender, indurated; conjunctivitis, fever

What is the diagnostic test for Periorbital (preseptal) cellulitis?

CT w/o contrast

What is the tx for periorbital cellulitis?

Augmentin

*if no improvement w/in 24 hrs- Linezolid or Bactrim

What are common pathogens of Orbital (septal) cellulitis?

Strep & staph

Where does the infxn that leads to Orbital cellulitis originate from?

spread from infected ethmoid sinus

How does Orbital cellulitis present?

appears ill, toxic/lethargic, proptosis, painful EOMs, dec vision

intense retro-orbital pain aggravated by ocular movement

What is the diagnostic test for Orbital cellulitis?

CT w/ contrast or MRI

What is the tx for orbital cellulitis?

Aggressive IV abx (Vanco + Rocephin) + Ophtho/ENT referral

What is acute tonsillopharyngitis?

Sore throat

How does Acute tonsillopharyngitis d/t EBV present?

posterior adenopathy, fatigue, and splenomegaly

How does Acute tonsillopharyngitis d/t GAS present?

fever, HA, erythematous tonsils w/wo exudate, and anterior adenopathy

Centor criteria for strep pharyngitis

1 pt: Fever, Lack of cough, Tender anterior adenopathy, Tonsillar exudates, 3-14 yo

0 pt: 15-44 yo

-1 pt: 45+

What is the tx for GAS acute tonsillopharyngitis?

Pen V or Amoxicillin

What is the tx for GAS acute tonsillopharyngitis with PCN allergy?

Azithromycin

How long after tx initiation are patients with strep throat still contagious?

24 hours

What dx tests can be used to dx EBV?

MonoSpot

What is the tx for EBV (mono)?

supportive, rest, NO contact sports x 6 weeks!!

Recurrent tonsillitis = > _____ episodes in 1 calendar year

6

Recurrent tonsillitis = > _____ episodes per year for 2 consecutive years

5

Recurrent tonsillitis = > _____ episodes per year for 3 consecutive years

3

What is the MCC of a Peritonsillar Abscess?

GAS

*next is S. Aureus