Peds EENT

URI, nasopharynx, negative, secretions, colonization, s. pneumoniae, 6-15

Acute Otitis Media

• Pathogenesis

  • ____ sx → inflammation of ____________ mucosa and ET → poor ventilation → ________ ear pressure → accumulation of ___________ in middle ear → ____________ with bacteria/viruses

• Etiology

  • _ __________ (MC)

  • H. influenza

  • M. catarrhalis

• Epidemiology

  • Peak between _-__ months

anatomy, genetic, bottle, breast, tobacco

AOM Risk Factors

• Immature or abnormal __________

• _________ predisposition

• Immunocompromised

• _______ fed (_______ feeding is protective)

• Exposure to __________ smoke

URI, fever, restless, otalgia, ears, otorrhea, bulging, mobility

AOM Symptoms

• ____ sx

• Infants

  • ______, irritability, _________ sleep, anorexia, vomiting/diarrhea

• Children

  • Fever, __________, tugging/pulling at _____

• __________ (if perforated)

• __________ TM with or w/o erythema

• Air fluid levels

• Decreased TM _____________ (pneumatic otoscopic exam)

clinical, tympanometry, tympanocentesis

AOM Diagnostics

• Usually ____________

• ___________ (tympanogram)

• _____________

  • Reserved for neonates, immunocompromised, or those not responding to therapies

6, otorrhea, bilateral, severe, unilateral, otorrhea, severe, bilateral

AOM Treatment

• < _ months

  • Treat immediately (10 days)

• 6-24 months

  • Treat immediately → AOM w/ _________, _________ OM, OM with ________ sx (10 days)

  • May observe 48-72 hrs → __________ AOM and mild sx

• >2 years

  • Treat immediately → AOM w/ __________ or AOM w/ severe sx (1st line 5-7 days; 2nd line 10 days)

  • May observe 48-72 hrs → ___________ AOM w/o otorrhea and mild sx or unilateral AOM w/o otorrhea

Amoxicillin, high, conjunctivitis, ofloxacin, cefdinir

AOM Treatment

• 1st line

  • _________ (____ dose)

  • Augmentin

    • If amoxicillin in the past 30 days, failing amoxicillin therapy, or has concomitant ___________ (otitis-conjunctivitis syndrome)

• 1st line for pt w/ tympanostomy tubes or TM perforation w/ AOM

  • Fluoroquinolones (__________, ciprofloxacin) ear drops

• 2nd line/PCN allergy

  • _________

  • Cefuroxime

  • Clindamycin

  • Macrolide

perforation, chronic, otorrhea, hearing, intracranial

AOM Complications

• TM _________

• __________ otitis media w/ effusion

• Chronic ____________

• _________ loss

• Cholesteatoma

• ___________ extension

• Mastoiditis

acute viral rhinitis (rhinosinusitis)

What condition are these pathogens associated with?

• Rhinovirus

• RSV

• Influenza

• Parainfluenza

• Adenovirus

• Enterovirus

• Coronavirus

• Human metapneumovirus

low, nasal, appetite, sleeping, low, headache, throat, nasal, clear

Acute Viral Rhinitis/Rhinosinusitis → Symptoms

• Infants

  • ______ grade fever, __________ congestion/discharge, fussiness, decreased _________, difficulty ___________

• Older Children

  • ____ grade fever, nasal congestion/discharge, _________, sore ______, cough

• Erythema/edema of ______ mucosa

• Lungs _______

fluids, warm, saline, humidifier, honey, avoid, 6-12, 12

Acute Viral Rhinitis/Rhinosinusitis → Treatment

• Symptomatic Treatment

  • _______ for hydration

  • _____ fluids (soup, tea)

  • Nasal _______ flushes

  • Cool mist _________

  • Antipyretics/analgesics

  • ________ in kids >1 y/o

• <6 y/o → ______ OTC cold meds

• _-__ y/o → do not recommend OTC cold meds

• >___ y/o → may use OTC cold meds

respiratory arrest

What is the #1 cause of cardiac arrest in children?

obstruction, smaller, larger, immature, reserve

Airway Anatomy

• Smaller airways (_________ easier)

• __________ oral cavity but ________ tongue

• ________ tissues

• Less respiratory _________

candida albicans, infants, steroid, white, difficult, friable, painful

Thrush

• Etiology

  • __________ _________

• Epidemiology

  • __________ (even otherwise healthy ones)

  • Immunosuppressed (DM, HIV, etc)

  • Inhaled ________ use

  • Abx use

• Symptoms

  • Creamy _____ plaques on oral mucosa and/or tongue

    • ________ to scrape off

    • Underlying mucosa red, inflamed, _________

  • Can be __________

    • Poor feeding or refusal to eat

clinical, fungal, KOH, nystatin, fluconazole, mother

Thrush

• Diagnosis

  • Usually _________

  • _______ culture

  • ____ prep

• Treatment

  • Oral ________ suspension (100,000 units) 4-6x/day until resolution

    • Apply directly to lesions with applicator

  • Oral __________ (disseminated or resistant cases)

• Don’t forget to treat _______ if breast feeding

A, pyogenes, rare, school

Strep Pharyngitis

• Etiology

  • Group _ Beta Hemolytic Streptococcus (streptococcus ___________)

• Epidemiology

  • _______ before age 2-3

  • Most common in young ______ aged children

erythema, exudate, petechiae, fever, cervical, pallor, strawberry, sandpaper

Strep Pharyngitis → Symptoms

• Sore Throat

  • _________ and edema of oropharynx

  • Tonsillar __________

  • ___________ of soft palate, uvula, and/or posterior pharynx

• Moderate-high _______

• _________ LAD

• HA, N/V, abdominal pain

• Scarlet Fever

  • Circumoral _______

  • __________ tongue

  • fine/diffuse/erythematous macular-papular rash (_____________ rash) (scarlitiniform rash)

centor, antigen, culture, penicillin V, amoxicillin, G, cephalexin, rheumatic, glomerulonephritis

Strep Pharyngitis

• Diagnosis

  • __________ Criteria

  • Rapid Strep _________ Test (BEST INITIAL)

  • Throat ___________ (Gold Standard)

• Treatment

  • __________ _ or __________ x 10 days (1st line)

    • Benzathine penicillin _ IM once is alternative if unable to tolerate oral meds

  • PCN allergic → __________, clindamycin, azithromycin

  • Treat to prevent secondary illness (_________ fever, _____________)

enteroviruses, coxsackie, odynophagia, sore, vesicles, ulcers, clinical, supportive

Herpangina

• Etiology

  • ________

  • __________ viruses

• Symptoms

  • Fever

  • _________

  • ____ throat

  • vomiting, abdominal pain, anorexia

  • Multiple, tender, papular, or pinpoint ________ on an erythematous base scattered over the soft palate, uvula, and sometimes tongue that enlarge (1-4 mm), rupture, and form ________

• Diagnosis

  • _________

• Treatment

  • _________ care

haemophilus, streptococcus, 1, throat, drooling, hot potato, stridor, tripod

Epiglottitis

• Life-threatening emergency

• Etiology

  • _________ influenza type B (decreased since vaccine)

  • Nontypeable H. influenza

  • Neisseria meningitides

  • ___________ species

• Epidemiology

  • < _ y/o most at risk but young children in general

• Symptoms

  • Fever

  • Severe sore ______

  • Dysphagia/_________

  • Muffled “___ _______” voice

  • Inspiratory ________

  • Respiratory distress

  • Sniffing/________ positioning

disturb, examine, secured, airway, OR, cherry red, thumbprint, cultures

Epiglottitis → Diagnosis

• DO NOT do anything that will _______ the child and DO NOT try to _______ the throat, which can both lead to worsening obstruction, until the airway is __________

• Throat should be examined by experienced _______ specialist typically in the __

  • Epiglottitis will be _____ _____ and swollen

• Lateral neck XR → “__________” sign

• Blood and epiglottitis __________

airway, anesthesiology, ENT, ceftriaxone, cefotaxime, vancomycin

Epiglottitis → Treatment

• _________ management FIRST

• Immediate __________ and ___ consult

• Broad spectrum Abx pending culture results

  • 3rd gen cephalosporin (__________ or ___________) and antistaphylococcal (__________)