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This comprehensive resource provides a detailed overview of key concepts in pediatric ear, nose, and throat (ent) through a series of questions and answers. it covers various conditions, including hearing loss, ear infections (otitis externa, media), sinusitis, tonsillitis, and nasal disorders. The q&a format facilitates understanding of diagnostic procedures, treatments, and risk factors associated with each condition. Valuable for medical students, residents, and healthcare professionals.
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What are the TWO types of hearing loss? Conductive hearing loss Sensorineural hearing loss What are SEVEN risk factors that predispose children to hearing loss? Premature birth In utero TORCH infection Family history of SNHL Craniofacial anomalies Head trauma Post-nasal infection (ie. meningitis) Drugs (ie. chemotherapy) A premature baby with what THREE risk factors has a higher likelihood of developinghearing loss?
Birth weight <1500g (VLBW) APGR of <3 at 1 minute and <6 at 5 minutes Mechanical ventilation of >10 days T/F. Infants with profound deafness can startle, laugh and babble. TRUE - further development will be delayed What type of hearing loss occurs due to mechanical obstruction in the external + middleear that interferes with transmission?
conductive hearing loss
Aminoglycosides Furosemide Vancomycin What is a perilymph fistula? congenital cause of sensorineural hearing loss that results from a leak in the inner earfluid due to a defect in the otic capsule
What findings on Weber and Rinne are consistent with sensorineural hearing loss? AC > BC Weber will lateralize to the UNAFFECTED ear
Otoacoustic Emission Brainstem Auditory Evoked Response What are the AAP/NIH screening guidelines for hearing assessment? Universal screening by 1 month If abnormal → confirm at 3 months
When examining the EAR, what are the 4D's that can be used as a guideline? Discharge Displacement Discoloration Deformity What type of ear infection is referred to as swimmer's ear? What causes it? acute otitis externa
topical otic ABX/steroid preparations
H. influenza M. catarrhalis An infant that suffers from their first AOM prior to 6 months of age is at a higher risk forwhat? chronic otitis What are SIX risk factors that can predispose children to developing AOM? Exposure to cigarette smoke
What ear infection is common with children that have down syndrome or a cleft palate? chronic recurrent OM What is the treatment for chronic recurrent OM? tympanostomy tubes (>4 AOM in 12 months) What TM changes can present with chronic recurrent OM? myringosclerotic changes - TM white, thickened and scarred due to chronic inflammation What is one of the most serious lesions of the ear drum that results from trappedepithelial tissue underneath the membrane?
cholesteatoma **can occur as a complication of chronic OM What is the MOST COMMON CAUSE of an aural polyp/granuloma? an old + retained tympanostomy tube What is the treatment for aural polyps/granulomas? ABX if infection is noted
blockage of the nasal opening
A child presenting with nasal polyps should be evaluated for what TWO conditions?CF
Asthma If crepitus is present upon palpation of the nose, what should be suspected? nasal fracture An untreated septal hematoma (submucosal bleeding) can lead to what type of nosedeformity? saddle nose deformity What is the most common cause of sinusitis in children? viral URI/allergic rhinitis
*if bacterial, same pathogens as AOM Which sinuses are present at birth? ethmoid and maxillary What S/S are consistent with sinusitis in children? Purulent rhinorrhea Halitosis Facial pain HA **sinus tenderness might not ALWAYS be present What ABX can be used in the treatment of sinusitis in children? Augmentin **also recommend use saline spray, warm compresses and avoid swimming What are FOUR complications of sinusitis?Pott puffy tumor
Epidural abscess
If periorbital cellulitis spreads INTO the orbit what can develop?orbital cellulitis
What is the SOURCE of an orbital cellulitis?infected ethmoid sinus
What clinical features are consistent with orbital cellulitis? Intense pain BEHIND the eye that is worse with eye movements Eyelid edema and proptosis (protrudes) What TWO ABX are used in the treatment of orbital cellulitis? Vancomycin PLUS Ceftriaxone What is the CRITERIA for recurrent tonsillitis?
6 episodes in 1 year 5 episodes/year in 2 years 3 episodes/year in 3 years
**can be referred for tonsillectomy What clinical features are consistent with acute tonsillopharyngitis caused by GABHS? Fever HA Enlarged + erythematous tonsils +/- exudates Palatal petechiae ANTERIOR adenopathy Abdominal pain What clinical features are consistent with acute tonsillopharyngitis caused by EBV? POSTERIOR adenopathy Fatigue Splenomegaly What is the 1st line treatment for acute tonsillopharyngitis caused by GABHS?
Unilateral sore throat Fever What are TWO risk factors for peritonsillar abscess? School-aged children Hx of poorly treated throat infection What is the 1st line treatment for peritonsillar abscess? I&D PLUS IV ABX If a patient presents with an asymmetrically enlarged tonsil WITHOUT evidence ofinfection, what could be a possible diagnosis? tonsillar lymphoma If CBC w/ diff. comes back abnormal for a patient with a tonsillar lymphoma, what is theNEXT step in evaluation? excisional biopsy What is a retropharyngeal abscess?posterior neck space abscess
What are the TWO most common pathogens that cause a retropharyngeal abscess? S. pyogenes
S. aureus What pediatric population is most commonly present with a retropharyngeal abscess? 2-4 y/o with an antecedent URI If older = due to puncture wound With a retropharyngeal abscess, how will the uvula and tonsils be displaced? What otherS/S can present?
uvula + ipsilateral tonsil will be displaced FORWARD **will also present with dysphagia, drooling and swelling What is the INITIAL diagnostic study for a retropharyngeal abscess?lateral neck XR
