ENT- Peds Exam 1
Terms in this set (62)
What is acute otitis media?
Pathogens in middle ear due to eustachian dysfunction and bacterial reflux.
What are the most common causes of acute otitis media?
Bacteria (75-80%): Steptococcus pneumonia, H. influenzae, Moraxella catarrhalis
Viruses (20-25%): rhinoviruses, RSV
overuse/inappropriate use of ABX due to overdiagnosis
RF for Acute Otitis Media:
Lower socioeconomic status
Native Americans or Alaskans
Parental history of AOM
Trisomy 21, cleft palate
Presentation of Acute Otitis Media in infants vs. older children:
Infants: poor feeding, fever, irritability, pulling at ears
Older children: ear pain and fever
How to we diagnose Acute otitis media?
Pneumatic otoscopy: assess TM mobility
Tympanogram: measures TM compliance and volume of ear canal
First line treatment for acute otitis media:
What do you do if their TM is perforated?
High dose amoxicillin
Augmentin or cephalosporins
use oral antibiotics with topical antibiotics
What can you modify risk factors to prevent acute otitis media?
limit pacifier use, avoid passive smoking, consider alternatives for daycare
prescribe ABX sparingly
be cautious with treatment because 80% resolve spontaneously
What are some complications of acute otitis media?
When should you consider pressure-equalizing tubes?
Recurrent AOM (3 episodes in 6mos/4 in a year)
Children at risk of developmental delays
3 mos of effusion with hearing loss
What is otitis media with effusion?
Build up of fluid in middle ear without symptoms of acute infections
what can cause otitis media with effusion?
How can we treat?
viruses, allergies, or exposure to irritants
usually no benefit from ABX, can treat with antihistamines and nasal steroids
What is Otitis externa?
What can cause it? Host factors vs. microbial factors?
inflammation and exudation in external canal
Host: swimming, diving, cleaning ear, water in ear during showering or bathing
Microbial: P. aeruginosa (MC), S. aureus, Candida, and aspergillus
**MOST COMMON IN SUMMER (swimmer's ear)
Presentation of otitis externa?
Pain, aural discharge, some hearing loss, pruritus and tenderness in/around ear canal, tenderness with otoscope insertion
cultures to ID pathogen if resistance to initial management occurs
How do we treat otitis externa?
Topical quinolones, neomycin/polymyxin B/ hydrocortisone otic, quinolone + steroid
NO SWIMMING FOR 7-10 DAYS
advise patient to keep moisture out for 4-6 weeks
How can you dry out ears in otitis externa?
use a 1/1/1 solution of vinegar, isopropyl alcohol, water--> burrow solution
What is mastoiditis? What is it a complication of?
complication of unresolved AOM
Bacterial infection of mastoid bone
Symptoms of mastoiditis?
fever, irritable, lethargy
Swelling of earlobe
Drainage from ear
Erythema and tenderness of posterior auricular
How do we diagnose mastoiditis?
How do we treat mastoiditis? Acute vs. Chronic
X-rays or CT, blood test, ear culture
Acute: IV ABX
Chronic: oral ABX, ear drops, regular ear cleanings, surgical drainage
What is acute sinusitis?
Obstruction of osteomeatal complex
- Mucosal inflammation obstructs mucous movement to ostia and nasopharynx
What causes the inflammation of acute sinusitis?
what sinuses are affected at what age:
- ethmoid and maxillary sinuses at _____
- sphenoid by age _____
- Frontal by age _____
- <7yrs: ________ sinuses
- >7yrs: ________ sinuses
ethmoid and maxillary
sphenoid and frontal
Symptoms of acute sinusitis?
Symptoms of severe sinusitis?
URI sx lasting >10days
Acute vs. Chronic sinusitis
- how long do symptoms last?
- when do they cough?
- how often do they get it?
Symptoms resolve < 30 days
Spontaneously resolves in 40-60 %
Chronic: Symptoms last > 90 days
Night time cough common
6 or more episodes/ year
common causes of acute sinusitis?
S. pneumo- 20-30%
Nontypeable H. flu- 15-20%
M. catarrhalis- 15-20%
How do we diagnose acute sinusitis?
Diagnosis is clinical
- allergy testing may be helpful in diagnosing allergic rhinitis
- CT scans required before surgery that show mucosal thickening or sinus opacification
When is abx indicated in acute sinusitis? What abx are used?
ancillary therapy options?
Severe acute sinusitis
4 weeks of beta lactamase resistant 2nd line antibiotic
Saline nasal irrigation
Nasal steroids for allergic rhinitis
Antihistamines for allergic symptoms
Nasal decongestants and mucolytics have variable efficacy
What is pharyngitis?
Inflammation of the pharynx due to viral or bacterial pathogen
Bacterial: group A strep
Viral: rhinoviruses, adenoviruses, RSV, herpangina, coxsackie, EBV
- Incubation period?
- Who is most affected?
- What time of the year does it occur?
Droplet or physical transfer of respiratory secretions
children 5-15 yrs
Clinical manifestations of Strep pharyngitis?
What is scarlet fever?
rapid onset of fever (<101F)
sore throat with dysphagia, HA, nausea, abdominal pain, vomiting
Erythema of tonsils and pharynx with white/yellow exudate
Tender and enlarged anterior cervical lymph nodes
Scarlet fever: fine, diffuse erythematous macular-papular rash (sandpaper-like)
How do you diagnose Strep Pharyngitis?
Rapid Streptococcal antigen- 90-95% sensitivity
Throat culture is gold standard
How do you treat strep?
When can kids return to school?
treatment of choice is PCN
- Benzathine penicillin G IM
- if allergic to PCN: erythromycin
24 hours after starting abx
What changes should you make at home with strep?
Follow-up for strep?
Change toothbrush after abx for 24 hrs
Recheck in office in 2-4 weeks, refer to ENT if recurrent
What are some complications of strep?
appears 1-3 weeks after strep infection
UA will show hematuria and proteinuria.
- S/Sx: elevated BP, edema, joint pain
Post-strep rheumatic fever
takes 1-5 weeks to show up-symptoms
- S/Sx include fever, carditis, migratory polyarthritis
How do we treat viral pharyngitis?
Soft, cool foods or warm liquids
- What is it?
- Triad of symptoms?
- Who is affected?
Acute viral syndrome
Triad of fever, pharyngitis, and adenopathy
adolescents and college-age adults
How do we diagnose mononucleosis?
Common symptoms include the classic triad as well as fatigue, eyelid edema, headache, pain behind eyes, and a palatal petechial rash.
Splenic enlargement may occur
CBC with diff-lymphocytosis
EBV antibody test
EBV antibody test results for possible early, primary infection:
- EA-D, IgG:
How do we treat mono?
What should you avoid?
Uncomplicated mono requires only symptomatic therapy (Usually last 3-4 weeks), plan a realistic schedule of rest (some patients experience fatigue for 6-12 months)
Avoid contact sports and strenuous activity for at least 1 month splenic rupture
Avoid Amoxicillin/Ampicillin during course of disease as a drug-related rash may develop
What is a Peritonsillar abscess/Cellulitis?
Who is is most common in?
Localized infection of peritonsillar tissues (usually unilateral, but can be bilateral)
Males 3:1, most common in older children and adults
Physical exam findings of Peritonsillar abscess?
HOT POTATO VOICE
Unilateral ear and throat pain
Peritonsillar tissues-swollen, red, displaced downward and medially
Swelling and erythema of soft palate
Tender cervical adenopathy, ipsilateral
How do we diagnose peritonsillar abscess?
CBC: WBC elevation with left shift
Immediate referral to specialist.
- IV abx initially, then oral
Hand foot and mouth disease
- common population?
Small oral vesicles or ulcers on tonsils, pharynx, or posterior buccal mucosa
Headache and malaise
Papulovesicular lesions with erythematous halo on hands and feet-may have also on arms, legs, and buttocks as well(HFM)
How do we manage HFM?
antipyretics, Mary's magic mouthwash, hydration, handwashing
- what are they?
- common cause?
- chronic inflammation of oral mucosal tissue with ulcers
- by immunologic response to oral mucosal antigens
- lesions in children usually singular, small (<1 cm) and painful
- Mary's magic mouthwash, avoid spicy, salty, and acidic foods
Nasal foreign body:
- who gets them?
Commonly seen in children < 5 years
Late presentation → signs of infection, Unilateral purulent discharge, foul breath
Treatment is removal
No urgency for removal unless battery
- who is usually affected?
viral- parainfluenza, EBV, HIV possible if known to be at risk
parotid gland is swollen, tender, and erythematous (usually unilateral), fever and leukocytosis
Culture of purulent material
hospitalization and IV abx (cover S. aureus- MCC)
What is ankyloglossia?
"Tongue-Tie"- A short lingual frenulum can hinder both
protrusion and elevation of the tongue.
Puckering of the midline tongue tip is
noted with tongue movement. Can cause feeding difficulties in the neonate, speech problems, and dental problems.
Frenulectomy (early treatment is favored)
What is allergic rhinitis?
Inflammation of mucous membranes of nose, usually accompanied by edema of mucosa and nasal discharge
strong association with sinusitis
etiology of allergic rhinitis?
Inhalation of aeroallergens
- Allergic response mediated by IgE, histamine, and other chemicals
- Biphasic allergic inflammatory response with first peak 15-30 min after exposure and second peak several hours after exposure
What are the two types of allergic rhinitis?
Seasonal allergic rhinitis- "hay fever"
Perennial allergic rhinitis
Symptoms of allergic rhinitis
Itching (eyes, ears, and throat)
Eye discharge or tearing
Physical exam findings of allergic rhinitis:
Pale, blue, boggy nasal mucosa
Cobblestoning of posterior pharynx
Infraorbital venous congestion "allergic shriners" (can be red, blue or purple)
How do we diagnose allergic rhinitis?
Skin test is confirmatory test of choice
Allergen specific IgE test
How do we manage allergic rhinitis?
Step 1: Allergen Avoidance and Environmental Control
Step 2: Pharmacotherapy- nasal steroids (preferred), antihistamines, decongestants, mast cell stabilizer, singulair
Step 3: Immunotherapy
What is the common cold? AKA?
- incubation period?
Commonly classified as URI
- An acute, mild and self-limiting syndrome caused by a viral infection of the upper respiratory tract mucosa
- rhinoviruses, coronaviruses, RSV (older children)
-Direct contact with infected secretions, Hand-to-hand, Hand-to environmental surface-to hand, Spread by aerosoles
- 1 to 3 days, shedding in 2-4 days
Clinical presentation of common cold:
Usually last 5-7 days but can predispose to bacterial infections
- Dry scratchy sore throat
- Sneezing, nasal stuffiness, rhinorrhea
- Hoarseness, cough
- Low grade fever, headache, and malaise
- Conjunctivae may be watery and inflamed
Treatment of common cold:
Saline nose drops
Steamy showers or inhalation of steam
No benefit to use antibiotics
OTC cough medications and decongestants
What is influenza?
acute viral disease of respiratory tract
What are the 3 types of influenza?
- Most virulent cause
- Potential to cause pandemics
- Cause annual winter epidemics
- Causes mild illness, not epidemics
- Flu vaccines does not cover
How is influenza transmitted?
Spread person-to-person by inhalation of small particle aerosols, by direct contact, by large droplet infection, or by articles recently contaminated with nasopharyngeal secretions
- most infectious in first 24 hours before onset of symptoms
Symptoms of influenza
Abrupt onset of fever, malaise, diffuse myalgia, headache, rhinitis, and nonproductive cough
Sore throat, nasal congestion, and sneezing
Nausea, vomiting, and diarrhea occur in children
Symptoms usually last 3-4 days but cough and malaise may persist for 1-2 weeks
Diagnosis of Flu?
Flu test (nasopharyngeal rapid test)
Consider CBC and UA
- Oseltamivir (Tamiflu): Can give as young as 2 weeks of age. Must begin within first 2 days of symptoms. Prophylactic treatment for household members
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