Term
| What are key points of the HEENT hx? |
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Definition
-age
-time of year
-associated sx: fever (and timing), cough, congestion, sore throat, HA, ear pain
-CHS: change in appetite, sleep, activity, elimination, ETS, tobacco or marijuana use
-SH: childcare, siblings, travel
-PMH: previous ENT infxn, hospitalization, vaccinations |
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Term
| What are key points of the HEENT PE? |
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Definition
-HEENT
-neck (lymphadenopathy) |
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Term
| What is the etiology of otitis media? |
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Definition
| -fluid and pathogen accumulation in the middle ear d/t Eustachian tube dysfunction |
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Term
| What is the incidence of otitis media? |
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Definition
-highest 6-36 mos; low >7 yrs
-highest in winter and spring
-more common in males, Caucasians, American Indians, Eskimos, and low SES
-70% of children have at least 1 episode, and 33% have 3+ by 3 yrs |
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Term
| What is the clinical presentation of otitis media? |
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Definition
| -fever -ear fullness, pain, discomfort, tugging -purulent otorrhea with TM rupture -rhinorrhea, nasal congestion -poor appetite, feeding, n/v -poor sleep |
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Term
| What diagnostic tests are used in otitis media? |
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Definition
-pneumatic otoscopy (mobility)
-tympanogram (compliance)
-hearing test
-language screen
-allergy, immunologic |
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Term
| What is the differential diagnosis for otitis media? |
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Definition
-crying
-serous otitis media
-tympanosclerosis
-cholesteotoma
-otitis externa |
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Term
| What is management of otitis media? |
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Definition
-abx
---if no improvement after 24-48 hrs
---10 day course (shorter if older child or mild case)
---1st line: Amoxicillin 80-90 mg/kg/day BID
---2nd line: Augmentin 90 mg/kg/day + 6.4 mg/kg/day clauvulanate BID
---3rd line: Ceftriaxone 50 mg/kg 2 doses IM 48 hrs apart
---PCN allergic: azithromycin or other macrolide abx
---prophylactic: amoxicillin, sulfisoxizole 1/2 treatment dose 1x/day with monthly follow up
-fever and pain control, unless perforation or PE Tubes in place
-NOT decongestants |
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Term
| When would a referral to an ENT be needed for otitis media? |
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Definition
-persistent resistant AOM: 1-2 mos
-frequent recurrent: 3/6 mos, 4-5/yr, 6 by 6 yrs
-persistent chronic OME: 3 mos
-hearing deficit or language delay |
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Term
| What is the etiology of otitis media with effusion? |
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Definition
-ET dysfunction: negative pressure in middle ear produces effusion
-sequelae of AOM |
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Term
| What is the incidence of otitis media with effusion? |
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Definition
-25-35% of otitis media cases
-30-40% associated with allergic rhinitis |
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Term
| What is the clinical presentation of otitis media with effusion? |
|
Definition
-ear fullness, crackling, mild discomfort
-hearing loss
-decreased attention
-yellow, dull, opaque, or translucent TM with possible fluid level or air bubbles
-retracted TM
-decreased mobility, high negative pressure or flat line on tympanometry |
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Term
| What is the management of otitis media with effusion? |
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Definition
-limit abx use and prophylaxis
-f/u every 3-4 weeks |
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Term
| What is the etiology of otitis externa? |
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Definition
-increased wetness (swimming and humidity in summer)
-loss of protective cerumen
-chronic irritation
-trauma: foreign body, digital irritation, Q-tip, hearing aid
-excessive dryness: eczema, psoriasis
-contact dermatitis (hair products, fragrances) |
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Term
| What is the most common pathogenic agent of otitis externa? |
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Definition
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Term
| What are the most common pathogenic agents of otitis media? |
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Definition
-Strep pneumoniae
-Hib
-Moraxella catarrhallis |
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Term
| What is the clinical presentation of otitis externa? |
|
Definition
-ear itching, pain, fullness
-hearing loss
-TM difficult to visualize d/t edema or exudate
-fluffy white debris and black spots on TM (fungal infxn)
-furuncle (localized infxn)
-pre- or post-auricular lymphadenopathy |
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Term
| What are diagnostic tests for otitis media externa? |
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Definition
| -culture only if unresponsive to medication |
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Term
| What is the differential diagnosis for otitis externa? |
|
Definition
-AOM with perforation
-dental infxn
-mastoiditis
-furunculosis
-foreign body
-eczema
-parotitis |
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Term
| What is the management for otitis externa? |
|
Definition
-gentle irrigation with warm water or NS if foreign body or debris, NOT if perforated TM a consideration
-topical abx drops (with hydrocortisone if edematous)
-cotton wick saturated with abx soln for 24-48h if significant edema
-oral abx if fever, lymphadenitis, facial cellulitis
-incision and debridement if furuncle
-oral analgesics
-avoid swimming, getting ear wet
-re-examine 1-2 weeks
-prevention: 1:1 white vinegar:rubbing alcohol after swimming |
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Term
| What is the etiology of sinusitis? |
|
Definition
-2ndary to URI, allergies, adenoidal hypertrophy, anatomical abnormalities, dental abscess, diving and swimming
-higher risk if CF or immune deficiency
-most frequently maxillary and ethmoid sinuses |
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Term
| What are common pathogenic organisms of acute sinusitis? chronic sinusitis? |
|
Definition
-Hib, Moraxella catarrhalis
-Group A strep, Staph aureus, anaerobes |
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Term
| What is the clinical presentation of sinusitus? |
|
Definition
-clear or mucopurulent rhinorrhea and/or post-nasal drainage
-erythema of nasal mucosa and/or throat
-pain on percussion with possible erythema and/or edema in area of affected sinus
-OEM in younger childrem |
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Term
| What are diagnostic tests for sinusitis? |
|
Definition
-nasal swab: eosinophils in allergy
-CT scan: sinus disease, complications, recurrent, unresponsive |
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Term
| What are differential diagnoses for sinusitis? |
|
Definition
-dental infections
-cleft palate
-foreign bodies
-tumors
-polyps
-nasal trauma
-nasal malformations
-allergic rhinitis
-purulent rhinitis
-common cold
-CF
-immunodeficiency states
-allergy
-asthma |
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Term
| What is management of sinusitis? |
|
Definition
-abx (same as AOM) 14-21 days, up to 6 weeks
-topical inhaled steroids
-normal saline nasal spray
-nasal decongestant sprays < 3 days
-analgesics
-humidity and fluids |
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Term
| What is the etiology of epistaxis? |
|
Definition
Inflammation
-viral, bacterial
-allergies
Trauma
-nose picking (digital trauma)
-foreign body insertion
-direct blunt trauma
-violent sneezing
Drying
-poorly humidified air
Substance abuse
-cocaine
-cannabis
Systemic
-HTN
-clotting abnormalities
-ASA or NSAID overuse
-neoplasms
-CA tx
-hormonal influences
-pregnancy |
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Term
| What is the clinical presentation of epistaxis? |
|
Definition
-unilateral bleeding
-tarry stools |
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Term
| What are diagnostic tests for epistaxis? |
|
Definition
-stool for occult blood (swallowing)
-X-ray (nasal fracture, foreign body)
-CDC with diff (platelets)
-PT, PTT, coagulation (bleeding d/o) |
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Term
| What is the differential diagnosis for epistaxis? |
|
Definition
-foreign body
-infection
-substance abuse
-allergies
-chronic rhinitis
-chronic nasal spray use |
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Term
| What is the management for epistaxis? |
|
Definition
-abx (infection)
-vasoconstrictor and packing (persistent)
-cauterization (recurrent, severe)
-pressure
-ice
-humidity
-vaseline
-avoid nose blowing |
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Term
| What are key points of hx and PE for epistaxis? |
|
Definition
-recent URI
-allergic rhinitis
-ASA or NSAID use |
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