ENT

Question 1

What are the indications for tonsillectomy?

Answer 1

Recurrent tonsillitis

• At least 7 episodes in the previous year
• At least 5 episodes in each of the previous 2 years
• At least 3 episodes in each of the previous 3 years

OSA

Modifying factors

• Hospitalizations due to severe symptoms
• Multiple antibiotic allergies making therapy difficult
• Recurrent peritonsillar abscess
• PFAPA
• Lemierre’s syndrome (internal jugular vein thrombosis) due to tonsillitis
• Rheumatic heart disease

Question 2

What is Gradenigo syndrome and a Bezold abscess?

Answer 2

Complications of mastoiditis

Gradenigo syndrome = triad of suppurative OM, paralysis or external rectus muscle + pain in ipsilateral orbit

Bezold abscess → complication resulting in neck abscess

Question 3

What is the treatment for mastoiditis?

Answer 3

• Myringotomy + parenteral antibiotics +/- mastoidectomy if osteitis
• Antibiotics → Ampicillin or Cefazolin or Cefuroxime

Question 4

What are the indications for supraglottoplasty in children with laryngomalacia?

Answer 4

• Progressive respiratory distress
• Cyanosis
• Cor pulmonale
• FTT

Question 5

What test should be done in an older child presenting with vocal cord paralysis?

Answer 5

MRI Brain!

Example CNS lesions: chiari malformation, myelomeningocele, hydrocephalus, birth trauma

Question 6

What are the typical organisms responsible for retropharyngeal abscess?

Answer 6

Typically polymicrobial - most common:

• Gram +: GAS, Streptococcus pyrogens, Staphylococcus aureus
• Resp anaerobes: Fusobacterium, Bacteroides, Peptostreptococcus
• Rare: Gram neg (e.g. Haemophilus), TB, Bartonella hensalae

Question 7

What percentage of children with asymptomatic congenital CMV develop neurological consequences?

Answer 7

5-15%

Question 8

What investigations do you order when congenital CMV is suspected?

Answer 8

• CBC, bili, AST/ALT, CSF + CMV PCR on CSF, HUS and MRI if abnormal or neurologic symptoms, hearing screen, ophtho

Question 9

What are genetic causes of SNHL loss?

Answer 9

Genetic causes make up 50% of SNHL causes

• SNHL often seen with ear/eye abnormalities, metabolic, MSK, renal and CNS
• Autosomal dominant: accounts for 10%
  
  • Most common Waardenburg (type I and II) & brachiootorenal syndromes
• Autosomal recessive: accounts for 80%
  
  • Most common: Usher (associated with blindness), Pendred syndrome and the Jervell and Lange-Nielsen syndrome

Question 10

What are the clinical features suggestive of bacterial sinusitis?

Answer 10

• Persistent URTI (nasal discharge, cough) >10d without improvement
• OR Severe respiratory sx (w/ T>39) + purulent nasal discharge 3-4 days

Question 11

What the major symptoms in bacterial sinusitis?

Answer 11

• Purulent anterior nasal discharge
• Purulent or discoloured posterior nasal discharge
• Nasal congestion or obstruction
• Facial congestion or fullness
• Facial pain or pressure
• Hyposmia or anosmia
• Fever (for acute sinusitis only)

“Classic presentation”: prolonged nasal congestion/discharge after URI without improvement for > 10 days OR sudden onset of fever and purulent nasal discharge for > 3 days

Question 12

What are the common pathogens for cervical adenitis?

Answer 12

• Staph aureus (#1)
• GAS
• Anaerobic
• Nontuberculous mycobacteria
• Tuberculosis
• Bartonella
• Toxoplasmosis
• Histoplasmosis
• EBV

Question 13

What are risk factors for hearing loss in the newborn period?

Answer 13

ABCD’s

A = affected family member

B = bilirubin

C = congenital intrauterine infections

D = defects of the ear, nose and throat

S = small at birth (< 1500g), low apgar, NICU

Question 14

What are findings on lateral soft tissue neck x-ray that is suggestive of RPA?

Answer 14

1. Thickening of prevertebral tissues (greater than half the width of the C2 vertebral body, or >7-mm diameter at C2, or >14-mm diameter at C6)
2. Locules of gas within the prevertebral tissues

Question 15

What is the clinical features of acute otitis externa?

Answer 15

Rapid onset (within 48h) in past 3wk

• AND

1. Symptoms of ear canal inflammation, including
   
   • Otalgia (often severe), itching or fullness
   • WITH or WITHOUT hearing loss or jaw pain

• AND

1. Signs of ear canal inflammation, including
   
   • Tenderness of the tragus, pinna or both
     
     • OR
   • Diffuse ear canal edema, erythema, or both
   • WITH to WITHOUT otorrhea, regional lymphadenitis, tympanic membrane erythema, or cellulitis of the pinna and adjacent skin

Question 16

What are complications of AOMs?

Answer 16

• Extracranial (local/temporal bone)
  
  • Most heal within 6wk
  • Otic drops (ciprodex) *always use in the setting of a draining ear
  • Repaired 9-10yo
  • Referral: otorrhea is persistent/perf is visible
• Tympanic membrane perforation
• Mastoiditis
• Post-auricular abscess
• Labyrinthitis, labyrinthine fistula
• Facial nerve paresis/paralysis
• Bezold’s Abscess
• Cholesteatoma
  
  • Otorrhea → unilateral, foul smelling, persistent/recurrent despite using oto-topicals
• Intracranial
  
  • Meninigitis
  • Brain abscess - subdural/epidural
  • Sino-venous thrombosis
  • Gradenigo’s Syndrome (Petrositis)
  • Otic Hydrocephalus
  • CSF leak

Question 17

What are three features of Pierre Robin Sequence?

Answer 17

• Micrognathia
• Retrognathia
• Glossoptosis
• +/- Cleft palate