ENT

Question 1

Common causes, resolution, diagnosis and management ASOM

Answer 1

1. Very common, most self limiting, spontaneous resolution in 80% in 24-48 hours.
2. Viral infections, H influenza, S pneumonia and Moraxella catarrhalis
3. Acute onset, MEE->bulding, limited movement, air fluid level, perforation or redness
4. Antibiotic therapy usually recommended in ATSI due to suppurative complications
5. it is estimated that up to 20 children must be treated at first presentation to prevent pain in one child at 2 to 7 days.
6. For every 14 children treated with antibiotic therapy, one child will experience an adverse drug reaction such as vomiting, diarrhoea or rash.
7. W/O systemic

>6mo->symptomatic, >2 days/worsens consider antibiotics/wait and see script

<6mo->symptomatic, r/v in 24 hours, if B/L/discharge->antibiotics

8. W/ systemic->high fever, vomiting, lethargy

Amoxycillin 15mg/kg up to 500mg tds or 5 days. If no response after 48 hours, amoxyclav

Question 2

Risk factors for recurrent bacterial OM

Answer 2

Risk factors for recurrent bacterial otitis media include:

1. exposure to smoke (cigarettes, wood fires)
2. group child care
3. allergic rhinitis
4. adenoid disease
5. various structural anomalies, such as cleft palate and Down syndrome.

Question 3

What is otitis media with effusion, traditional management, referral

Answer 3

Presence of middle ear effusion for longer than 3 months

1. Visible loss of lucency of tympanic membrane
2. Visible grey-white/blue fluid
3. An immobile tympanic membrane w/ dilated vessels

Treatment

1. Grommets->ventilation tube
2. Optomise learning
3. Modify risk factors

Referral

1. Effusion > 3 months w/ speech delay or educational handicap
2. Effusion > 3 months, audiometry showing bilateral hearing loss
3. Structural damage to tympanic membrane

Question 4

Define CSOM, complications, management

Answer 4

1. Infection of middle ear w/ perforated eardrum and discharge at least 6 weeks
2. Can cause hearing impairment
3. Can lead to mastoiditis, intracranial infections

Management

1. Dry aural toilet
2. Ear drops->ciprofloxacin ear drops BD until free of D/C for at least 3 days
3. May require hearing aid, grommet, addenoidectomy

Question 5

Mastoiditis

Answer 5

1. Following ASOM
2. May have subperiosteal abscess, may develop IC abscess
3. Requires admission, IV antibiotics, fluid, analgesia, follow up.
4. May require mastoid surgery w/ grommet

Question 6

What is cholesteatoma

Answer 6

1. Keratinising squamous epithelium
2. Skin in incorrect place
3. Offensive discharge
4. Conductive hearing loss
5. Serious complications
6. Surgery

Question 7

Complications of periorbital cellulitis

Answer 7

1. Chandlers classification
2. Potential orbital abscess
3. Loss of red/green discrimination
4. Permanent optic neuroppathy damage in 1 hour
5. Requires urgent drainage