Chronic Drooling - causes in children (3)
Poor oro-moto control of saliva (NOT due to over production
Normal up until age of 5
Causes:
- Developmental delay
- nasal blockage (eg large adenoid and dental factors may also contribute)
-
Associated with some syndromes
- Down’s syndrome (large tongue = poor lip seal)
- Cerebral palsy (poor neck posture)
Acute conditions e.g. tonislitis etc not covered here
Managment of chronic drooling
Initial management
SALT input:
- Oro-motor exercises
- Improving posture
Medical:
- Anticholinergic agents
- Botox injections under ultrasound guidance.
Surgical:
- Submandibular duct transposition
- Adenotonsillectomy
- Submandibular gland excision
Choanal Atresia
Aetiology
Aetiology: Failure of bucconasal membrane to rupture before birth
Choanal Atresia
Presentation:
Unilateral
* May be asymptomatic at birth
Over time
* Nasal discharge
* Obstruction
Bilateral - presents as an airway emergency at birth
* Difficulty in breathing as newborn
* Accessory muscles
* Nasal flaring
* Cylical cyanosis
* Pallor
* Resolves upon opening mouth > cries (Crying resolves distress), cy*cle repeats
Choanal Atresia
Associations
CHARGE association
* Coloboma of the iris
* Heart defect (atrial septal)
* Atresia (of the choanae) 100%
* Retarded growth and development
* GU abnormalities e.g. cyptorchidism
* Ear defects (deafness)
Half exhibit facial palsies
One third have laryngotracheal anomalies
Non chromosomal:
* Narrowed nasopharynx
* Widened vomer
* Medialised lateral nasal wall
* Arched hard palate.
CHARGE =
CHARGE association
* Coloboma of the iris
* Heart defect (atrial septal)
* Atresia (of the choanae) 100%
* Retarded growth and development
* GU abnormalities e.g. cyptorchidism
* Ear defects (deafness)
Choanal atresia - investigations (4)
- Mirror test - no fog on metal / mirror when placed under that nares
- Catheter - failure to pass a catheter into nasopharynx
- FNE
- CT sinuses (nature and thickness of obstruction)
Choanal atresia - management
Initial / emergency:
* Insert oral airway
Elective
* Transpalatal repair
* Transnasal repair (e.g. endoscopic nasal surgery with microdebrider or KTP laser)
Types of damage caused by button batteries
- Thermal damage - from low voltage electrical current
- Chemical necrosis - release of Na hydroxide and chlorine gas
- Liquefactive necrosis - leaking of alkali contents
Button battery damage in nose and ear
- Local inflammation / burns / ulceration / necrosis
- Perforation of TM, nasal septum, oesophagous
- Local destruction e.g. osscles, facial nerve palsy
- Aspiration (e.g. if in nose)
- Fistula (e.g. Tracheoesophageal)
- Stricture (e.g. oesophageal)
- Deformity (e.g. saddle nose)
Child giving false results on audiogram, further options to clarify hearing status?
Auditory Brainstem Response Audiometry
Cortical Evoked Response Audiometry
