A collection suite of final medical notes to ace your penultimate and final year exams!
Save the stress of accessing multiple resources as these documents collate and summarise information from several resources including but not limited to:
-Talley and O’Connor clinical examinations
-OSCE r...
PAEDIATRICS ENT
EAR & NOSE ISSUE
EAR WAX Glue Ear
OTITIS EXTERNA
[cerumen (Otitis media w/ OTITIS MEDIA Hearing Loss
“swimmer’s ear”
impaction] effusion)
• Impacted wax Middle ear becomes filled with Infection of middle ear Ø Infection of outer ear Divided into:
accumulation and fluid leading to hearing loss in Ø common site of Ø Swimmer’s ear” Ø Conductive hearing loss
stuck to eardrum affected ear infection in kids (due to Ø Sensorineural hearing
PP /
• ear wax = normally Ø 2nd to blocked Eustachian horizontal Eustachian loss
comp.
protective to tube allowing tube)
prevent infection in accumulation of middle Ø bacterial infection
external ear ear secretions preceded by viral URTi
• Cotton bud usage URTI - Tonsillitis, rhino- • Swimming Congenital
Ø Down’s syndrome sinusitis • Humid environments Ø TORCH infection
Recurrent ear infections • Viral URTI (mainly) • Ear polyps (rubella, CMV)
• Bacterial URTI Ø Genetic deafness (AR,
• FB in ear
o Streptococcus AD)
• Bacterial infection Ø Down’s syndrome
pneumoniae (pseudomonas aeruginosa,
(main bacterial S. aureus)
cause) Perinatal
RF / • Fungal infection (e.g. aspergillus,
o HiB Ø Prematurity
causes candida) ® after ABx usage
o Moraxella Ø Hypoxia during or after
• eczema birth
catarrhalis
• seborrheic dermatitis
o S. aureus
• contact dermatitis Post-natal
• Passive smoking
• Previous ear infections Ø Trauma
Ø OME / glue ear
Ø Meningitis
Ø Chemotherapy
• Conductive hearing • Aural discharge NON-specific signs (e.g. • Otalgia • Speech delay
loss • Otalgia vomit, lethargy, poor • Aural discharge • Frustrated or bad
• Aural fullness feeding) behaviours
• Hearing loss • Itchiness
• Pain • Otalgia • Ignores commands and
• Aural fullness • Conductive hearing loss (blocked
• Tinnitus • Reduced hearing of ears) parental voice
Clinical affected ear • Poor school
Sx • Unwell + fever performance
• URTi – cough, coryza and
sore throat
• +/- vertigo
• +/- aural d/c (if eardrum
perforated)
AOM • Otitis media • Mastoiditis/abscess ® Malignant otitis externa ® osteomyelitis Speech delay
meningitis in temporal bone (diabetes, immunsupp.
• OME HIV)
Comp. • Temporary hearing loss Ø Facial nerve damage
• Perforated TM Ø CNIX, CNX, CNXI damage
• Recurrent infection Ø Meningitis
• Labyrinthitis Ø Intracranial thrombosis
Otoscope - • Otoscope – dull eardrum Ø Otoscope – inflamed • Otoscope – inflamed red swollen Audiometry (audiogram)
CERUMEN with air bubbles and bulging red tympanic outer ear with narrowed external < 6mths = Auditory Brainstem
IMPACTION visible fluid level membrane canal Response Testing
Ø Audiometry – check Ø +/- perforation • Ear swab - M/C/S and PCR (identify 6mths – 3 years ® Visual
Ix extent of hearing loss causative organism) Reinforcement Orientation
Audiometry (VROA/ puppet
show test)
Children (3-7 years) ® Pure
Tone Play Audiometry
1) Avoid cotton ENT referral Conservative Mild Otitis externa MDT management
bud usage Ø Grommet insertion - drain • Reassure - ear toilet • Ear toilet and dry ear (avoid Ø Speech pathologist
2) Ear drops (olive fluid from middle ear and dry ear + avoid headphone and swimming for 10 days) Ø ENT
oil or 5% Bicarb) Ø Advise parents that swimming • OTC acetic acid 2% (antifungal and Ø Educational
3) Saline irrigation grommets fall out within • Simple analgesia (2x antibacterial effect) ® used psychologists
(CI = if year Panadol PO tds for 7 therapeutically or prophylactically
perforated Ø 1 in 3 require further days) Interventions
eardrum or grommets for persistent Ø Hearing aids
Moderate Otitis externa [use ear wick]
infection) glue ear Ø Sign language
Medical – ABx No Sofradex (dex, framycetin +
4) Microsuction • 30mg/kg Amoxicillin PO perf gramicidin) ear drops (3x drops
Grommets = tympanostomy
bd for 5 days daily for 7 days)
tubes
• Clarithromycin (penicillin Perf Ciloxan (cipro 0.3% ear drops) ®
Mx allergy) 5x drops bd for 7 days
• Erythromycin (penicillin
Comp Ciproxin HC (cipro +
allergy in pregnant)
. hydrocortisone) ® 3x drops bd 2
*consider delayed ABx days
When to refer or follow-up? prescription (valid only after 3
days if symptoms persist) Fung Triamcinolone (neomcycin +
• F/U = 8 weeks esp. if recurrent OME, al nystatin, gramicidin) 3x drops tds
AOM or hearing difficulties Indications for ABx
for 7days
*If severe –Admit to hospital and give IV ABx
• ENT referral = uncontrolled pain, Ø 6/12 old
Medical – malignant otitis externa
failure to resolve w/ AB or ≥6 x Ø ATSI
Ø Admit under ENT
episodes in past 12 months Ø Immunocompromised
Ø Hearing aids (cochlear) Ø IV ABx
Ø Only hearing ear Ø CT or MRI (identify extent of infection)
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