PEDIATRIC OTOLARYNGOLOGY

1. PEDIATRIC OTOLARYNGOLOGY Geoffrey d’Allemand PA-C

3. EARS Normal Anatomy: changes with age

6. Pneumatic Otoscopy Positive and negative pressure

9. Pneumatic Otoscopy • Acute purulent otitis (AOM) • Otitis with air-fluid level • Chronic serous otitis (OME) • Negative pressure without effusion

11. Acute Otitis Media • Majority viral • Almost always…. Don’t really know, can look just as nasty as bacterial. Fever, pain, runny nose • If bacterial, can be • Strep pneumonaie • Hemophillus influenzae • Moraxella catarrhalis • Staph aureus • Pseudomonas aeruginosa

13. Acute Otitis Media: Treatment • When to treat? • 1 Amoxicillin: low dose- 40mg/kg vs high dose- 80mg/kg • 2 Amoxicillin-clavulanate (Augmentin) for resistant bacteria • Azithromycin (Zithromax) stays inside body for up to a month… used 1x a day for 5 days • 3 Cephalosporins PO or IM

14. Bullous Myringitis • Often painful • Potential for drainage • Treatment same as acute otitis media

16. Otitis Media With Effusion • Serous otitis • Sterile vs septic • Treatment varies with circumstances

18. Chronic/Recurrent Otitis • Effusion normally persists 2 to 6 weeks • Intercurrent URI • Antibiotic resistance • Conductive hearing loss • Almost all hearing loss in children is conductive • ENT referral • Pressure Equalizing tubes • Potential CNS involvement

20. Complications of Otitis Media • Cholesteatoma: cystic mass lesion of the eardrum • Requires surgical treatment

22. Complications of Otitis: Mastoiditis • Extension into mastoid sinus • Requires IV therapy; mastoidectomy • Physical exam: displacement of external ear

25. Otitis Externa • “Swimmer’s Ear” • Bacterial or fungal overgrowth from prolonged exposure to moisture • Possible foreign body or cerumen impaction • #1 foreign body – do not use q-tips • Topical treatment

27. NOSE

28. Upper Respiratory Infection • Incidence: • 5 to 10 episodes annually in first 5 years of life • Nasal passages in infants and children prone to obstruction • Unable to blow nose • 2-4 years old MILESTONE

29. Upper Respiratory Infection • Infants obligate (are) nose breathers in first 3 months of life • URI persisting > 10-14 days associated with bacterial overgrowth

30. Allergic Rhinitis • Physical findings may contrast URI • Treatment: inhaled nasal steroid replacing oral antihistamine as first line

31. Adenoid and Tonsillar Hypertrophy • Enlarge to peak size at age 8 to 10 • Decrease at onset of adolescence • Causes: atopy and recurrent infection • Cycle of obstruction/infection • Complications: otitis, sinusitis, obstructive sleep apnea • Criteria ENT referral and surgery

34. Nasal Trauma • Displaced nasal fracture • Septal deviation • Septal hematoma

39. Epistaxis – “Nose Bleed” • Infection and mucosal excoriation at Kesselbach’s plexus • Screen for bleeding disorders and vascular anomalies • Topical treatment

42. Sinusitis • Development from infancy to adolescence • Maxillary and ethmoidal sinuses most involved • Mucosal swelling impedes drainage; leads to effusion and infection • Predisposition: defect, recurrent viral infection, allergy

46. Sinusitis • Clinical presentation: prolonged rhinorrhea and/or cough (> 10 to 14 days) • Headache, facial pressure, periorbital swelling usually only seen in adolescents • Children #1 presentation is cough • Treatment: considerations as in otitis; longer duration