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    This document provides an overview of common ear, nose, and throat (ENT) problems in school-aged children. It discusses important ENT examination principles like evaluating for shortness of breath, hoarseness, difficulty swallowing, and stridor. Common otologic issues covered include otitis externa, tympanic membrane perforations, and vertigo. Nasal disorders like epistaxis and sinusitis are also reviewed. The document then examines facial, oral, and pharyngeal infections such as cellulitis, parotiditis, pharyngitis, and peritonsillar abscesses. It concludes with sections on airway obstruction and sleep problems.

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    Common Ear Nose & Throat (ENT) Problems in School Aged Population

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    This document provides an overview of common ear, nose, and throat (ENT) problems in school-aged children. It discusses important ENT examination principles like evaluating for shortness of breath, hoarseness, difficulty swallowing, and stridor. Common otologic issues covered include otitis externa, tympanic membrane perforations, and vertigo. Nasal disorders like epistaxis and sinusitis are also reviewed. The document then examines facial, oral, and pharyngeal infections such as cellulitis, parotiditis, pharyngitis, and peritonsillar abscesses. It concludes with sections on airway obstruction and sleep problems.

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    © All Rights Reserved
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    28 views42 pages

    Ent Badi PDF

    Uploaded by

    sandeep
    This document provides an overview of common ear, nose, and throat (ENT) problems in school-aged children. It discusses important ENT examination principles like evaluating for shortness of breath, hoarseness, difficulty swallowing, and stridor. Common otologic issues covered include otitis externa, tympanic membrane perforations, and vertigo. Nasal disorders like epistaxis and sinusitis are also reviewed. The document then examines facial, oral, and pharyngeal infections such as cellulitis, parotiditis, pharyngitis, and peritonsillar abscesses. It concludes with sections on airway obstruction and sleep problems.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 42

    Common Ear Nose & Throat

    (ENT) Problems in School Aged


    Population

    Arun Badi, MD, PhD, FAAP


    Board Certified ENT and Sleep Medicine
    Dallas ENT Group
    Don’t forget these medical
    maxims:
    • ABCs – C also stands for Control the bleeder.
    • Primum non nocere - First do no harm.
    • Don’t forget that the ear, nose and throat are attached
    to the rest of the body
    • If they feel better, they heal better
    • There is a reason they call them “vital” signs
    • Chance favors the prepared mind
    • Know your backup, have an evacuation plan
    Golden Rules
    • 4 principle questions of ENT history you must
    always ask about.
    • I call these the Golden 4
    • Shortness of Breath
    • Hoarseness (Or voice change)
    • Difficulty Swallowing (Dysphagia). Odynophagia
    (painful swallowing)
    • Stridor (Noisy Breathing)
    Overview
    • Otologic Disorders
    • Nasal Disorders
    • Facial, Oral and Pharyngeal
    Infections
    • Airway Obstruction
    Otologic Disorders
    Anatomy
    • Auricle
    • Ear canal
    • Tympanic
    membrane
    • Middle ear and
    mastoid disorders
    • Inner Ear
    Traumatic Disorders of the Auricle
    • Hematoma
    - cartilaginous necrosis
    - drain, antibiotics, bulky
    ear dressing close follow
    up
    • Lacerations - single
    layer closure, pick up
    perichondrium, bulky ear
    dressing
    Use posterior auricular
    block for anesthesia
    Auricle
    • Chondritis - Cellulitis ?
    - infectious, difficult to treat
    because poor blood supply,
    cover S. Aureus and
    pseudomonas
    - extra care in diabetics
    - inflammatory causes related
    to seronegative arthritis at
    times indistinguishable from
    infection usually the ear lobe
    is spared
    Otitis Externa
    • Infection and inflammation
    caused by bacteria
    (pseudomonas, staph), and
    fungi
    - treat with antibiotic-steroid
    drops
    - use wick for tight canals
    - diabetics can get malignant
    otitis externa (defined by the
    presence of granulation
    tissue)
    Foreign Bodies in Ear Canal
    • Usually put in by patient,
    some bugs fly in
    • kill bugs with mineral oil,
    or lidocaine
    • Emergency if it is organic
    matter, insect or corrosive
    chemical or battery.
    • Otherwise can wait a
    week or so.
    Tympanic Membrane Perforation
    • Hard to see – Hx of drainage
    • Usually from middle ear pressure
    secondary to fluid or barotrauma
    • Sometimes from external trauma
    • most heal uneventfully but all need
    otology follow-up
    • perfs with vertigo and facial nerve
    involvement need immediate referral
    • treat with antibiotics
    • drops controversial but indicated for
    purulent discharge (avoid gentamycin
    drops)
    Middle Ear
    • Serous Otitis Media - Eustachian
    tube dysfunction - treat with
    decongestants, decompressive
    maneuvers
    • Otitis Media - infection of middle
    ear effusion - viral and bacteria
    • Mastoiditis - Venous connection
    with brain, need aggressive
    treatment (can lead to brain
    abcess or meningitis)
    Inner Ear
    • peripheral vertigo (vestibulopathy)
    BPV, labyrhinthitis
    • - acute onset, no central signs, usually
    young, horizontal nystagmus
    The Nose
    Epistaxis
    Anterior
    • 90% (Little’s Area) Kisselbach’s plexus -
    usually children, young adults
    Etiologies
    • Trauma, epistaxis digitorum
    • Winter Syndrome, Allergies
    • Irritants - sprays
    • Pregnancy
    Epistaxis
    Posterior
    • 10% of all epistaxis - usually in the elderly
    • Etiologies
    – Coagulopathy
    – Atherosclerosis
    – Neoplasm
    – Hypertension (debatable)
    Epistaxis
    Management
    • Calm patient
    • Topical vasoconstrictor (Afrin)
    • Gown, mask, goggles
    • Pain meds, Digital pressure
    • Evacuate clots
    • Identify source
    Sinusitis
    Orbital Infections
    • Treatment
    Sinusitis
    acute - amoxil, septra
    chronic - amoxil-clavulinic acid,
    clindamycin, quinolones
    decongestants, analgesia, heat
    7th Nerve Palsy
    • Most cases are idiopathic
    - link to HSV
    - Protect eye
    Facial Infections
    Sinusitis
    • Signs and symptoms
    - H/A, facial pain in sinus
    distribution
    - purulent yellow-green
    rhinorrhea
    - fever
    - CT more sensitive than
    plain films
    • Causative Organisms
    - gram positives and H. flu
    (acute)
    - anaerobes, gram neg
    (chronic)
    Facial Cellulitis
    • Most common strept
    and staph,
    • Rarely H.Flu
    • Can progress rapidly
    Parotiditis
    • Usually viral
    -paramyxovirus
    • Bacterial
    - immunosuppressed
    - associated with dehydration
    - cover - Staph, anaerobes
    Pharyngitis
    • Allergies
    • Irritants
    -reflux, trauma, gases
    • Viruses
    - EBV, adenovirus
    • Bacterial
    -GABHS, mycoplasma, gonorrhea,
    diptheria
    Peritonsillar Abcess
    • Complication of
    suppurative tonsillitis
    • Inferior - medial
    displacement of
    tonsil and uvula
    • dysphagia, ear pain,
    muffled voice, fever,
    trismus
    Epiglottitis
    Clinical Picture
    • Older children and adults
    • decrease incidence in children
    secondary to HIB vaccine
    • Onset rapid, patients look toxic
    • prefer to sit, muffled voice,
    dysphagia, drooling,
    restlessness
    Epiglottitis
    • Avoid agitation
    • Direct visualization if patient allows
    • soft tissue of neck
    - thumb print, valecula sign
    • Prepare for emergent airway, best achieved
    in a controlled setting
    • Unasyn, +/- steroids
    Masticator - Parapharyngeal
    Space Infection
    • Infection of the lower
    molars invade masticator
    space
    • Swelling, pain fever,
    TRISMUS
    • Treatment
    IV antibiotics (PCN or
    Clindamycin)
    ENT admission
    Angioedema
    • Ocassionally life
    threatening
    • Heriditary and related
    to ACE inhibitors
    • Antihistamines,
    steroids and doxepin
    Airway Obstruction
    • Aphonia - complete upper airway
    • Stridor - incomplete upper airway
    • Wheezing - incomplete lower airway
    • Loss of breath sounds- complete lower
    airway
    Foreign Body Airway
    • Heimlich Heimlich
    • Heimlich
    • Heimlich
    • Heimlich
    Word about Sleep
    • Problems w QUANTITY of sleep
    • Insufficient Sleep
    • Insomnia
    • Problems w QUALITY of sleep
    • Apnea
    • Sleep Walking, Sleep Talking, Bed Wetting
    • Narcolepsy
    Questions and Answers

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