15 ENT

Ear

OTM

  • path:

    • URI bugs, strep, moraxella, H. flu

    • middle ear (tympanic membrane affected)

  • symptoms: unilateral painful ear relieved by pulling of pinna (tug ear)

  • diagnosis

    • otoscope: loss of light reflex, bulging erythematous tm, fluid behind ear

    • pneumatic insulflation: rigid tm

  • treatment:

    • 1st line: amoxicillin

    • recurrence: add clavulanic acid

    • recur and recur: ear tubes, tympanoplasty. 3 occurences in 6 months. 4 occurences in 1 year

    • penicillin allergy: cephalosporin if no anaphylaxis, cefdinir. Azithromycin if anaphylaxis

OTE

  • path

    • infection of outer ear, pinna and canal

    • swimmer's ear: shower, swimming. Pseudomonas

    • digintal trauma: picking at ear canal with Qtip. Staph

  • symptoms: unilateral, worse with pulling of pinna

  • diagnosis

    • otoscope: outer canal erythematous, no bulging tm

    • clinical diagnosis

  • treatment

    • spontaneous resolve for mild cases

    • if malignant and bad: ear drops. Cipro for antibiotic. Steroid to feel better

    • rule out mastoiditis

Mastoiditis

  • path: infection of mastoid bones caused by pseudomonas

  • pt: risk if has ear tubes

  • symptoms

    • looks like OTM

    • mastoid swelling (behind ear)

    • Anteriorly rotated ear

  • diagnosis: clinical and CT showing swelling of mastoid

  • treatment: surgical decompression

Sinus

Bacterial

  • path: URI bugs, strep usually. If recurrent, foreign body

  • symptoms

    • congestion

    • bilateral purulent discharge, thick white smelly from both nose

    • pain on facial tap

  • diagnosis

    • do not order xray/CT. Air fluid levels on xray and opacification on CT

    • Clinical

  • treatment

    • supportive

    • if temp > 38 or > 10 days, or symptoms worsens: penicillin (amoxicillin, clavulanic).,

Viral - "cold"

  • path: rhinovirus

  • symptoms

    • congestion

    • bilateral clear rhinorrhea, copious

  • diagnosis: no xray/CT, PCR, IF. No culture to see if bacterial

  • treatment

    • Supportive.,

  • CT if recurrent viral or bacterial sinusitis to find anatomic defect.

Pharyngitis

  • path: viral (most likely) or GAS

  • symptoms

    • sore throat

    • odynophasia: pain with swallowing

  • diagnosis: Centor criteria

  • treatment

    • Centor < or 1: nothing

    • 2 - 3: rapid strep, f/u with culture if negative and really suspicious

    • greater or equal to 4: treat with antibiotics (amox, clavulanic)

    • r/out EBV: sorethroat, big spleen

    ​

  • C: no cough

  • E: exudates

  • N: nodes, LAD

  • T: temp > 38

  • OR: age

    • if < 14: +1

    • if > 44: -1

Foreign body

  • path

    • kids stick things in places

    • causes bacterial infection (ear, nose)

  • symptoms: unilateral bacterial infection

  • diagnosis: clinical suspicion

  • treatment: remove obj with forceps, endoscopy, bronchoscopy

Homeless population

  • path: homeless put coins in ears to prevent insects

  • symptoms: scratching, buzzing

  • treatment

    • do not shing light

    • use lidocaine to paralyze insect first

Epistaxis

  • path: digital trauma (nose picking) or injury

  • symptoms: unilateral and < 30 min

  • diagnosis: clinical

  • treatment

    • lean forward, allow blood drip, apply pressure or ice

    • anterior recurrent: cauterize with nitric stick

    • posterior recurrent: packing

Choanal Atresia

  • path: path from nose to throat blocked due to atresia or stenosis. Can't breath through nose

  • symptoms

    • baby turn blue with feeds and pink with crying

    • Child that snores

  • diagnosis: fail to pass catheter. Fiber optic wire for stenosis

  • treatment: surgery

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