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)
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)
