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Friday, November 22, 2019

PEARLS AND PITFALLS: Pediatric ENT


PEARLS AND PITFALLS

• Otalgia is an expected phenomenon for up to 2 weeks following tonsillectomy.

• Hematoma of the external ear (pinna) necessitates same-day referral for emergency care because of the potential for permanent deformity secondary to avascular necrosis of the cartilage.

• First-line therapy for AOM is amoxicillin (90 mg/kg/day divided twice a day) × 10 days.

• Caregivers should be instructed to warm ear drops in their hands prior to administration to decrease patient discomfort.

• Patients with benign paroxysmal vertigo of childhood are at increased risk of typical migraine headache as adolescents and adults.

• CHARGE is the most commonly associated congenital anomaly with choanal atresia.

• In children, 90% of epistaxis occurs from the anterior septum (Kiesselbach plexus), and the most frequent cause is digital trauma.

• Nasal fractures are the most common facial fracture in children.

• Presence of nasal polyps in children should prompt testing for cystic fibrosis.

• Nasal saline rinses should be used with caution in children with history of aspiration.

• The most common cause of a neck mass in the pediatric population is cervical lymphadenitis.

• If there is clinical suspicion for lymphoma, systemic steroids should be avoided, as these may interfere with flow cytometry results.

• Midline neck mass is most likely a thyroglossal duct cyst secondary to the embryologic derivative at the base of the tongue (foramen cecum). Ultrasound should be performed to confirm the presence of a normal thyroid in its expected location.

• The most common congenital lesion of the larynx is laryngomalacia; most children will outgrow the diagnosis by 24 months of age.

• Cough, rhinorrhea, and diarrhea are more common with viral than with bacterial pharyngitis.

• The diagnostic gold standard for bacterial pharyngitis is a throat culture.

• Diagnosis of PTA is a clinical diagnosis based on history (double worsening, URI symptoms > 5 days prior to new symptoms) and physical exam (hot potato voice, trismus, uvular deviation)

• The American Academy of Pediatrics recommends screening for OSA by history (snoring, daytime symptoms) during well-child checks. Symptoms may include irritability, hyperactivity, daytime sleepiness, and nocturnal enuresis; this is a different constellation of symptoms than in adult patients.

• Ankyloglossia often manifests as discomfort in the mother’s nipples.

• Children with cleft palate are at an increased risk of developing Eustachian tube dysfunction resulting in OME and recurrent AOM.

• Eruption cysts present as blue or purple compressible cysts at the site of an erupting deciduous or permanent tooth. These are often self-limiting but may require treatment if they become infected or limit feeding.

Wednesday, November 20, 2019

PEDIATRICS MCQS, TOACS, PEARLS & UPDATES: PEDIATRICS UP-DATES: Indication for Tonsillectomy ...

PEDIATRICS MCQS, TOACS, PEARLS & UPDATES: PEDIATRICS UP-DATES: Indication for Tonsillectomy ...: Indication for Tonsillectomy  (+/– Adenoidectomy): Absolute Indications • Moderate to severe obstructive sleep apnea • Suspici...

PEDIATRICS UP-DATES: Indication for Tonsillectomy (+/– Adenoidectomy)


Indication for Tonsillectomy (+/– Adenoidectomy):

Absolute Indications
• Moderate to severe obstructive sleep apnea
• Suspicions of tonsillar malignancy, including posttransplant lymphoid proliferative disorder (PTLD)

Relative Indications
• Mild obstructive sleep apnea
• Recurrent tonsillitis—must meet criteria:
–– Frequency:
◦◦ Seven or more episodes in 1 year
◦◦ Five or more episodes per year for 2 years
◦◦ Three or more episodes per year for 3 years
• Associated with one or more of the following:
–– Temperature > 38.3 ° C (101 °F)
–– Cervical lymphadenopathy
–– Tonsillar exudate
–– Positive test for GABHS
• Chronic tonsillitis unresponsive to antimicrobial therapy
•  Severe halitosis
•  Peritonsillar Abscess (greater than one episode)
• PFAPA syndrome (periodic fever, aphthous ulcers, pharyngitis, cervical adenitis)
• PANS/PANDAS syndrome: a controversial indication (pediatric acute-onset neuropsychiatric syndrome/pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection)

Indication for Adenoidectomy Alone
• Moderate to severe nasal obstruction with persistent symptoms
• Refractory chronic sinusitis
• Recurrent acute otitis media or otitis media with effusion in a child who had prior tympanostomy tubes that have now extruded (e.g., repeat surgery when indicated would consist of adenoidectomy plus myringotomy ± insertion of ventilation tube) and is over 4 years of age

PEDIATRICS MCQS, TOACS, PEARLS & UPDATES: PEDIATRICS TOP-UP: Preauricular Pits/Sinus (PPS)

PEDIATRICS MCQS, TOACS, PEARLS & UPDATES: PEDIATRICS TOP-UP: Preauricular Pits/Sinus (PPS): Preauricular Pits/Sinus (PPS) • Small indentations located anterior to the  helix and superior to the tragus • Can occur unilate...

PEDIATRICS TOP-UP: Preauricular Pits/Sinus (PPS)


Preauricular Pits/Sinus (PPS)
• Small indentations located anterior to the helix and superior to the tragus

• Can occur unilaterally (~50%) or bilaterally (~50%)

• Prevalence ranges between 1% and 10% depending on ethnicity

• Can occur in isolation with no increased risk of hearing impairment or renal         issues

• Can be associated with hearing impairment and organ malformations

• Branchio-oto-renal (BOR) syndrome:
–– Most common inherited syndrome causing hearing loss (autosomal dominant)
–– Clinical presentation: preauricular pits, sensorineural hearing loss (SNHL), branchial cysts (may present as holes/pits in the side of the neck or as tags/pits in front of the ear), renal anomalies

• Beckwith-Wiedemann syndrome:
–– Clinical presentation: macroglossia, asymmetric ear lobules or creases, omphalocele, Wilms tumor, hepatoblastoma.
–– Hearing loss can present later in childhood as conductive or mixed hearing loss

• PPS do not require surgical excision unless they are frequently draining or infected
• Passing of prenatal hearing screen should be confirmed in all patients
• Audiogram should be performed if there are other outer ear deformities or any evidence of genetic syndromes

When to suggest renal ultrasound in children with ear anomalies when accompanied by any of the following:
–– Other known organ malformations
–– Family history of deafness and auricular and/or renal malformation
–– Maternal history of gestational diabetes mellitus