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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