Services for Paediatric ENT
The Congential Ear
Ear infections in childhood :
Acute otitis media
- Usually healthy child
- Sudden onset ear pain, blocked feeling
- Fever, h/o URTI
Finding :
- Congested, dull drum with / w/o discharge
- Audiogram - conductive hearing loss
- Tympanogram - type "B" curve
Treatment :
- Antibiotics
Anti-histaminics
Nose drops
Analgesic Anti-inflammatory agents - IF toxicity persists :Myringotomy to drain the mucopus
Otitis media with effusion
- Overweight dull child
- h/o frequent URTI & mouth breathing
- h/o frequent sore throat / tonsillitis / fever
- No systemic s/s
Findings :
- Dull drum / yellow tinge with bubbles if acute occ. Blue tinge with retracted TM
Glue Ear
- Audiogram - conductive hearing loss
- Tympanogram - type "B" or "C" curve
- When valsalva is positive / bubbles exist
- Tympanogram - negative pressure + stapedius reflex
- Antibiotics - 1 course of amoxy-clav
- Anti-histaminics
- Nose drops
- Analgesic Anti-inflammatory agents
- Steroids
- valsalva
- In addition : GROMMET Insertion w/ Adenoidectomy under vision!!
Typical presentation of a child with a central perforation :
- 7 year old child
- Frequent otorrhea
- Freq colds
- Mouth breather
- HOH on affected side
- Audiogram - CHL
- X-ray - adenoid enlargement
Treatment :
- If small (<3mm) - conservative treatment
- Antibiotics - culture directed after 10 days of broad-spectrum
- Treat underlying URTI
- Ear drops -
Non-steroid ONLY - ciprofloxacin
aminoglycoside
Fluconazole
Preferably eye drops - Stop immediately upon cessation of otorrhea!!
- If the perforation is large: Surgery ONLY - AGE NO BAR !!!