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Paediatric ent emergencies
Clinical Manifestations of congenital laryngeal abnormalities
Respiratory obstruction Stridor Weak cry Dyspnea Tachypnea Aspiration Cyanosis Sudden death
Supraglottic Anomalies
Supraglottic Anomalies
Saccular cysts Similar to
laryngoceles Filled with
mucous May need
immediate trach/intubation*
Endoscopically vs. open
Glottic Anomalies
Congenital High Upper Airway Obstruction (CHAOS) 1994– ultrasound with large lungs, flat
diaphragms, dilated airways, fetal ascites EXIT procedure (ex utero intrapartum
treatment) Multidisciplinary team
C-section, maintain placental blood flow, quick tracheotomy
Subglottic Anomalies
Subglottic stenosis Acquired or
congenital Failure of
laryngeal lumen to recanalize
Membranous vs. cartilaginous
Other anomalies Less than 4.0 mm
(3.5 mm)
Subglottic Anomalies
Subglottic stenosis Respiratory
distress at delivery to recurrent croup
Usually not at birth*
History and PE (biphasic stridor)
Endoscopy Cotton grading
system
Subglottic Anomalies
Subglottic stenosis Most
conservative* Dilation or
laser not useful
EAR
Auricle Tympanic membrane
Middle ear and mastoid
Inner Ear
Ear canal
Foreign Bodies in Ear Canal
Usually put in by patient, some bugs fly in
kill bugs with mineral oil, or lidocaine
remove with forceps, suction or tissue adhesive
Complication: Infection & mucosal erosion
Auricular Haematoma Hematoma - cartilaginous necrosis- drain, antibiotics,
bulky ear dressing close follow up
Lacerations - single layer closure, pick up perichondrium, bulky ear dressing
Use posterior auricular block for anesthesia
Aspiration of Auricular Hematoma
Furuncle, boil or ear canal laceration
Extremely painful
Will cause canal stenosis if not immediately treated
Iccthammol pack or bipp pack (short duration)
Otitis Externa - Features
Discharge, pain, hearing loss, itching
Commonest organisms: S Aureus Ps Aeruginosa Proteus
Predisposing factors: Water Cotton buds Eczema
Treatment: Topical antibiotics Aural toilet Analgesia
Otitis Externa - Variants
Fungal Malignant OE
- Diabetes- VII palsy
Acute Otitis Media
Rx : Systemic antibiotics
Analgesia
Decongestants
Symptoms:
Pain DischargeHearing loss Pain subsides
Middle Ear Serous Otitis Media -
Eustachian tube dysfunction - treat with decongestants, decompressive maneuvers
Otitis Media - infection of middle ear effusion - viral and bacteria
Mastoiditis - Venous connection with brain, need aggressive treatment (can lead to brain abcess or meningitis)
Acute Mastoiditis
THE NOSE
Foreign Body in Nose
Do not use forceps for round objects
Foreign bodies
Unilateral foul smelling discharge in children
Usually lodge on the floor of nose or under middle turbinate
May aspirate
Septal Haematoma/Abscess
SeptumIT
Treatment of septal abscess/ haematoma
EpistaxisAnterior
90% (Little’s Area) Kisselbach’s plexus - usually children, young adults
Etiologies Trauma, epistaxis digitorum Winter Syndrome, Allergies Irritants - cocaine, sprays Pregnancy
epistaxis
Most common kesselbach’s plexus
Squeeze nose tip 5-20 mins
Insert cotton pledget (with decongestant
Cautery with sliver nitrate
Initial first aid Assessement of
blood loss Evaluation of cause Procede to stop
bleeding
How NOT to pack a nose!!!
EpistaxisComplications
severe bleeding hypoxia, hypercarbia sinusitis, otitis media necrosis of the columella or nasal
ala
sinuses
Subperiosteal abscess – Chandler’s grade 3
Facial InfectionsSinusitis
Signs and symptoms- H/A, facial pain in
sinus distribution- purulent yellow-green
rhinorrhea- fever- CT more sensitive than
plain films Causative Organisms- gram positives and H.
flu (acute)- anaerobes, gram neg
(chronic)
Facial InfectionsSinusitis
Treatmentacute - amoxil, septrachronic - amoxil-clavulinic acid,
clindamycin, quinolonesdecongestants, analgesia, heat Complicationsethmoid sinusitis - orbital
cellulits and abcessfrontal sinusitis - may erode
bone (Potts Puffy Tumor, Brain Abcess)
Facial Cellulitis
Most common strept and staph,
Rarely H.Flu Can progress
rapidly Admit broad
spectrum antibiotics
THE THROAT
Foreign body - throat
Fish Bone in Tonsil
Fish Bones & Xray
Very Opaque:
Cod, Haddock, Cole fish, Lemon sole, Gurnard
Moderate Opaque:
Grey Mullet, Plaice, Monkfish, Red Snapper
Not Opaque:
Herring (Kipper), Salmon, Mackerel, Trout, Pike
Normal tonsils
Pharyngitis
Irritants-reflux, trauma, gases Viruses- EBV, adenovirus Bacterial-GABHS, mycoplasma,
gonorrhea, diptheria
Peritonsillar Abcess Complication of
suppurative tonsillitis Inferior - medial
displacement of tonsil and uvula
dysphagia, ear pain, muffled voice, fever, trismus
Treatment - Antibiotics, I&D, +/-steroids
HSV
common presentation of primary herpes simplex virus (HSV) infection in young children is herpetic gingivostomatitis.
children ages 6 months to 5 years. significant discomfort and disturbing appearance The primary infection may present with associated
flu-like symptoms, including an abrupt onset of high fever, irritability, and malaise.
Oral findings include erythematous, edematous, and friable gingivae as well as oral and perioral clusters of vesicles, which coalesce to form large, painful ulcers. Symptoms usually last less than 1 week but may continue for up to 21 days
EpiglottitisClinical Picture
Children 3 – 7 yrs and adults decrease incidence in
children secondary to HIB vaccine
Onset rapid, patients look toxic
prefer to sit, muffled voice, dysphagia, drooling, restlessness
Epiglottitis
Avoid agitation Direct visualization if patient allows soft tissue of neck- thumb print, valecula sign Prepare for emergent airway, best
achieved in a controlled setting Unasyn, +/- steroids
Epiglottitis
Retropharyngeal Abcess Anterior to prevertebral
space and posterior to pharynx
Usually in children under 4 (lymphoid tissue in space)
pain, dysphagia, dyspnea, fever
swelling of retropharyngeal space on lateral x-ray
Complications - mediastinitis
Airway Obstruction
Aphonia - complete upper airway Stridor - incomplete upper airway Wheezing - incomplete lower airway Loss of breath sounds- complete lower
airway
Thank you….
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