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….