Presented To : Mrs. Maheshwari M.Sc (N) H.O.

D, Pediatric Nsg, Goutham College of Nursing

Presented By : Miss Tina Ann John II M.Sc(N)

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The upper respiratory tract warms, humidifies & filters the air that enters the body. The structures of the upper respiratory tract constantly comes into contact with a barrage of foreign organisms, including pathogens which can sometimes lead to airway irritation & illness.

The tracheal division of the right & left bronchi is higher in a child·s airway & at a different angle than the adult. The trachea primarily increases in length rather than diameter in the first 5 yrs of life. .Š Upper Airway Differences: ƒ ƒ ƒ ƒ ƒ The airway is shorter & narrower than an adult The infant·s airway is approximately 4mm in diameter in contrast to the adult·s airway diameter of 20 mm. The cartilage that supports the trachea is more flexible & can compress the airway if head & neck is not positioned appropriately.

. newborns are obligatory nose-breathers.Š Š Š Narrower airway causes a greater increase in airway resistance.breathing is controlled by maturing neurologic pathways. Mouth. Until 4 wks of age.

. ARI accounts for 30-40% of the hospital visits by children in office practice.Š Š Š Š Acute respiratory infections (ARI) are a major cause of morbidity and mortality in young children world wide.9 million deaths every year globally. On an average a child has 5 to 8 attacks of ARI annually. They account for nearly 3.

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The accessory paranasal sinuses & the middle ear are generally involved. Infections spread quickly & serious complication can result if the child is malnourished.Š Š Š Acute nasopharyngitis is the most common respiratory infection in infants & children. .

It is the inflammation of the nasopharynx. .Š Š Nasopharyngitis can be acute & chronic condition that affects the nasopharyngeal passage of the upper respiratory tract.

In infants & younger children.Š Š Š The commonest cause of nasopharyngitis is the rhino virus.influenza & staphylococci. In older children ² group A streptococci.H. .

. mononuclear cell infiltration that becomes polymorphonuclear Separation & possible sloughing off the superficial epithelial cells & the production of mucus that is profuse and later becomes thick & purulent.Š Š Š The rhinovirus are the most common infectious agents The Pathophysiology changes that occurs include edema & vasodilation in the sub mucosa.

Complications may occur in infants .Š Š The child is infectious from a few hrs before 1 to 2 days after the infection appears. .

Profuse nasal discharge. . restless & fretful. Young infants: ƒ ƒ ƒ ƒ ƒ may not have an elevated temperature. Infants may become irritable. Infants & young children between 3 mths & 3yrs may have a sudden onset of fever of 39-400 C (1021040 F) Febrile convulsions may occur during infancy if the temperature rises upto 400.Š Š Clinical manifestations are more severe in infancy than during childhood.

Child feels chilly. .Moderate respiratory difficulty may occur in very young infants. ƒ Poor feeding ƒ Gastrointestinal disturbances. ƒ Š In Older Children: ƒ ƒ ƒ ƒ ƒ ƒ ƒ ƒ Irritation & dryness of the mucus membrane of nose & throat. sneeze & cough may be present Thin nasal discharge later purulent discharge Slight fever Headache General malaise & muscle aches Anorexia The acute symptoms may subside in 6-10 days.

.Š Š Š Thorough clinical history Thorough clinical examination Nasal & throat swabs for culture sensitivity.

.Š Š Š Š Š Š Cared at home generally Nursing intervention is that of parent education & problem solving Serious complications require admission. Vital signs are frequently assessed Nasal decongestants are given Antibiotics are not used unless evidence of bacterial infections.

ƒ Otitis media ƒ Laryngitis ƒ Bronchitis ƒ Pneumonia .Š Occur more frequently in infants than younger children.

Š Š Š Š Recovery is good for both infants & older children Effective vaccines are not yet developed for prevention of common cold Maintain good nutrition & wellness. Hand washing of caregivers & children after every activity .

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.Š Acute pharyngitis refers to infection primarily involving the throat. It may also include acute conditions such as tonsillitis & pharyngotonsillitis.

Š Š Š Streptococcal pharyngitis is uncommon in infants but accounts for 10% of all respiratory & febrile illnesses in children between 5 to 16 yrs. Frequency of positive throat culture in children seen by physicians ranges from 35-50% Frequency of streptococcal pharyngitis increases during the winter & spring. .

(GABHS) Š Š Other bacteria include non-group A streptococci. such as rhinovirus and corona virus . Other viruses. Bacterial pharyngitis is commonly known as strep throat.Š Š Viral infections constitute 80% of the underlying cause.

Streptococcal infections are characterized by local invasion and release of extracellular toxins and proteases . gram positive bacteria. causing a local inflammatory response. bacteria or viruses may directly invade the pharyngeal mucosa. With infectious pharyngitis.Š Š Š Streptococci is round.

VIRAL PHARYNGITIS Š Š Š Š Š Š Š Š STREP THROAT Š Š Š Š Š Š Š Š Š Nasal congestion Mild sore throat Conjunctivitis Cough Hoarseness Mild pharyngeal redness Minimal tonsillar exudate Mildly tender anterior cervical lymphadenopathy Fever < 38. . nausea.30C (1010F) Abrupt onset Tonsillar exudate Painful cervical lymphadenopathy Anorexia. vomiting. malaise Fever Petechial mottling of soft palate. abdominal pain Severe sore throat Headache.

Posterior pharynx with petechiae and exudates in a 12year-old girl. . Both the rapid antigen detection test and throat culture were positive for group A beta-hemolytic streptococci.

parapharyngeal. although results can take as long as 48 hours ƒ Throat culture results are highly sensitive and specific for group A beta-hemolytic streptococci (GABHS) Š Š Imaging studies are usually not necessary unless a retropharyngeal.Š Throat culture ƒ A throat culture remains the criterion standard for diagnosis. or peritonsillar abscess is suspected. In such cases. a plain lateral neck film can be used as an initial screening tool Honikman & Massell criteria for throat culture .

2 million units for 10 days. in conjunction with prevention of dehydration and supportive care for pain. Improved compliance with regimens has been noted when penicillin treatment is administered 2-3 times daily.Š Š Š Penicillin is the typical therapy for group A beta-hemolytic streptococci (GABHS) pharyngitis. .000 units/kg body wt to a maximum of 1. as compared with traditional regimens with 4 daily doses. Administer a minimum of 30.

Acute glomerulonephritis is a possible complication.Š Š Š Š Š Children allergic to penicillin are given oral erythromycin for 10 days. It may appear in 1 to 2 wks after pharyngitis Urine specimen is assessed after two wks of treatment for protein to avoid the development of glomerulonephritis. . Sulfonamides suppress but do not eradicate the streptococci from the pharynx & do not prevent fever.

Š Š Š Š Š Children with viral pharyngitis recover in 24 hrs to 5 days. Mesenteric adenitis.abdominal pain with or without vomiting. Follow-up is essential to avoid the risk of developing glomerulonephritis & rheumatic fever. . Purulent otitis media is a rare complication Streptococcal pharyngitis recovery occurs in 114 days.

children complain of throat discomfort including dryness & irritation. In acute episodes. The lymphoid tissue is usually hypertrophiedpebbled appearance Blood vessels may be prominent on inflamed mucus membrane. adenoids or tonsils. .Š Š Š Š Š Š Rarely occurs Results from infection of the sinuses. Muco-purulent secretions are present in the pharyngeal wall.

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.Š Failure of the nasal cavities to open posteriorly into the nasopharynx (choanae) during fetal development is called Choanal Atresia.

Choanal Atresia occurs with equal frequency in people of all races.82 cases per 10.Š Š Š The average rate of Choanal Atresia is 0. Maternal age or parity does not increase the frequency of occurrence. The ratio of unilateral to bilateral cases is 2:1.000 individuals. More studies report significantly more females than males affected . Chromosomal anomalies are found in 6% of infants with Choanal Atresia. Unilateral Atresia occurs more frequently on the right side. A slightly increased risk exists in twins.

In 2008.Š Š Š Š Š The nasal cavities extend posteriorly during development under the influence of the posteriorly directed fusion of the palatal processes. . which separates the nasal cavities from the oral cavity. carbimazole) medications was linked to Choanal Atresia. the 2-layer membrane consisting of nasal and oral epithelia ruptures and forms the choanae (posterior nares). By the 38th day of development. Failure of this rupture results in Choanal Atresia. Thinning of the membrane occurs. Barbero et al suggested that prenatal use of antithyroid (methimazole.

Š A number of theories have been proposed to explain the occurrence of Choanal Atresia. Medial outgrowth of vertical and horizontal processes of the palatine bone. Misdirection of mesodermal flow due to local factors. Failure of the bucconasal membrane to rupture. Abnormal mesodermal adhesions forming in the Choanal area. . and they can be summarized as follows: ƒ ƒ ƒ ƒ ƒ Persistence of the buccopharyngeal membrane.

ƒ Cycles between spells of cyanosis & crying occurs Š Unilateral Choanal Atresia may be present later in infancy or early childhood with unilateral nasal discharge or blockage. .Š Š The process may be unilateral or bilateral Bilateral Choanal Atresia usually presents in the neonate immediately after birth with respiratory distress.

. and patients may present with unilateral rhinorrhea or congestion. When crying alleviates respiratory distress in an obligate nasal breather Unilateral Atresia may not be detected for years. Symptoms of severe airway obstruction and cyclical cyanosis are the classic signs of neonatal bilateral Atresia.A small feeding tube could be used to determine the patency of the choana.Š Š Š Complete physical examination. but a complete nasal and nasopharyngeal examination should be performed using a flexible fiber optic endoscope to assess the deformity.

and/or inner ear may be involved.Š Š Š Associated malformations occur in 47% of infants without chromosome anomalies. middle. Only a small proportion of infants with Choanal Atresia and related components probably represent this entity. choroid. and/or microphthalmia Heart defect such as atrial septal defect (ASD) and/or conotruncal lesion Atresia of choanae Retarded growth and development Genitourinary abnormalities such as cryptorchidism. and/or hydronephrosis Ear defects with associated deafness (The external. The components of the CHARGE association are as follows: ƒ ƒ ƒ ƒ ƒ ƒ Coloboma of the iris. Nonrandom association of malformations can be demonstrated using the CHARGE association. microphallus.) .

ƒ Evaluate Choanal Atresia (vomer bone width and Choanal airspace distance). For good results. careful suctioning is performed to clear excess mucus. ƒ Determine the degree of bony. . ƒ Exclude other possible nasal sites of obstruction. The purpose of CT scanning is outlined as follows: ƒ Confirm the diagnosis of Choanal Atresia (unilateral or bilateral).Š CT scanning is the radiographic procedure of choice in the evaluation of Choanal Atresia. and a topical decongestant is applied. or mixed Atresia. ƒ Delineate abnormalities in the nasal cavity and nasopharynx. membranous.

5 cm from the alar rim The lack of movement of a thin wisp of cotton under the nostrils while the mouth is closed The absence of fog on a mirror when it is placed under the nostrils Acoustic rhinometry Listening for breath sounds with either a stethoscope or a Toynbee auscultation tube Gently blowing air into each nasal cavity with a Politzer bag Administering into the nose a colored solution that is visible in the pharynx .Š Diagnostic Procedures: ƒ ƒ ƒ ƒ ƒ ƒ ƒ Failure to pass an 8F catheter through the nasal cavity more than 5.

Š Š Š Š Bilateral Choanal Atresia in a neonate is an emergency Bilateral Choanal Atresia in the newborn requires prompt diagnosis and airway stabilization. The transseptal technique . McGovern nipple. and intubation are viable options. An oral airway. Transnasal puncture.

Diagram illustrating the Transpalatal correction of Choanal Atresia .Choanal Atresia.

Š Following surgical repair of Choanal Atresia. patients may require operative debridement or periodic dilatations. . Periodic dilations can sometimes be performed as an outpatient procedure with local decongestant and topical anesthesia using urethral sounds.

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is a common pediatric complaint. and spontaneous but may also be recurrent. or nosebleed. Most nosebleeds are benign. Most incidents are rarely life threatening but cause significant parental concern. self-limiting. Many uncommon causes are also noted. .Š Š Š Epistaxis.

Consider cocaine abuse in adolescent patients. nose picking) does not occur until later in the toddler years. Occurrence is unusual in infants in the absence of a coagulopathy or nasal pathology (e.g.g. Choanal Atresia.Š Š Š Š Š Epistaxis usually occurs in children aged 2-10 years. . Older children and adolescents also have a less frequent incidence.. neoplasm). Local trauma (e..

and coagulopathies. nasal tumors.g. accidental warfarin ingestion). Š Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) and chronic use of nasal steroids for treatment of allergic rhinitis are also frequently involved.. such as nose picking (frequently in the setting of dry nasal membranes). hemophilia. both intrinsic (e.. Other common causes of nosebleeds include: Š direct trauma with or without nasal or facial fractures. foreign body. OslerWeber-Rendu syndrome. Von Willebrand disease) and acquired (e. Excessive coughing causing nasal venous hypertension may be observed in pertussis or cystic fibrosis.Š Š Š Š The primary cause of epistaxis in children is minor trauma. .g. Š exposure to warm and dry air causing dry membranes (rhinitis sicca). rhinitis. Some less common causes include leukemia.

and nasal foreign bodies that cause local trauma can be responsible for rare cases of epistaxis. Juvenile nasal angiofibroma in adolescent males may cause severe nasal bleeding as the initial symptom . VII. IX.Š Š Š Š Š Š Arterial hypertension rarely causes epistaxis Children with migraine headaches have a higher incidence of recurrent epistaxis than children without the disease. often begins in the nasal. although rare. Etiologies such as liver disease. which causes capillary fragility. Intranasal rhabdomyosarcoma. which can lead to clotting factor deficiencies (II. orbital. Young infants with gastroesophageal reflux into the nose may have epistaxis secondary to inflammation. or sinus area in children. X). Osler-WeberRendu syndrome.

More than 90% of bleeds occur anteriorly and arise from the Little area.Š Š Epistaxis can be divided into 2 categories. These capillary or venous bleeds provide a constant ooze. rather than the profuse pumping of blood observed from an arterial origin. Bleeding typically occurs when the mucosa is eroded and vessels become exposed and subsequently break. based on where the bleeding originates. where the Kiesselbach plexus forms on the septum. anterior bleeds and posterior bleeds. .

A posterior source presents a greater risk of airway compromise.Š Posterior bleeds arise further back in the nasal cavity. aspiration of blood. are usually more profuse. . and greater difficulty controlling bleeding. and are often of arterial origin.

potentially. transfusion. HBP may impede clotting. causes epistaxis on its own. ƒ Persistent tachycardia must be recognized as an early indicator of significant blood loss requiring intravenous fluid and. . however. Check blood pressure and complete a workup if HBP is present. if ever. Vital signs ƒ High blood pressure (HBP) rarely.Š Š Skin: Examine the skin for evidence of bruises or petechiae that may indicate an underlying hematologic abnormality.

Carefully remove by suction any large amount of clot. reassess this area and. otologic. Begin the examination with inspection. Anterior bleeds from the nasal septum are most common.Š Nasal examination ƒ ƒ ƒ ƒ Š Use of a large-sized. if bleeding is noted in the pharynx with an anterior pack in place. looking specifically for any obvious bleeding site on the septum that may be amenable to direct pressure or cautery. handheld speculum (shown in the image below) can be helpful. Observe the posterior pharynx for constant dripping of blood that may signify a posterior rather than an anterior bleed. Pharynx examination ƒ ƒ . After placement of an anterior pack (see images below). strongly consider a posterior bleed. and the site can frequently be identified if bleeding is active.

ƒ Š Procedures ƒ Direct visualization with a good directed light source. ƒ If significant blood loss. leukemia. perform a CBC count with differential. perform CBC count and obtain prothrombin time (PT)/activated partial thromboplastin time (aPTT) and bleeding time. and nasal suction should be sufficient in most patients. or malignancy is suspected or if recurrent bleeding occurs. ƒ If a coagulopathy is suspected. nasal speculum (see image below). ƒ Insertion of nasal packing or cautery may be indicated .Š Laboratory Studies For the most part. laboratory studies are not needed for first-time or infrequent recurrences with a good history of nose picking or trauma to the nose.

g. This maneuver works more than 90% of the time. without frequent peeking to see if the bleeding is controlled. ƒ Patients should keep their heads elevated but not hyperextended because hyperextension may cause bleeding into the pharynx and possible aspiration. ƒ If bleeding is caused by excessive dryness in the home (e.Š Medical Care ƒ Initial treatment begins with direct pressure by squeezing the nostrils together for 5-30 minutes straight. from radiator heating). patients may benefit from the following care options: Humidify the air with a cool mist vaporizer in the bedroom. Usually only 5-10 minutes is required. ..

000 or phenylephrine (Neo-Synephrine) may be placed in the affected nostril to help vasoconstrict and achieve hemostasis . Nasal saline sprays are useful. If direct pressure is not sufficient. with fewer cardiac adverse effects.Alternately. gauze moistened with epinephrine at a ratio of 1:10. local application of bacitracin or petrolatum ointment directly to the Kiesselbach area with a cotton applicator to prevent further drying (studies recommend 2 wk). a metal basin of water may be placed on top of a radiator to humidify the ambient air. Oxymetazoline (Afrin) may also be used.

Š Š Surgical Care Cauterization of an identified small bleeding area: ƒ ƒ ƒ ƒ ƒ ƒ ƒ Can be performed with silver nitrate sticks Caution advised not to burn the entire septum or cause perforation (septal perforation is a risk) Performed in only one nostril at a time Used very judiciously. preferred by some (especially helpful in patients with leukemia) other tampon like packing that expands when water is injected into it . must avoid nasal tissues other than the bleeding site of septum Presents risk of nasal stenosis of the vestibule Oxycel cotton with bacitracin. which dissolves and does not have to be removed.

Š Antibiotic agents ƒ Antibiotics with staphylococcal and streptococcal coverage are required if nasal packing is placed. The oral route is used most commonly because most patients are treated on an outpatient basis. If the patient requires admission. Continue all antibiotics until the packing is removed . initially use intravenous medications.

Airway compromise is another potential complication. Excessive bleeding into the pharynx causes coughing and gagging. aspiration and subsequent respiratory arrest occur. If this occurs in an infant who is unable to roll over and clear the blood.Š Š One complication is excessive bleeding to the point of shock requiring transfusion. .

. or drug abuse in adolescents. saline spray. better thermostatic control. warfarin (e. rat poison in toddlers). and antibiotic ointment on the Kiesselbach area. Keeping the child's nails well trimmed may be helpful. . Protection from direct trauma from some sports activities occurs with helmet and/or face piece use.g. A hot dry home environment may benefit from humidifiers.Š Š Š Š Nose picking is difficult to deter and is going to occur. Consider drug education relating to use or accidental ingestion of aspirin.

.Š Š Patients with epistaxis that occurs from dry membranes or minor trauma do well with no long-term effects. Patients with bleeding from a hematologic problem or cancer have a variable prognosis.

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Children generally have larger tonsils. Antibody formation.Š Š Š Š Tonsils are masses of lymphoid tissue located in the pharyngeal cavity. The tonsils filter & protect the respiratory & alimentary tract from invasion by pathogenic organisms. .

Adenitis refers to the infection & inflammation of the adenoid (pharyngeal) tonsils.Š Š Tonsillitis is the term commonly used to refer to infection & inflammation of the palatine tonsils. .

PATHOPHYSIOLOGY Š . Causative organisms may be viral or bacterial.Š Š Often occurs with pharyngitis.

Š Š Š Š Š Š Edema of the palatine tonsils (kissing tonsils) Difficulty in swallowing & breathing. Persistent cough . Voice may be nasal & muffled quality. Offensive mouth odour & impaired sense of taste & smell. Adenoid enlargement causes nasal obstruction.

Š Š Complete health assessment Physical examination with focus on the respiratory system .

Š Medical Care: ƒ Symptomatic management ƒ Antibiotic treatment Tonsillectomy Indications:  Conservative  Controversial Š Surgical Care: ƒ ƒ Adenoidectomy Indications:  Conservative .

Š Contraindications: ƒ Cleft palate ƒ Acute infections at time of surgery ƒ Uncontrolled systemic diseases or blood dyscrasias. Reducing Fear ƒ Pre-operative ƒ Post Operative ƒ Home Care Š Nursing Intervention: ƒ .

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Š Š Acute infections of the larynx & trachea are more frequent in toddlers than in older children Primarily affected sites are the larynx & trachea .

. acute infectious pharyngitis.Š The term croup syndrome includes acute epiglotittis. acute laryngotracheobronchitis & acute spasmodic laryngitis.

. Viral infections are the common causative agent Haemophilus influenza are one of the common pathogen.Š Š Š Occur in infancy & toddler period with exception for epiglotittis.

. ‡Rapidly increasing inspiratory & sometime expiratory stridor.4 C(103 F) ‡Sore throat.pain on swallowing ‡Drooling of saliva ‡Muffled voice ‡Young child may assume position of hyperextension of neck ‡Older children may lean forward while sitting up. obstructive supraglottic laryngitis) Pathophysiology & Onset Maximum obstruction above the vocal chords (supraglottic) Rapid onset over a period of 4-12 hrs.Condition Acute Epiglotittis (epiglotittis. with mouth open & tongue protruding.supraglotitti s. Assessment ‡Child with high fever of 39.

Condition Pathophysiology & Onset Assessment ‡Possible inspiratory suprasternal & substernal retractions ‡Irritability & restlessness ‡Mild hypoxia with pallor to obvious coma & cyanosis ‡Rapid total airway obstruction may occur within minutes during first 6-12 hr of onset. ‡Possible slight temp. Acute Infectious Laryngitis Maximum obstruction at larynx (glottic) & subglottic area. Gradual onset with upper respiratory tract infection. . inspiratory stridor. elevation ‡Few symptoms to severe obstructive laryngitis ‡Mild hoarseness to loss of voice with ¶brassy cough· ‡If severe. retractions & dyspnea. restlessness.

Condition Pathophysiology & Onset Assessment .

. anxious ‡May have some cyanosis ‡Clinical manifestations may persist for several hrs. if untreated may have only hoarseness & cough the next morning but symptoms may recur the next 1 or 2 nights. Assessment ‡Paroxysmal attacks of laryngeal obstruction ‡Barking or brassy cough ‡Hoarseness ‡Sever inspiratory stridor. spasmodic laryngitic allergic croup) Pathophysiology & Onset Maximum obstruction at the vocal cords (glottic) laryngeal spasm vary with sudden onset Typically occur at night. midnight croup. without fever ‡Inspiratory retractions sometimes evident. ‡Restless.Condition Acute Spasmodic Laryngitis (spasmodic croup.

flaring of alae nasi. suprasternal.Š Š Š Š Š Initially a mild barking or brassy cough with intermittent stridor. use of accessory muscles. infrasternal & intercostal retractions Emotionally stressed. . Hypoventilation becomes severe-hypoxemiahypercapnea Dyspnea.respiratory difficulty Prefers sitting position or held upright.

.Š Š Š Š X-ray of the neck Nasopharyngeal culture Blood culture Examination of the Epiglottis.

Š Acute Laryngitis: ƒ .Š Acute Epiglottis: ƒ Endotracheal intubation or tracheostomy ƒ Antibiotic administration. Self-limited without long-term sequelae ƒ Symptomatic relief ƒ Fluids ƒ Humidified air.

Nebulized epinephrine Corticosteroid therapy. Š Acute Laryngitis: ƒ Self-limited disease. ƒ Cool mist therapy ƒ Nebulized epinephrine ƒ Corticosteroid therapy .Š Acute Laryngotracheobronchitis: ƒ ƒ ƒ ƒ ƒ Medical care of infection High humidity with cool mist Fluid maintenance in absence of respiratory difficulty.

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Usually mild but occasionally can be severe or rarely accompanied by serious complications.Š Š It is an acute. . self-limiting infectious disease that is common among young people under 25 yrs of age.

.Š The disease is characterized by an increase in the mononuclear elements of the blood & by symptoms of an infectious process.

Š Š Š Š Š The herpes-like Epstein Barr (EB)virus is the principal cause. Transmitted through direct intimate contact with oral secretions. . It is contagious & the period of communicability is unknown. Appears in both sporadic & epidemic forms. The incubation period following exposure is 46 wks.

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Heterophil antibody test Spot test (Monospot) .Š Š Š The diagnosis is established on the basis of clinical manifestations.

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No specific treatment Symptomatic management Bed rest Regulation of activities Short course of oral penicillin for sore throat. Warm gargles, hot drinks, analgesics including opiods or anaesthetic troches

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Self-limiting disease Prognosis is generally good. Live vaccines are avoided for several months after recovery.

Š Š Inflammation of the middle ear. . It is the second most common disease of infants & young children after upper respiratory infections.

. To protect the middle ear from nasopharyngeal secretions.Functions of the Eustachian tube: ‡ ‡ ‡ To clear secretions produced within the middle ear into the nasopharynx To equilibrate the air pressure with the atmospheric pressure in the middle ear by replenishing the oxygen that has been absorbed.

Š Š Š Š Š Š Š Length of the Eustachian tube. Humeral defense mechanism. Position. Lymphoid tissues. Frequency of URI. Cartilaginous support. . Muscles.

Š Š Š Acute Otitis Media Chronic Otitis Media Serous Otitis Media .

Child stops crying when carried upright. .Š Š Š Š Š Š Š Infant tugs & pulls the affected ear. Screams with pain during night. Toddlers tilt head to one side Irritability & lethargic Sucking or chewing leads to increase the discomfort. Physical examination.

Š Š Š Otoscopy Tympanocentesis Tympannometry .

Myringotomy .Š Š Analgesic & antipyretic such as acetaminophen.

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with most deaths occurring before hospital evaluation and treatment. .Š approximately 3000 deaths occur each year from foreign body aspiration.

peanuts are the most common food item aspirated. Vegetable matter tends to be the most common airway foreign body. . has decreased in frequency secondary to the advent of disposable diapers. The incidence of metallic foreign body aspirations.Š Š Š Š Š Most airway foreign body aspirations occur in children younger than 15 years children aged 1-3 years are the most susceptible. particularly of safety pins.

ƒ They tend to be running or playing at the time of aspiration. . ƒ They tend to put objects in their mouth more frequently. ƒ They lack coordination of swallowing and glottic closure.Š Young children comprise the most common age group for foreign body aspiration because of the following: ƒ They lack molars for proper grinding of food.

ƒ Of aspirated foreign bodies. or bronchus. the larynx.Š After foreign body aspiration occurs. 80-90% become lodged in the bronchi. ƒ Larger objects tend to become lodged in the larynx or trachea. ƒ Several studies have demonstrated equal frequency of right and left bronchial foreign bodies in children. the foreign body can settle into 3 anatomic sites. . trachea.

aspiration of foreign bodies produces the following 3 phases: ƒ Initial phase . atelectasis. coughing. or abscess . or airway obstruction at the time of aspiration ƒ Asymptomatic phase . lasting hours to weeks ƒ Complications phase .Subsequent lodging of the object with relaxation of reflexes that often results in a reduction or cessation of symptoms.Foreign body producing erosion or obstruction leading to pneumonia.Š In general.Choking and gasping.

ƒ Tracheal foreign bodies present similarly to laryngeal foreign bodies but without hoarseness or aphonia. . ƒ Bronchial foreign bodies typically present with cough. unilateral wheezing. but only 65% of patients present with this classic triad.Š Clinical presentation depends on the location of the foreign body. Tracheal foreign bodies can demonstrate wheezing similar to asthma. such as asthma. A large foreign body lodged in the larynx or trachea can produce complete airway obstruction from either the dimensions of the object or the resulting edema. Foreign body aspiration differs in the presence of unilateral wheezing and decreased breath sounds. Š Foreign body aspiration can mimic other respiratory problems. ƒ Laryngeal foreign bodies present with airway obstruction and hoarseness or aphonia. and decreased breath sounds.

1 ƒ Chest radiographs may reveal obstructive emphysema or hyperinflation.Š Š Š Imaging Studies High-kilovolt anteroposterior and lateral radiographs of the airway are the tests of choice in patients in whom laryngeal foreign bodies are suspected Posteroanterior and lateral chest radiographs are an adjunct to the history and physical examination in patients in whom foreign body aspirations are suspected. plastic) are not. but radiolucent objects (e. Radiopaque objects are visible. ƒ Š Š Š Lateral decubitus chest films may be helpful in children in whom the dependent lung remains inflated with bronchial obstruction. atelectasis.g.. Biplane fluoroscopy uses intraoperative fluoroscopic evaluation while identifying and locating a foreign body within the lung periphery . and consolidation. Chest radiographs (inspiratory and expiratory films) demonstrate atelectasis on inspiration and hyperinflation on expiration with a foreign body obstructing the bronchus.

Typically.Š Diagnostic Procedures ƒ Chest auscultation is critical in the evaluation of a patient in whom a foreign body aspiration is suspected. Patients may have normal examination findings despite having a foreign body within the airway because it may partially obstruct the airway. . these patients have wheezing. decreased breath sounds. or both on the side of the foreign body.

gagging. and vocalizing have partial obstruction.Š Medical therapy: Patients with complete airway obstruction require immediate medical attention and typically are aphonic and unable to breathe. ƒ . ƒ Most patients who arrive at the hospital are beyond the acute stage and are not in respiratory distress. but use of it in patients with partial obstruction may produce complete obstruction. antibiotics and steroids are not administered initially. ƒ In most cases. a decision is made in regard to the need for surgical intervention. ƒ After a complete history and physical examination are completed and radiographic studies are performed. Use of the Heimlich maneuver has improved the mortality rate of patients with complete airway obstruction. Patients who are coughing.

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personnel familiar with the use of the instrumentation. and anesthesiologists experienced in foreign body removal are critical for safe removal of airway foreign bodies. .Š Surgical Therapy ƒ An operating room well equipped with proper endoscopic equipment of various sizes.

.Š Follow-up ƒ Follow-up care is necessary if the patient's signs and symptoms return after discharge.

Bleeding can occur from granulation tissue surrounding the foreign body or erosion into a major vessel. . Pneumothorax and pneumomediastinum can result from an airway tear. Of patients with laryngotracheal foreign bodies. 67% experience associated complications when the removal delay is more than 24 hours.Š Š Š Š Š Most complications are the result of a delay in diagnosis. Pneumonia and atelectasis are the most common complications secondary to and after removal of bronchial foreign bodies.