Peadiatric

ENT
Mr Kristian Hutson
ST7 ENT
 Case 1
5yo child sent by GP as mother worried he is struggling at school and is disruptive at home
Otitis Media with Effusion (OME)
Otitis Media with Effusion (Glue ear)
 T-tubes
Shah Grommets
PTA’s:
 Case 2
2yo child with recent
URTI presents with
ear tugging
Case 2 continud: Mother hasn’t had time to collect
antibiotics and now brings the child into A&E with a
temp of 39 and floppy after a seizure at home
Mastoiditis:
• Rare complication of untreated AOM
• Inflammation/ suppuration and empyema in mastoid air cells (over 7-10 days).
• Involvement of mastoid- swelling/ subperiosteal abscess
• Possible intracranial involvement

• Invx: CT temp bones/ head – if concern over IC complication, or failure to improve

• Rx: IV abx (Augmentin)

+/- cortical mastoidectomy/ abscess drainage/ ventilation tubes

• Commonest differential: otitis externa

 Case 3
Painless
Otorrhea and
reduced hearing
Cholesteatoma
• Negative middle ear pressure > retraction
pocket in pars flaccida > squamous epithelium
trapped > infection > invades pars flaccida
• Can cause hearing loss, vertigo, facial nerve
palsy and recurrent otitis media
• Investigations: Microscopy, Pure Tone
Audiometry, CT Temporal Bone
• Treatment: Mastoidectomy
Foreign Bodies
Case 4
• 3 year old
• unwittnessed
• Choking episode
• Now cough and wheeze

• CXR:
 Neonate- obligate nasal breather

Larynx sat higher (c2/3)

Peadiatric
airway Epiglottis- omega shaped

Smallest cross section - at

subglottis
 Case 5

•A baby presents with

respiratory distress at birth >
he is pale and cyanotic, which
improves a little when crying.
After intubation – the
following scan was taken:
Choanal Atresia
•Congenital choanal atresia is due to the
embryological failure of the primitive
bucconasal membrane to rupture before birth
(usually occurs sixth week of gestation),
resulting in a bone plate (90%), membrane or
both obstructing the posterior nares.
•May be unilateral (most common) or bilateral
•Occurs in 1 in 7000 births – there is a family
tendency
 Colobama
Heart disease

CHARGE Atresia Choanae

association Retarded growth
Genital anomalies
Ear abnormalities and deafness
Definitive repair involves transnasal
puncture/trephine and stenting or
transpalatal resection
Case 6:
• 2 month old
• Mum feels not putting on weight
• Intermittent ‘noisy’ breathing
• Improves when prone
• Worse when supine/ feeding
• Normal cry
Laryngomalacia
• Commonest cause stridor
• Most children grow out of it by aged 2
• May require intervention if not thriving/ weight loss

• Cause: short aryepiglottic folds, inward collapse arytenoids/ epiglottis

• Rx: anti-refulx medication/ ?surgery if severe

Case 7

• 2 year old
• Recent URTI
• Barking cough
• ‘noisy’ breathing
• Fever
 • 6 months to 3 years
• Usually over winter - URTI
• Viral (parainfluenza/ RSV)

•
Croup •
Barking cough
Low grade fever
• Stridor – often biphasic
• Treat with IV antibiotics and adrenaline
nebulizers
RX of Croup:

• Usually supportive
• Humidifed air
• Steroids
• Nebulised adrenaline

• Recurrent croup – MLB ? Sublottic stenosis

 • A one year child presents
with biphasic stridor, poor
feeding and poor
development. She has a
history of intubation as a
child.

Case 8
Subglottic stenosis
Management options:
• Close observation (higher risk of croup) – grade I
• Surgical intervention -  grade I-II: balloon dilation, lasers,
microdebrider.
• Surgical intervention -  grade III-IV: tracheostomy,
laryngotracheal reconstruction or partial cricotracheal
resection
Case 9
• You are called to see a 4yo child who
complained earlier in the day of having
a sore throat and pain when
swallowing, they later developed a
muffled voice. When you see them
they have a temperature of 39, an
inspiratory stridor and they are sat up
in the emergency department leaning
forward and dribbling.
 • HIB infection
• Rare now (HIB vaccine)
• Aged 1-5yrs
• URTI- severe sore throat/
dysphagia
• Stridor
• Toxic appearance
• Sat up/ wont lie down,

Epiglottitis
 Croup Acute epiglottitis
Pathogen Parainfluenza virus HIB
Age <5 2-6 yrs

Location Subglottic Supraglottic

Onset Gradual Sudden onset
Cough Barky Normal
Posture Supine Upright
Drooling No Yes
Fever Low grade High grade
Radiograph Steeple sign Thumb print
Rx Supportive Airway management and Abx
Other airway pathology: