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Chapter 2 Index
A. Evaluation by system:
1. General 2. HEENT
--Otitis Media:
Classification, Rx and Complications |
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Pediatric ENT:
1. When to Refer for Tubes
2. Laryngeal Abnormalities
(Dr. John Bent 12/95: Pediatric ENT)
I. Tubes, adenoidectomy and tonsillectomy: (Indications and
complications of each)
1. Tubes:
- Otitis Media: Caused by Strep pneumo, H influenzae, and Branhamella
catarrhalis
- Predisposing factors: race, daycare, season, smoke, family history,
breastfeeding
- Effusion present after infection: 40% after 1 mo, 15% after 2 mos, and
10% after 3 mos
- Indications for tubes:
- 3-6 months serous otitis media with > 20 db loss
- 3 episodes of otitis media in 3 months
- 4-6 cases of otitis media in 12 months
- Complications of tubes: otorrhea (1-3%), perforation
2. Adenoidectomy
- Indications for adenoidectomy: airway obstruction, abnormal facial, or
dental growth, recurrent otitis media or effusion: (ref: Paradise:
JAMA 1990;263:2066-73)
- More effective if combined with tubes: (ref Gates: NEJM
1987;317:1444-51)
- Complications: nasopharyngeal stenosis and hemorrhage
3. Tonsillectomy
- Indications: recurrent strep, airway obstruction, peritonsillar
abscess; recurrent tonsillitis
(ref: Paradise: NEJM 1984;310:674-83)
- Technique: no advantage to laser
- Inpatient vs. outpatient: if less than 3 years of age, chronically
ill, or poor access to medical care, better done in the hospital.
II. Laryngology: most common larynx problems and their treatment:
1. Laryngomalacia: most common congenital laryngeal
anomaly. Presents hours to months after birth; characterized by a high
pitched inspiratory stridor. Often requires no treatment, but can require
epiglottoplasty or tracheostomy.
2. Vocal cord paralysis: second most common congenital
larynx problem. Congenital or acquired - left > right. If unilateral has
weak cry; if bilateral: strong cry.
3. Vocal cord nodules: most common cause of hoarseness;
results from misuse of voice. Always bilateral. Can be helped by speech
therapy.
4. Recurrent papillomas: most common neoplasm in larynx.
Etiology: HPV, birth transmission, promiscuity. Treatment: CO2 laser,
interferon, Vit A, chemotherapy
5. Subglottic stenosis: >95% acquired; can diagnose from
plain films or by direct laryngoscopy. Treat by laser, dilation,
tracheotomy, and laryngotracheoplasty if needed.
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