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Ebook Ghai essential pediatrics (8/E): Part 2

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(BQ) Part 2 book "Ghai essential pediatrics" has contents: Otolaryngology, disorders of respiratory system, endocrine and metabolic disorders, central nervous system, disorders of cardiovascular system, skin disorders, neuromuscular disorders, childhood malignancies,. and other contents. | Otolaryngology Sandeep Samant, Grant T. Rohman, Jerome W. Thompson DISEASES OF THE EAR Otitis Media Otitis media is a common early childhood infection. Anatomic features that make young children particularly susceptible to ear infections include shorter, more horizontal and compliant eustachian tubes and bacterial carriage in the adenoids. Other risk factors include expo­ sure to cigarette smoke, overcrowding, bottlefeeding, cleft palate, Down syndrome, allergy and immune dysfunction. These risk factors contribute to the pathophysiology of the two common varieties of otitis media, acute otitis media and otitis media with effusion. Acute Otitis Media Acute otitis media (AOM) in children tends to have a bimodal age distribution, with children between ages 6 and 24 months and 5 to 6 yr at greatest risk. Etiology. The most common organisms causing AOM are Streptococcus pneumoniae and Haemophilus influenzae, accounting for approximately 65% cases; 15% are caused by Moraxell a catarrh alis, Streptococcus pyogenes and Staphylococcus aureus. Respiratory viruses play an important role in initiating otitis media and may be the only pathogens in some cases, since 20% of middle ear aspirates are sterile. Diagnosis. AOM is characterized by the rapid onset of symptoms, which may be local, e.g. otalgia or ear tugging, and/or systemic, e.g. fever or crying. Older children may report impaired hearing. History of recent upper respira­ tory tract infection is common. Otoscopic examination reveals a red and bulging tympanic membrane with redu­ ced mobility as measured by either tympanometry or insufflation through the otoscope (pneumatic otoscopy). Rupture of the drum with ear discharge (suppuration) may have already occurred, in which case the ear canal contains an opaque yellow-green or reddish-brown fluid. Cleaning of this fluid usually reveals an intact drum, as the rupture is small and closes promptly after spontaneous perforation. The diagnosis of AOM is considered certain if