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OT42 Otolaryngology
Pediatric Otolaryngology
Toronto Notes 2019
• edemaofsoftpalate
• uvulardeviation
• dysphonia(edema→failuretoelevatepalate)2°toCNXinvolvement • unilateralreferredotalgia
• cervicallymphadenitis
Complications
• aspirationpneumonia2°tospontaneousruptureofabscess • airwayobstruction
• lateraldissectionintoparapharyngealand/orcarotidspace • bacteremia
• retropharyngealabscess
Treatment
• secureairway
• surgicaldrainage(incisionorneedleaspiration)withC&S
• warmsalineirrigation
• IVpenicillinGx10difculturespositiveforGAS
• addPO/IVmetronidazoleorclindamycinx10difculturepositiveforBacteroides • considertonsillectomyaftersecondepisode
Other Sources of Parapharyngeal Space Infections
• pharyngitis
• acutesuppurativeparotitis(seeSalivaryGlands,OT30) • AOM
• mastoiditis(Bezold’sabscess)
• odontogenicinfection
Tonsillectomy
Absolute Indications
• mostcommonindication:sleep-disorderedbreathing
• 2ndmostcommonindication:recurrentthroatinfections
• tonsillarhypertrophycausingupperairwayobstruction,obstructivesleepapnea,severedysphagia,or
cardiopulmonary complications such as cor pulmonale
• suspicionofmalignancy(e.g.lymphoma,squamouscellcarcinoma) • orofacial/dentaldeformity
• hemorrhagictonsillitis
Relative Indications (To Reduce Disease Burden)
• recurrentthroatinfectionwithafrequencyofatleast7episodesinthepastyear,atleast5episodes
per year for 2 yr, or at least 3 episodes per year for 3 yr with documentation in the medical record for each episode of sore throat, and 1 or more of the following: temperature >38.3 °C, cervical adenopathy, tonsillar exudate, or positive test for Group A β-hemolytic Streptococcus (Paradise Criteria)
• chronictonsillitiswithhalitosis(badbreath)orsorethroat±tonsilloliths(clustersofmaterialthatform in the crevices of the tonsils)
• complicationsoftonsillitis:quinsy/peritonsillarabscess,parapharyngealabscess,retropharyngeal abscess
• failuretothrive
Relative Contraindications
• velopharyngealinsufficiency:overtorsubmucous/covertcleftofpalate,impairedpalatalfunctiondue to neurological or neuro-muscular abnormalities
• hematologic: coagulopathy, anemia
• infectious:activelocalinfectionwithouturgentobstructivesymptoms
Complications
• hemorrhage:primary(within24h);secondary(withinfirst7-10d) • odynophagiaand/orotalgia;dehydration2°toodynophagia
• infection
• atlantoaxialsubluxation(Grisel’ssyndrome)-rare
Airway Problems in Children
DIFFERENTIAL DIAGNOSIS BY AGE GROUP
Neonates (Obligate Nose Breathers)
• extralaryngeal
■ choanal atresia (e.g. CHARGE syndrome)
■ nasopharyngeal dermoid, glioma, encephalocele
■ glossoptosis: Pierre-Robin sequence, Down syndrome, lymphatic malformation, hemangioma