Pediatric EENT

Eye

Ophthalmia Neonatorum

  • Purulent conjunctivitis in < 1 mo old
  • High risk for GC/Chlam, corneal ulceration/perforation
  • Can have disseminated GC (arthritis, bacteremia, CNS)
  • Need PCR GC/chlam and HSV
  • Need full sepsis w/u (including LP/BCx) and abx (cefotax) – admission and optho consult
  • Irrigate eyes w/ saline
  • No topical erythromycin

Conjunctivitis

  • Low threshold to treat as bacterial
  • Ok to return to school when discharge is gone

Raccoon Eyes

  • DDx includes TBI/NAT, neuroblastoma, rhabdomyosarcoma, allergic shiners
  • MRI preferred imaging if child is stable

Strabismus

  • Bruckner test – position of light reflex to differentiate true strabismus from pseudo strabismus

Leukocoria (white reflex)

  • DDx includes retinoblastoma, cataract, retinal detachment

Nasal duct obstruction

  • Usually resolves by one year, massage w/ warm compresses
  • Can be complicated by dacrocystitis which will also need abx

Preseptal Cellulitis

  • Usually starts as dacrocystitis or bug bite
  • Consider admission to obs vs outpt management depending on symptoms – if more than 2 of swlling, redness, discharge, pain, injection or shut eye probably should admit
  • Abx: PO- Augmentin or 2nd/3rd gen cephalosporin; IV – ceftriaxone +/- MRSA coverage
  • CT w/ contrast if no improvement after 24-48 hr of treatment or too much edema to examine the eye or signs of eye involvement including pain w/ EOM, ocular palsy, decreased vision, proptosis etc.
  • Complications – cavernous/venous sinus thrombosis, orbital abscess or intracranial abscess

Orbital Cellulitis

  • Usually starts as sinusitis or odontogenic source
  • Pain with EOM, IOP >25, loss of sensation in V1/V2
  • Best imaging is MRI if available
  • Complications include orbital compartment syndrome, cavernous thrombosis, brain abscess
  • Tx – 3rd gen ceph + MRSA coverage x 10-14 days

Eye Exam Tips

  • Hold vertically to get eyes open
  • Assess tracking using distraction aid or dolls eyes maneuver

 

Dental

General

  • Different system for teeth (uses letters)
  • 4 teeth by 6 mo, first molars at 1 year

Trauma

  • Fractures – Now classified as complicated vs uncomplicated depending on pulp involvement or not
  • Baby teeth
    • Avulsion or subluxation  – NTD
    • Intrusion/Luxation: Check for normal occlusion, dental f/u in 1-2 days to assess underlying permanent tooth
  • Permanent teeth
    • Avulsion – can reimplant < 60 min (milk or Hanks solution), don’t touch root
  • Penetrating oral injuries
    • Consider risk for CVA due to injury to carotid -> dissection and thrombosis
    • Consider and have relatively low threshold for MRA or CTA
    • Injuries to hard or soft palate probably pretty low risk for carotid injury
    • Soft diet x 5 days, CHX swish and spit, Abx PPx are +/-, parental monitoring for neuro sequelae

 

Oral

HFM/Herpangina

  • Symptomatic tx w/ OTC meds, popsicles, milk
  • Don’t need antivirals