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Chapter-24 Otorhinolaryngology

BOOK TITLE: IAP Management Algorithms for Common Pediatric Illnesses

Author
1. Lakshmanan Somu
2. Ismail Nazrin Mohamed
3. Singh Urvashi
ISBN
9789352501977
DOI
10.5005/jp/books/12810_25
Edition
1/e
Publishing Year
2016
Pages
10
Author Affiliations
1. Sri Ramachandara Medical College and Hospital, Chennai, Tamil Nadu, India, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu
2. Sri Ramchandra University, Chennai, Tamil Nadu, India, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu
3. Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu
Chapter keywords
acute otitis media, epistaxis, complete blood count, ear swab, antibiotic sensitivity, computed tomography, membranous tonsillitis, X-ray mastoid, Diagnostic nasal endoscopy, septal deviation

Abstract

This chapter provides an overview of acute otitis media, tonsillitis, foreign bodies in ear, nose and throat, and epistaxis. Complete blood count with total and differential count is investigated once stage of suppuration has reached for acute and chronic otitis media. Ear swab is investigated for culture and antibiotic sensitivity. X-ray mastoid is done to rule out mastoiditis. X-ray paranasal sinus (water\'s view) is used to rule out sinusitis. Risk factors for complicated acute otitis media include child less than 6 months, recurrent acute otitis media and family history of complicated acute otitis media. Throat swab is used for culture and antibiotic sensitivity taken routinely for all patients with acute follicular and membranous tonsillitis. Swab to be taken sweeping across the medial surface of tonsil and posterior pharyngeal wall. Complete blood count is investigated. X-ray nasopharynx lateral view is used to rule out presence of adenoid hypertrophy. No imaging required ideally as most foreign bodies are radiolucent. However, in patients with history of foul smelling discharge with no obvious foreign body visualized on anterior rhinoscopy, X-ray or computed tomography (CT) paranasal sinus may be done. For all patients, X-ray of neck, chest and abdomen anteroposterior (AP) and lateral view is done for investigating foreign body throat. Flat foreign bodies like coins usually orient in the coronal plane and appear as a circular object on an AP view, whereas objects lodged in the trachea tend to orient in the sagittal plane and are best seen in lateral projection. Toys made of plastic or wood, some thin metal objects, and many types of bones including fish bones are not readily seen on plain X-rays. Radiography can be helpful in localizing coins and button batteries. Complete blood count especially hemoglobin and platelet count is investigated for epistaxis. Diagnostic nasal endoscopy is used to rule out local causes like septal deviation or spur.

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