Ear Nose and Throat Overviewfor school Nurses

Dr. Robert PollardEar Nose and Throat Physicians and Surgeons of Charleston 3043579049

OVERVIEW

• OVERVIEW OF HEARING SCREENING• COMMON THROAT ISSUES• OTITIS MEDIA• OTITIS EXTERNA• NECK AND SWALLOWING COMPLAINTS• ALLERGY AND IMMUNOTHERAPY• AMPLIFICATION IN THE CLASSROOM• EVALUATION OF EAR PAIN

HEARING SCREENING

• INTERVENTION IN THE PAST RELIED UPON THE HIGH RISK REGISTER AND “LATE SCREENING”

• SOPHISTICATED TESTING AT BIRTH AND GENETIC TESTING HAS TAKEN THE BURDEN OFF OF PRESCHOOL TESTING FOR THE PROFOUNDLY DEAF

• SCREENING AT 5, 1 AND 2K HELPFUL TO IDENTIFY MOSTLY CONDUCTIVE LOSSES

Hearing Screening/Roundup

Screening for Hearing Loss

• Designed to produce false positives and few false negatives

• Easy to administer• Thresholds significant for speech development• 5,1,2• 1,2,4• Easily understood referral criteria• RESA

The Audiogram and Frequency Responses

History of Hearing Screening

• 1990 High risk register• OAE looking for cochlear emissions• Fast ABR establishing intact pathway from

canal to brain• Follow up established by hospital where birth

ocurred• Dictated by law

Hearing Screening

• Fewer students seen with delayed identification of profound loss

• Role of School Nurse changes to screen for persistent middle ear effusion and subsequent hearing loss

• Referral to qualified medical professional

Bob’s Referral Criteria

• Hearing Thresholds >25 db• Subjective Hearing Loss• Abnormal Tympanometry with no prior tube

insertion• Speech and Language issues without reason• Chronic Otorrhea

Special Topics

• Amplification in the classroom• Cochlear implants• Child placement • Auditory trainer

AudItory Trainer

Chronic mucoid effusionBest fit for tube insertionImmediate correction of conductive hearing loss

Tubes/audiometry

Impact of Tubes on Screening

Acute otitis mediaBULGING TYMPANIC MEMBRANE

Tube granulomaManaged best with ciprodex

atelectasisLoss of the air containing space behind the tympanic membraneLikely eventual loss of ossicular chair

Otitis Externa

• Eczema • Fungus• Swimming• Hearing aids

Bacterial Externa

Otitis Externa Contact Dermatitis

Ear Foreign Bodies

Complications of Piercings

Tonsillitis

Peritonsillar Abscess

Tonsillitis

• Exudative• Strep• Mono• Bleeding• Peritonsillar abscess• Asymmetry• Establish protocols for intervention/treatment

Post Tonsillectomy

• When to return to school• Normal activities at 3 weeks• Would not release to full contact until 3 wks• Risk of bleeding greatest between 7-12 d

Post Tonsillectomy

Allergy and Immunotherapy

• Immunotherapy increasing used to chronically sick children with multiple allergies

• Serum is prepared from known concentrations of antigens to which the individual is allergic

• “immunity” is conveyed by the development of “blocking” antibodies when antigen is placed in the subdermal tissues away from the target organ (nose, mouth and lung)

Allergy and Immunotherapy

• Progressively higher concentrations are given over a schedule of 3-6 months until the individual achieves maintenance

• Definition of Maintenance• Weekly maintenance injections for several

years• 10 min wait time after injection• Auto injector to manage reactions (rare)

Nose Bleeds

• Most commonly associated with allergy and sinusitis

• Ice pack, compression and elevation • Refer quickly if not improving• Packing is very rarely needed for children• Cautery is used for persistent bleeding or

recurrences

HPV RELATED CANCERS

• Relationship between virus and cervical cancers known for many years

• Vaccine available for about 10 years commercially

• Tremendous growth in the amount of oral, tonsil, tongue base cancers make this a growing public health issue