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Ear Nose and Throat Overview
for school Nurses
Dr. Robert Pollard
Ear Nose and Throat Physicians and
Surgeons of Charleston 3043579049
OVERVIEW
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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
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Amplification in the classroom
Cochlear implants
Child placement
Auditory trainer
AudItory Trainer
Chronic mucoid effusion
Best fit for tube insertion
Immediate correction of conductive hearing loss
Tubes/audiometry
Impact of Tubes on Screening
Acute otitis media
BULGING TYMPANIC MEMBRANE
Tube granuloma
Managed best with ciprodex
atelectasis
Loss of the air containing space behind the tympanic membrane
Likely eventual loss of ossicular chair
Otitis Externa
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Eczema
Fungus
Swimming
Hearing aids
Bacterial Externa
Otitis Externa Contact Dermatitis
Ear Foreign Bodies
Complications of Piercings
Tonsillitis
Peritonsillar Abscess
Tonsillitis
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Exudative
Strep
Mono
Bleeding
Peritonsillar abscess
Asymmetry
Establish protocols for intervention/treatment
Post Tonsillectomy
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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