1. Ear Nose and Throat Overview for school Nurses Dr. Robert Pollard Ear Nose and Throat Physicians and Surgeons of Charleston 3043579049

2. 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

3. 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

4. Hearing Screening/Roundup

5. 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

6. The Audiogram and Frequency Responses

7. 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

8. 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

9. 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

10. Special Topics Amplification in the classroom Cochlear implants Child placement Auditory trainer

11. AudItory Trainer

12. Chronic mucoid effusion Best fit for tube insertion Immediate correction of conductive hearing loss

13. Tubes/audiometry

14. Impact of Tubes on Screening

15. Acute otitis media BULGING TYMPANIC MEMBRANE

16. Tube granuloma Managed best with ciprodex

17. atelectasis Loss of the air containing space behind the tympanic membrane Likely eventual loss of ossicular chair

18. Otitis Externa Eczema Fungus Swimming Hearing aids

19. Bacterial Externa

20. Otitis Externa Contact Dermatitis

21. Ear Foreign Bodies

22. Complications of Piercings

24. Tonsillitis

25. Peritonsillar Abscess

26. Tonsillitis Exudative Strep Mono Bleeding Peritonsillar abscess Asymmetry Establish protocols for intervention/treatment

27. 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

28. Post Tonsillectomy

29. 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)

30. 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)

31. 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

32. 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