Epstein's pearls and Bohn's nodules

Epstein's pearls are tiny cystic lesions of the palate found in approximately 2/3rds of newborns. They are visible over the region of fusion of the posterior palatal segments and are a result of the inclusion of epithelial cells during palatal fusion.  Bohn's nodules are also benign and much less frequent than Epstein's pearls. They occur along the junction of the hard and soft palate or adjacent to the midpalatal raphe and are derived from epithelial remnants of developing palatal salivary glands. Distinction between Epstein's pearls and Bohn's nodule is difficult and clinically irrelevant because both of these lesions regress and require no treatment.

Do not confuse these with the following conditions:

Congenital epulis is a very rare tumor seen in the newborn period (especially in females). It is usually firm and pedunculated and visible on the anterior alveolar ridge of the maxilla. It is benign in nature but may lead to difficulty with feeding and/or respiration requiring excision.

Mucoceles are clear fluid-filled, well-circumscribed, small lesions usually visible on the labial mucosa of the lower lip. These occur as a result of trauma to a submucosal salivary duct, usually from blunt trauma or lip biting. They usually also require no treatment. Large lesions may be de-roofed.

Treatment of Acute Otitis Media (AOM) in Children

Acute otitis media is the commonest diagnosis in sick children visiting the pediatrician's office in the United States.

Middle ear effusion is common after the resolution of acute symptoms. It may persist for three months in 10%. If persistent it can cause conductive hearing loss and may affect speech, language, and cognitive ability.

Treatment of involves pain relief and antibiotics.

Motrin (ibuprofen), Tylenol(crocin/parecetamol/acetaminophen) are effective for pain.

Less than 24 month olds should always get antibiotics. Older kids with bilateral infection should also always get antibiotics. Otherwise healthy, older children with unilateral infection may be observed without antibiotics.

Amoxicillin is the usual first-line therapy and duration is usually 7 days. If they persist to have symptoms despite 48-72 hours of treatment may be changed to Augmentin(amoxicillin-clavulinic acid).

Less than 2 year olds and older kids with language deficits should have a follow up visit 2-3 months from the acute infection to ensure resolution of effusion.

Unilateral hyperacusis

Unilateral hyperacusis is usually a sign of LMN facial nerve paralysis. Stapedius muscle which is innervated by the nerve to the stapedius keeps the ear drum tense preventing hyperacusis normally.

Gradenigo syndrome

Gradenigo Syndrome is also known as Petrous Apicitis. It is a rare complication of otitis media and is a triad of :

 

- Retro orbital pain

- 6th Nerve paralysis on the same side

- Otitis media

 

Treatment is usually by broad spectrum IV antibiotics. In rare cases surgical intervention and drainage may be required.

Quiz

What is the diagnosis?

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Ans: Waardenberg syndrome. Note the heterochromia irides, white forelock and hypertelorism. There is sensori-neural hearing loss in this condition.