ABOHNS Complex Pediatric Otolaryngology cheat sheet

Neonates are obligate nasal breathers for the first ~2-6 months; bilateral choanal atresia causes cyclical cyanosis relieved by crying - an airway emergency requiring an oral airway and prompt evaluation.

CHARGE syndrome: coloboma, heart defects, atresia choanae, retarded growth, genitourinary anomalies, ear anomalies; CHD7 mutation in most; bilateral choanal atresia should prompt CHARGE workup.

Kartagener syndrome (primary ciliary dyskinesia) triad: situs inversus, chronic sinusitis, bronchiectasis; suspect with recurrent otitis media and sinus disease from infancy.

Cystic fibrosis sinonasal disease: nasal polyps in a child under 12 should prompt sweat chloride/CFTR testing; polyps are uncommon in children without CF.

Juvenile nasopharyngeal angiofibroma: adolescent male, recurrent epistaxis and nasal obstruction; biopsy is contraindicated - image with CT/MRI and consider angiography; treat with embolization plus resection.

Laryngeal cleft types I-IV by extent: I supraglottic to interarytenoid, II through cricoid, III through cricoid into cervical trachea, IV into thoracic trachea; type I may present only with aspiration.

Recurrent respiratory papillomatosis: HPV 6/11; juvenile-onset usually diagnosed 2-4 years; adjuvant intralesional cidofovir or bevacizumab with severe disease; HPV vaccination reduces risk.

Peritonsillar abscess in children: trismus, uvular deviation, hot-potato voice; needle aspiration or incision and drainage plus antibiotics; consider imaging if extension suspected.

Stridor timing localizes lesion: inspiratory = supraglottic/laryngeal; biphasic = glottic/subglottic; expiratory = tracheobronchial; biphasic with worse inspiration suggests fixed subglottic stenosis.

Laryngomalacia is the most common cause of infant stridor; symptoms worsen with supine position, feeding, and crying; resolves by 12-18 months; supraglottoplasty for severe cases with failure to thrive or apnea.

Subglottic stenosis grading (Myer-Cotton): grade I <50%, II 51-70%, III 71-99%, IV complete obstruction; congenital SGS from incomplete laryngeal recanalization.

Croup (laryngotracheobronchitis): barking cough, steeple sign; dexamethasone plus nebulized epinephrine for moderate-severe; parainfluenza most common.

Epiglottitis: drooling, tripod position, muffled voice, high fever; avoid throat exam and agitation; secure airway in OR; Haemophilus influenzae type b vaccine has shifted epidemiology.

Recurrent croup or stridor in a child over 1 year with failure to thrive suggests subglottic hemangioma (usually asymmetric narrowing) or papillomatosis; endoscopy is diagnostic.

Tracheostomy in children: smaller tube sizes, higher risk of accidental decannulation and granulation tissue; airway reconstruction (LTR) uses anterior and/or posterior costal cartilage grafts.

Laryngeal web: congenital glottic web presents with weak cry or aphonia; anterior web managed with endoscopic division; thick webs may require keel or open approach.

Acute otitis media: bulging tympanic membrane, otalgia, recent onset; Streptococcus pneumoniae, nontypeable Haemophilus influenzae, Moraxella catarrhalis; amoxicillin first-line unless recent beta-lactam.

Tympanostomy tube indications: recurrent AOM (3 episodes in 6 months or 4 in 12 months), chronic OME with hearing loss or speech delay, persistent effusion >3 months with symptoms.

Cholesteatoma in children: more aggressive and recurrent than adults; congenital cholesteatoma presents as a white mass behind an intact tympanic membrane; treatment is surgical, often staged.

Cochlear implant candidacy: severe-to-profound bilateral sensorineural hearing loss, limited benefit from hearing aids, auditory nerve present; MRI/CT to assess cochlear anatomy and nerve.

Congenital CMV is the leading nongenetic cause of pediatric sensorineural hearing loss; screen with urine/saliva PCR in infants with SNHL; hearing may be delayed or progressive.

Enlarged vestibular aqueduct: most common inner ear malformation associated with pediatric SNHL; hearing loss may be progressive or stepwise after head trauma; MRI is diagnostic.

Vestibular schwannoma in children suggests NF2; screen for bilateral tumors, cutaneous schwannomas, and cataracts; genetic testing for NF2 gene.

Vestibular evaluation in children: VNG, rotary chair, and vHIT; vestibular migraine is common; BPPV in children is rare and usually post-traumatic.

Congenital neck masses by location: midline - thyroglossal duct cyst (moves with tongue protrusion, Sistrunk procedure); lateral - branchial cleft cyst (second cleft most common, anterior to SCM).

Cystic hygroma/lymphatic malformation: posterior triangle, transilluminates, may cause airway compromise; treat with sclerotherapy (OK-432, bleomycin) or sirolimus for extensive disease.

Fibromatosis colli: sternocleidomastoid mass in neonates causing torticollis; conservative management with stretching; surgery rarely needed.

Pediatric thyroid nodules: higher malignancy rate than adults (~20-25%); evaluate with ultrasound and FNA; total thyroidectomy with central neck dissection for confirmed carcinoma.

Rhabdomyosarcoma is the most common pediatric soft tissue sarcoma of the head and neck; parameningeal sites require aggressive local control plus chemotherapy; staging by IRS group.

Neuroblastoma in the neck: may present with Horner syndrome; evaluate for catecholamine metabolites and primary adrenal disease; treatment risk-stratified.

Microtia reconstruction: Nagata or Brent techniques use autologous costal cartilage; typically staged starting at age 6-10 when rib cartilage is adequate; canaloplasty considered separately.

Cleft lip and palate: lip repair at ~3-6 months (rule of 10s), palate repair at ~9-18 months; multidisciplinary team includes audiology, speech, orthodontics, and genetics.