Pediatric Otorhinolaryngology
Core concepts
Know the age-dependent airway anatomy: infants have a large occiput, anterior and cephalad larynx, omega-shaped epiglottis, and narrowest point at the cricoid (vs adult glottis). Recognise stridor timing: inspiratory (laryngomalacia - most common cause of infant stridor, worse supine/feeding, resolves), biphasic (subglottic stenosis, croup), expiratory (tracheomalacia/foreign body). Understand otitis media with effusion (persistent >3 months, hearing impact, grommets if significant) versus acute otitis media (bulging red tympanic membrane, antibiotics). Know tonsillectomy indications (recurrent tonsillitis meeting criteria, obstructive sleep apnoea) and adenoidectomy for obstruction/OME. Recognise juvenile nasopharyngeal angiofibroma (adolescent male, epistaxis, nasal mass - do NOT biopsy), laryngomalacia, and foreign body aspiration (sudden choking, unilateral wheeze).
Traps
Do not biopsy a vascular adolescent nasal mass - image first (JNA). Stridor is a sign, not a diagnosis - always assess severity (recession, cyanosis, exhaustion). Croup vs epiglottitis: epiglottitis is toxic, drooling, tripod, no cough - airway emergency, do not examine the throat.
Rule of thumb
In any child with stridor, assess airway first, then localise by phase and age. For suspected epiglottitis, keep the child calm and secure the airway in theatre.