Pediatric Otolaryngology
Core concepts
Know the developmental anatomy of the pediatric airway, including the higher laryngeal position and the narrowest point at the cricoid in infants. Understand the causes of stridor by age and level: laryngomalacia (most common cause of infant stridor), subglottic stenosis, tracheomalacia, and foreign body. Be familiar with the management of otitis media with effusion and the indications for tympanostomy tubes. Know the approach to pediatric neck masses (congenital vs inflammatory vs neoplastic) and the timing of tonsillectomy indications.
Traps
A common trap is assuming all infant stridor is laryngomalacia; consider subglottic stenosis or a vascular ring if the stridor is persistent, worsening, or associated with feeding difficulty. Another is over-diagnosing sinusitis in young children, where viral upper respiratory infections are frequent. Questions on foreign body aspiration often test that the right main bronchus is the most common site. Do not forget that recurrent tonsillitis criteria require documented episodes with specific frequency thresholds.
Worked example
A 6-month-old has inspiratory stridor that worsens when supine and improves when prone, with normal weight gain. This pattern is typical of laryngomalacia, which usually resolves by 12–18 months; surgery is reserved for severe cases with failure to thrive or apnea.