Paediatric Otolaryngology
Core concepts
Understand airway development and the paediatric airway's unique features: large occiput, anterior larynx, floppy epiglottis, narrowest point at the cricoid (until ~8–10 years). Distinguish laryngomalacia (inspiratory stridor, worse supine/feeding, resolves by 12–18 months) from tracheomalacia (expiratory, barking) and subglottic stenosis (biphasic, persistent). Know the Cotton-Myer grading of subglottic stenosis and the indications for supraglottoplasty. In otology, be fluent in otitis media with effusion (persistent >3 months, 20–30 dB loss, grommets if hearing/speech affected) and the pars tensa vs pars flaccida cholesteatoma distinction. Know the Glasgow benefit of tonsillectomy criteria (Paradise) and the absolute indications for adenotonsillectomy (obstructive sleep apnoea).
Traps
Examiners test the "wait and see" rule versus intervention: OME resolves spontaneously in most children within 3 months, so grommets are not first-line. Another trap is confusing croup (steeple sign, barking cough, dexamethasone) with epiglottitis (drooling, tripod, thumb sign, do not examine the throat). Remember bilateral choanal atresia presents with cyclical cyanosis relieved by crying - an airway emergency.
Worked example / rule of thumb
A 2-year-old with 4 months of bilateral OME and 25 dB conductive loss with delayed speech: offer grommet insertion (with or without adenoidectomy if indicated). Rule of thumb: "OME <3 months = observe; >3 months with hearing/speech impact = refer for grommets."