Pediatric Otolaryngology
Core rules
Acute otitis media is diagnosed by acute onset plus middle-ear effusion, with a bulging tympanic membrane or otorrhea. Observation is appropriate for selected nonsevere cases in older children; immediate antibiotics are used for severe pain, high fever, or young infants. Tympanostomy tubes are considered for recurrent acute otitis media (three episodes in 6 months or four in 12 months) or persistent otitis media with effusion with hearing loss. Obstructive sleep apnea in children usually reflects adenotonsillar hypertrophy; polysomnography is used in complex cases, and adenotonsillectomy is first-line surgery. Congenital neck masses include thyroglossal duct cysts, which are midline and move with tongue protrusion and are treated by Sistrunk procedure; branchial cleft cysts are lateral. Laryngomalacia causes inspiratory stridor and is managed by supraglottoplasty when severe. Croup and airway foreign bodies are key differentials for stridor.
Worked example
A 3-year-old snores, has witnessed apneas and large tonsils. Polysomnography confirms obstructive sleep apnea. Adenotonsillectomy is planned, with postoperative monitoring because of apnea risk.
Traps
Do not use antibiotics for otitis media with effusion. Do not miss bilateral choanal atresia in a neonate with respiratory distress that improves with crying. Not every pediatric neck mass is a lymph node. Avoid tonsillectomy without documenting indication and bleeding risk.