Pediatric Otolaryngology: Ear, Airway, and Neck Mass Decisions
Scope
Pediatric otorhinolaryngology tests acute otitis media, otitis media with effusion, tonsillectomy criteria, obstructive sleep apnea, stridor, foreign bodies, and congenital neck masses. Management differs from adults because observation and hearing development drive decisions.
Core rules
- Acute otitis media: bulging tympanic membrane or otorrhea. Antibiotics are indicated for children under 2 years, severe symptoms, or bilateral disease; selected older children can be observed.
- Otitis media with effusion: middle-ear fluid without acute signs. Observe for 3 months; tympanostomy tubes are considered for persistent hearing loss greater than 20 to 30 dB, speech delay, or recurrent acute otitis media.
- Tonsillectomy criteria include seven episodes in 1 year, five per year for 2 years, or three per year for 3 years, plus obstructive sleep apnea or recurrent abscess.
- Stridor: laryngomalacia causes inspiratory stridor that worsens supine; croup causes barking cough; epiglottitis causes drooling and tripod positioning. Do not inspect the throat if epiglottitis is suspected.
- Button battery in the airway or esophagus is an emergency; remove urgently.
- Thyroglossal duct cyst is midline and moves with swallowing; branchial cleft cyst is lateral.
Worked example
A 2-year-old has six episodes of acute otitis media in 12 months, persistent effusion, a 30-dB hearing loss, and delayed speech. Tympanostomy tube placement is indicated. Prophylactic antibiotics are not the preferred solution because of resistance and limited benefit.
Traps
Treating otitis media with effusion with antibiotics; missing mastoiditis; sedating a child with stridor; delaying button battery removal; and failing to test hearing after recurrent ear disease.