Pediatric Otorhinolaryngology
Pediatric Otorhinolaryngology
This domain tests acute otitis media (AOM), otitis media with effusion (OME), recurrent throat infection, and pediatric airway basics. The exam favors age-specific observation rules and avoidance of unnecessary antibiotics.
Core rules
- AOM diagnosis requires bulging tympanic membrane, otorrhea, or acute inflammation with middle-ear effusion. For children 6–23 months with nonsevere unilateral AOM, observation for 48–72 hours is acceptable; amoxicillin 80–90 mg/kg/day is first-line when antibiotics are needed.
- OME is fluid without acute infection; it usually resolves. Tympanostomy tubes are considered for persistent bilateral effusion with hearing loss, speech delay, or recurrent AOM (three episodes in 6 months or four in 12 months).
- Tonsillectomy is indicated for recurrent throat infection meeting frequency criteria and for obstructive sleep apnea.
- Mastoiditis presents with postauricular swelling, tenderness, and a protruding ear; it requires urgent imaging and intravenous antibiotics.
Worked example
A 2-year-old has had three AOM episodes in 6 months and persistent bilateral effusion with mild hearing loss. The child meets criteria for tympanostomy tube placement after audiologic assessment. The reasoning is recurrent AOM plus persistent effusion affecting hearing, not a single uncomplicated episode.
Traps
Do not use antibiotics for OME. Do not recommend decongestants or antihistamines. Do not place tubes for a first episode of AOM without persistent effusion. Do not treat mastoiditis with oral antibiotics alone.