Discipline - Paediatric Otolaryngology

• Otitis Media: One of the most common conditions in children, otitis media is an infection or inflammation of the middle ear. Symptoms include ear pain, fever, and hearing loss. Paediatric otolaryngologists often treat recurrent or chronic cases with antibiotics, and in some cases, surgically insert tympanostomy tubes to ventilate the middle ear and prevent future infections.

• Hearing Loss: Hearing loss in children can result from various causes, including congenital conditions, infections, or trauma. Early diagnosis and intervention are crucial for speech and language development. Treatment options may include hearing aids, cochlear implants, or surgical procedures to correct structural abnormalities.

• Ear Deformities: Conditions like microtia (underdeveloped external ear) and atresia (absence of the ear canal) are congenital deformities that can affect hearing and appearance. Paediatric otolaryngologists perform reconstructive surgeries to restore normal ear structure and function.

• Cholesteatoma: A non-cancerous skin growth that can develop in the middle ear behind the eardrum, which may require surgical intervention to prevent complications such as hearing loss or infection.

• Chronic Sinusitis: Persistent inflammation of the sinuses can lead to chronic sinusitis, causing nasal congestion, discharge, and facial pain. Treatment may involve medical management with antibiotics and nasal corticosteroids, or surgical interventions such as endoscopic sinus surgery to improve sinus drainage.

• Nasal Obstruction: Conditions like deviated septum or enlarged adenoids can obstruct nasal airflow, causing breathing difficulties and sleep disturbances. Surgical procedures such as septoplasty or adenoidectomy are performed to alleviate these obstructions.

• Allergic Rhinitis: Allergic rhinitis, or hay fever, is an allergic response to environmental triggers like pollen or dust mites, leading to symptoms such as sneezing, itching, and nasal congestion. Treatment includes allergen avoidance, medications, and immunotherapy.

• Nasal Polyps: Benign growths in the nasal passages that can cause breathing difficulties and chronic infections, sometimes requiring surgical removal.

• Epistaxis (Nosebleeds): Pediatric otolaryngologists also manage recurrent or severe nosebleeds, which may be due to trauma, structural abnormalities, or underlying medical conditions.

• Tonsillitis and Adenoiditis: Infections of the tonsils and adenoids are common in children and can lead to symptoms like sore throat, difficulty swallowing, and obstructive sleep apnoea. Recurrent infections or significant airway obstruction may necessitate surgical removal (tonsillectomy and adenoidectomy).
• Voice Disorders: Paediatric otolaryngologists address voice disorders resulting from vocal cord nodules, polyps, or paralysis. Voice therapy and, in some cases, surgical interventions are used to improve voice quality and function.
• Swallowing Disorders: Dysphagia (difficulty swallowing) can result from various congenital or acquired conditions. Evaluation and treatment involve a multidisciplinary approach, including speech therapy and surgical correction of anatomical abnormalities if needed.
• Obstructive Sleep Apnoea (OSA): Caused by enlarged tonsils or adenoids, leading to breathing difficulties during sleep. Treatment includes adenotonsillectomy (removal of the tonsils and adenoids) to improve airway patency.

• Laryngomalacia: A common congenital condition where the soft tissues of the larynx collapse inward during inhalation, causing noisy breathing (stridor). Most cases resolve with growth, but severe cases may require surgical intervention.
• Subglottic and tracheal Stenosis: Narrowing of the airway below the vocal cords and the trachea can cause breathing difficulties. Treatment includes endoscopic procedures to dilate the airway or open surgery for more severe cases.
• Tracheomalacia and Bronchomalacia: These conditions involve the weakening of the tracheal or bronchial walls, leading to airway collapse. Management may include medical treatment or surgical repair.
• Tracheo-oesophageal fistula – a connection between the trachea and oesophagus which can cause breathing and swallowing problems and may need surgical intervention either endoscopic or open.
• Airway Reconstruction: Paediatric otolaryngologists often perform laryngotracheal reconstructions and tracheoplasties for more complex cases of airway stenosis, allowing for better long-term airway function.
• Foetal surgery – Otolaryngologists play a pivotal role in EXIT procedures (extra-uterine intrapartum treatment) to treat infants with congenital head and neck pathology that is deemed to not compatible with a safe airway after birth.
• Tracheostomy

• Congenital Neck Masses: Paediatric otolaryngologists diagnose and treat congenital neck masses such as branchial cleft cysts and thyroglossal duct cysts, often requiring surgical removal.
• Lymphatic Malformations: Benign masses that occur in the lymphatic system, often requiring surgical or medical treatment to improve function and appearance.
• Cervical Lymphadenopathy: Swollen lymph nodes in the neck, which can result from infections, inflammatory conditions, or, rarely, malignancies.
• Facial Trauma: Paediatric otolaryngologists also manage facial fractures, lacerations, and other head and neck injuries that may occur in children.

• Cleft Lip and Palate: Paediatric otolaryngologists are often involved in the care and surgical correction of children born with cleft lip and palate, improving feeding, speech, and appearance.
• Craniosynostosis/ craniofacial malformations : A condition where the skull bones fuse prematurely or where the maxilla or mandible is deformed affecting normal brain and skull growth, feeding and breathing,  often requiring surgical intervention to correct. The Otolaryngologist is vital team member in caring for children with craniofacial pathology.

• Head and Neck Tumours: Paediatric otolaryngologists treat both benign and malignant tumours of the head and neck, including rhabdomyosarcoma and thyroid tumours, often requiring a combination of surgery, chemotherapy, and radiation.
• Thyroid and Parathyroid Disorders: Paediatric otolaryngologists may treat conditions involving the thyroid and parathyroid glands, including nodules, hyperthyroidism, or thyroid cancer, sometimes requiring surgical removal of the glands.

The otolaryngologist play a central role in managing many children with syndromes including Down Syndrome, Velocardiofacial syndrome, CHARGE syndrome, Robin Sequence, Goldenhar syndrome, Bekwith Wiedemann syndrome to name a few.