Chapter
Preface and Acknowledgments
Part I: General Considerations in Children’s ENT
1. Introduction to Pediatric Otolaryngology
1.2 Training and Accreditation
1.3 History of Pediatric Otorhinolaryngology
1.4 Ear, Nose, and Throat Societies
1.5 Organizing Otorhinolaryngology Services for Children
1.5.1 Hospitals and Clinics
1.5.2 Emergencies and Transport
2. The Pediatric Consultation
2.2.4 Preparing for the Consultation
2.4 Normal Growth, Development, and Child Health Promotion
2.5 Promoting Child Health
2.6 Pediatric Medical Assessment
2.6.1 Attention Deficit Hyperactivity Disorders
2.6.2 Autistic Spectrum Disorders
2.6.3 Functional Disorders
2.8 Consent and Parental Responsibility
3. Anesthesia and Perioperative Care
3.2.2 Balanced Anesthesia
3.3 Induction of Anesthesia
3.3.1 Intravenous Induction
3.3.2 Inhalational Induction
3.4 Methods of Control of the Airway
3.4.2 Oropharyngeal and Nasopharyngeal Airways
3.4.3 The Laryngeal Mask Airway
3.4.5 Cuffed or Uncuffed Endotracheal Tube?
3.5 Muscle Relaxation (Paralysis) during Anesthesia and Reversal
3.8 Anesthesia for Common Pediatric ENT Procedures
3.8.1 Myringotomy and Grommets
3.8.4 Anesthesia for Airway Problems in Infants
3.8.5 Tracheostomy in Infants
3.9 Anesthesia in Children with Specific Syndromes or Disabilities
4. Pediatric Ear, Nose, and Throat Emergencies
4.2.1 Foreign Bodies in the Ear
4.2.2 Foreign Bodies in the Nose
4.4 Sinusitis and Its Complications
4.4.2 Management of Acute Sinusitis
4.4.3 Complications of Sinusitis
4.6.1 Superficial Cervical Lymphadenopathy
4.6.2 Deep Neck-Space Infections
4.6.3 Lemierre’s Syndrome
4.6.4 Peritonsillar Abscess (Quinsy)
4.6.5 Retropharyngeal Abscess
5. The Child with Special Needs
5.2 The Ear, Nose, and Throat Consultation
5.2.1 General Considerations
5.3 Otological Conditions
5.3.3 Sinuses and Nasal Diseases
5.4 The Airway in the Child with Special Needs
5.4.1 Tonsils and Adenoids
5.4.2 Other Airway Conditions
6. Disorders of the External Ear
6.2 Applied Clinical Anatomy and Development
6.3 Acquired Disorders of the External Ear
6.3.1 Furuncle (Otitis Externa Circumscripta)
6.3.2 Swimmer’s Ear (Otitis Externa Diffusa)
6.3.4 Bullous Myringitis (Otitis Externa Bullosa Hemorrhagica)
6.3.5 Erysipelas (Auricular Cellulitis)
6.3.6 Chronic External Otitis
6.4.3 Thermal Injuries (Burns)
6.4.4 Otohematoma and Otoseroma
6.4.5 Partial and Total Avulsion
6.5 Congenital Disorders of the External Ear
6.5.1 Auricular Appendages
6.5.2 Fistulas and Sinuses
6.5.3 Auricular Dysplasias
7.2 Definitions and Classification of Otitis Media
7.2.2 Recurrent Acute Otitis Media
7.2.3 Otitis Media with Effusion
7.3 Epidemiology, Prevalence, and Risk Factors.
7.3.2 Geographical and Ethnic Factors
7.3.3 Environmental Factors
7.3.4 Anatomical Factors and Comorbidity
7.4 Pathophysiology of Acute Otitis Media
7.4.1 Eustachian Tube Function
7.4.3 Bacterial or Viral Load
7.6.3 Diagnostic Uncertainty
7.7.1 Analgesia and Symptom Control
7.7.2 Antimicrobial Therapy
7.7.3 Choice of Antibiotic
7.8.1 Antimicrobial Therapy Modification
7.9 Recurrent Acute Otitis Media
7.10 Complications of Acute Otitis Media
7.10.1 Extracranial Complications
7.10.2 Intracranial Complications
7.11 Acute Otitis Media and Chronic Suppurative Otitis Media
8. Otitis Media with Effusion
8.2 Epidemiology and Prevalence
8.3 Etiology and Risk Factors
8.4 Clinical Presentation
8.7.1 Expectant Treatment
8.7.3 Mechanical Treatment
8.7.7 Treatment Recommendations
9. Disorders of the Middle Ear
9.2.1 Prevalence and Classification
9.2.2 Pathophysiology and Flora
9.2.3 Clinical Features of Tympanic Membrane Perforation
9.2.4 Management of Tympanic Membrane Perforations
9.3 Tubercular Otitis Media
9.4.1 Classification and Natural History
9.4.2 Management of Attic Retraction
9.5 Congenital Disorders of the Middle Ear
9.5.1 Atresia and Congenital Ossicular Fixation
9.5.3 Vascular Anomalies in the Middle Ear
9.6 Other Conditions Affecting the Middle Ear
9.6.2 Temporal Bone Fracture
9.6.4 Malignant Disease of the Ear
10.2.1 Congenital Cholesteatoma
10.2.2 Primary Acquired Cholesteatoma
10.2.3 Secondary Acquired Cholesteatoma.
10.2.4 Presentation, Early Management, and Imaging
10.3 Treatment of Cholesteatoma
10.3.2 Choice of Approach
10.3.3 Surgical Technique
10.3.4 Cavity Reconstruction
10.4 Long-Term Management: Follow-Up
10.4.1 “Second-Look” Surgery
10.6 Tips for Cholesteatoma Surgery
11.2 Physiology of Balance in Children
11.2.1 Maturation and Development
11.2.2 Vestibular Reflexes
11.3 Clinical Presentation
11.4 Differential Diagnosis and Management
11.4.1 Balance Disorders with Normal Hearing
11.4.2 Balance Disorders with Hearing Impairment
12. Facial Palsy Reconstruction in Children
12.2 Anatomy of the Facial Nerve
12.3.1 The Facial Motor Nerve
12.3.2 Intratemporal Course
12.3.3 Branches of the Nervus Intermedius
12.3.4 The Facial Motor Nerve in the Face
12.4 Classification of Facial Palsy
12.5 History and Examination
12.5.1 Secondary Features: Synkinesis, Spasm, and Contracture
12.5.2 Documenting the Severity of Facial Palsy: Grading Systems, Standardized Photography and Patient-Reported Outcome Measures
12.7.1 Supportive Management
12.7.2 Medical Management
12.7.3 Reconstructive Management
Part III: The Hearing Impaired Child
13. Introduction, Detection, and Early Management
13.2 Epidemiology and Prevalence
13.3.1 Genetic Causes of Permanent Childhood Hearing Impairment
13.3.2 Environmental Causes of Permanent Childhood Hearing Impairment
13.4 Risk Factors for Hearing Loss
13.5 Identification of Hearing Loss
13.5.1 Neonatal Hearing Screening
13.5.2 Screening Strategies
13.6 Diagnostic and Etiological Work-Up Following Referral from Screening
13.6.1 Audiological Assessment
13.6.2 Etiological Assessment
13.7 Rehabilitation and Hearing Aids
13.8 Measures to Prevent Hearing Deterioration
13.8.2 Specific Preventive Measures
14. Nonsurgical Management of the Child with Hearing Loss
14.2 What Is the Impact of Hearing Loss for Children?
14.3 Diagnosis of Acquired Hearing Loss
14.3.1 Objective Hearing Assessment in the Early Months of Life
14.3.2 Behavioral Hearing Tests
14.3.3 Measuring Middle Ear Function
14.4 Types of Hearing Loss
14.4.1 Conductive Hearing Loss
14.4.2 Sensorineural Hearing Loss
14.4.3 Auditory Neuropathy Spectrum Disorder
14.4.4 Mixed Hearing Loss
14.4.5 Unilateral Hearing Loss: A Special Case
14.4.6 Nonorganic Hearing Loss
14.4.7 Auditory Oversensitivity or Hyperacusis and Tinnitus
14.5 Fitting of Hearing Aids
14.5.1 Principles of Amplification with Hearing Aids
14.5.2 Hearing Aids for Conductive Hearing Loss
14.5.3 Constraints of Hearing Aids
14.5.4 Assistive Listening Device Options for Children
14.5.5 Family-Centered Management
14.6 Hyperacusis and Tinnitus
14.7 Outcomes for Hearing-Impaired Children
15. Surgical Management of the Hearing-Impaired Child
15.2 Bone Conduction Hearing Devices
15.2.1 Physiology of Hearing through Bone Conduction
15.2.2 Clinical Indications for Bone Conduction Hearing Device
15.2.3 Selection of Children
15.2.4 Percutaneous Devices
15.2.5 Transcutaneous Devices
15.3 Active Middle Ear Implants
15.3.1 Vibrant Soundbridge
15.3.2 Magnetic Resonance Imaging Compatibility
15.4 Severe-to-Profound Sensorineural Hearing Loss
15.4.2 Cochlear Implantation
15.4.3 Bilateral Cochlear Implantation
15.4.4 Unilateral Cochlear Implantation
15.4.5 Children with Complex Needs
15.4.6 Auditory Brainstem Implants
Part IV: The Nose and Sinus
16. Nasal Obstruction in Children
16.2 Etiology of Pediatric Nasal Obstruction
16.3 Congenital Anomalies
16.4.1 Infective/Inflammatory
17. Pediatric Rhinitis and Rhinosinusitis
17.2 Development of the Paranasal Sinuses
17.2.3 The Frontal and Sphenoid Sinuses
17.3 Definition and Classification of Disease
17.4 Acute Rhinosinusitis
17.4.1 Incidence of Acute Rhinosinusitis in Children
17.4.2 Definition and Diagnosis of Acute Rhinosinusitis in Children
17.4.3 Differential Diagnosis
17.4.4 Pathogenesis of Acute Rhinosinusitis
17.4.5 The Diagnostic Work-Up
17.4.6 Treatment of Acute Rhinosinusitis in Children
17.4.7 Complications of Acute Rhinosinusitis
17.5 Chronic Rhinosinusitis in Children
17.5.1 Classification and Diagnosis
17.5.2 Prevalence of Chronic Rhinosinusitis in Children
17.5.3 Pediatric Chronic Rhinosinusitis and Quality of Life
17.5.4 Pathogenesis of Chronic Rhinosinusitis in Children
17.5.5 Diagnostic Work-Up for Chronic Rhinosinusitis
17.5.6 Management of Pediatric Chronic Rhinosinusitis
17.6.1 Prevalence of Allergic Rhinitis
17.6.4 Pathogenesis of Allergic Rhinitis
17.6.5 Diagnosis and Clinical Evaluation
17.6.6 Comorbid Conditions and Allergic Rhinitis
17.6.7 Treatment of Allergic Rhinoconjunctivitis in Children
18. Tongue, Floor of Mouth, Adenoids, and Tonsils
18.2 Tongue-Tie (Ankyloglossia)
18.2.1 Definition and Prevalence
18.3.1 Definition and Classification
18.4.1 Etiology and Presentation
18.5 Adenoids and Tonsils
18.5.1 Applied Physiology
18.5.3 Adenotonsillectomy
19. Obstructive Sleep Apnea
19.2 Epidemiology and Prevalence
19.3 Physiology of Normal Sleep
19.4 Pathophysiology of Obstructive Sleep Apnea
19.5 Effects of Obstructive Sleep Apnea
19.5.2 Increased Health Care Utilization
19.5.3 Neurobehavioral Deficits
19.5.4 Cardiovascular Dysfunction
19.5.5 Growth Retardation
19.5.6 Decreased Quality of Life
19.6 Clinical Presentation
19.6.2 Physical Examination
19.7 Investigation and Diagnosis
19.7.2 Imaging for Obstructive Sleep Apnea
19.8 Treatment of Obstructive Sleep Apnea in Children
19.8.2 Noninvasive Ventilation
19.8.4 Adenotonsillectomy
19.8.5 Mandibular/Maxillary Advancement
19.8.6 Intranasal Surgery
19.8.7 Hyoid/Tongue Suspension
19.9 Comorbidity and Specific Conditions in Pediatric OSA
19.9.1 Congenital Anatomical Anomalies
19.9.3 Head and Neck Neoplasm
19.9.5 Neonatal Nasal Obstruction
19.9.6 Neurologic Conditions
19.10 Perioperative Management of Children with OSA
19.11 Complications of Adenotonsillectomy
19.11.4 Postobstructive Pulmonary Edema
19.11.6 Velopharyngeal Insufficiency
19.12 Postoperative Monitoring and Treatment
20. Airway Obstruction in Children
20.2 Physics of Airway Obstruction
20.2.1 Resistance to Airflow
20.2.2 Laminar and Turbulent Flow
20.2.3 The Bernoulli Principle
20.3 Assessment of the Airway
20.3.1 Clinical Assessment by History
20.3.2 Clinical Assessment by Examination
20.3.3 Airway Endoscopic Assessment
20.3.4 Combined Flexible and Rigid Airway Endoscopy
20.3.5 Imaging the Airway
20.4 Transfer of Acute Airway Child
21. Congenital Disorders of the Larynx, Trachea, and Bronchi
21.2 Applied Basic Science
21.5 Clinical Manifestations of Airway Pathology
21.5.4 Trachea and Bronchi
22. Acquired Disorders of the Larynx, Trachea, and Bronchi
22.2.1 Historical Perspective
22.2.2 Acute Epiglottitis
22.2.3 Croup or Viral Acute Laryngotracheobronchitis
22.2.4 Bacterial Tracheitis (Pseudomembranous Croup)
22.2.5 Recurrent Respiratory Papillomatosis
22.3 Injury and Stenosis of the Larynx and Upper Trachea
22.3.1 Mechanisms of Injury to the Larynx and Trachea
22.3.3 Clinical Problems in Acquired Stenosis of the Larynx and Trachea
22.3.4 Assessment of Airway Stenosis
22.3.5 Treatment of Airway Stenosis
22.4 Acquired Disorders of the Vocal Fold
22.4.2 Mucosal Lesions of the Vocal Folds
23.3 Emergency Tracheotomy
23.4 Preoperative Planning
23.5 Special Considerations in Children
23.12 Tracheocutaneous Fistula
24. Neck Masses in Children: Congenital Neck Disease
24.1.1 Development of the Pharyngeal Arches
24.2 Congenital Neck Masses
24.2.1 Dermoid Cysts in the Neck
24.2.2 Thyroglossal Duct Cyst
24.3 Pharyngeal Arch Disorders
24.3.1 First Pharyngeal Arch Anomalies
24.3.2 Second Pharyngeal (Branchial) Arch Anomalies
24.3.3 Third and Fourth Arch Anomalies
24.4 Vascular Malformations and Hemangiomas
24.4.2 Vascular Malformations
24.5 Venous Malformations
25. Neck Masses in Children: Acquired Neck Masses
25.2 Neck Masses in Children Who Are Acutely Unwell
25.2.1 Clinical Assessment
25.2.2 Acute Lymphadenitis
25.2.3 Deep Neck-Space Infection
25.2.4 Noninfective Inflammatory Conditions
25.3 Neck Masses in Children Who Are Systemically Well
25.3.1 Clinical Assessment
25.3.3 Noninfective Inflammatory Conditions
26. Salivary Gland Disorders in Childhood
26.2 Congenital Disorders
26.2.1 Anatomical Anomalies
26.2.2 Congenital Tumors and Hamartomas
26.2.3 Pharyngeal (Branchial) Arch Anomalies
26.2.4 Parotitis in Cystic Fibrosis
26.3 Acquired Salivary Gland Disorders
26.3.1 Salivary Gland Trauma
26.3.2 Inflammatory Disorders
26.3.3 Pediatric Salivary Gland Tumors
26.4 Pediatric Parotidectomy
26.5 Sialorrhea (Drooling)
26.5.1 Multidisciplinary Management
26.5.3 Surgical Management
27. Ear, Nose, and Throat Problems in Cleft Lip and Palate
27.4.1 Antenatal Diagnosis
27.4.2 Diagnosis and Counseling at Birth
27.5 Surgical Management of Cleft Lip and Palate
27.5.2 Alveolar Bone Grafting
27.6 ENT Problems in Cleft Lip and Palate
27.6.1 Otitis Media with Effusion
27.6.2 Tympanic Membrane Retraction and Cholesteatoma
27.7 Submucosal Cleft Palate
28. Disorders of the Esophagus and Gastroesophageal Reflux
28.2 Congenital Disorders
28.2.1 Tracheoesophageal Fistula
28.2.2 Esophageal Strictures,Web, and Rings
28.3 Acquired Esophageal Disorders
28.3.1 Esophageal Strictures
28.3.2 Caustic Esophageal Damage
28.3.3 Gastroesophageal Reflux
28.3.4 Barrett’s Esophagus
28.3.5 Eosinophilic Esophagitis
28.3.6 Esophageal Foreign Body
28.3.8 Dysphagia and Regurgitation
28.3.9 Esophageal Motility Disorders in Children
28.3.10 Upper Gastrointestinal Bleeding
Appendix: Strength of Clinical Evidence
Pediatric Otolaryngology
：Practical Clinical Management
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