PEARLS AND PITFALLS: Pediatric ENT

PEARLS AND PITFALLS

• Otalgia is an expected phenomenon for up to 2 weeks following tonsillectomy.

• Hematoma of the external ear (pinna) necessitates same-day referral for emergency care because of the potential for permanent deformity secondary to avascular necrosis of the cartilage.

• First-line therapy for AOM is amoxicillin (90 mg/kg/day divided twice a day) × 10 days.

• Caregivers should be instructed to warm ear drops in their hands prior to administration to decrease patient discomfort.

• Patients with benign paroxysmal vertigo of childhood are at increased risk of typical migraine headache as adolescents and adults.

• CHARGE is the most commonly associated congenital anomaly with choanal atresia.

• In children, 90% of epistaxis occurs from the anterior septum (Kiesselbach plexus), and the most frequent cause is digital trauma.

• Nasal fractures are the most common facial fracture in children.

• Presence of nasal polyps in children should prompt testing for cystic fibrosis.

• Nasal saline rinses should be used with caution in children with history of aspiration.

• The most common cause of a neck mass in the pediatric population is cervical lymphadenitis.

• If there is clinical suspicion for lymphoma, systemic steroids should be avoided, as these may interfere with flow cytometry results.

• Midline neck mass is most likely a thyroglossal duct cyst secondary to the embryologic derivative at the base of the tongue (foramen cecum). Ultrasound should be performed to confirm the presence of a normal thyroid in its expected location.

• The most common congenital lesion of the larynx is laryngomalacia; most children will outgrow the diagnosis by 24 months of age.

• Cough, rhinorrhea, and diarrhea are more common with viral than with bacterial pharyngitis.

• The diagnostic gold standard for bacterial pharyngitis is a throat culture.

• Diagnosis of PTA is a clinical diagnosis based on history (double worsening, URI symptoms > 5 days prior to new symptoms) and physical exam (hot potato voice, trismus, uvular deviation)

• The American Academy of Pediatrics recommends screening for OSA by history (snoring, daytime symptoms) during well-child checks. Symptoms may include irritability, hyperactivity, daytime sleepiness, and nocturnal enuresis; this is a different constellation of symptoms than in adult patients.

• Ankyloglossia often manifests as discomfort in the mother’s nipples.

• Children with cleft palate are at an increased risk of developing Eustachian tube dysfunction resulting in OME and recurrent AOM.

• Eruption cysts present as blue or purple compressible cysts at the site of an erupting deciduous or permanent tooth. These are often self-limiting but may require treatment if they become infected or limit feeding.