When Would My Child See an ENT Surgeon?

If your child has sleep disordered breathing or obstructive sleep apnea with a history of restless sleep, snoring, gasping and sleep pauses your child will be referred to an ENT for a tonsillectomy and adenoidectomy evaluation. A sleep study is usually not needed. Adenoid enlargement alone may be the cause of obstructive symptoms. Often a trial of nasal steroid spray is pursued if the tonsils are not enlarged. In cases of severe tonsillar enlargement do to infection that does not respond to antibiotics and systemic steroid treatment ENT referral may be needed. Another uncommon condition is a retropharyngeal or peritonsillar abscess that would require surgical drainage.

If your child accidentally swallows a small object and it is lodged in the windpipe he will need bronchoscopy to have it removed. General anesthesia is used in the operating room and a small endoscope with a camera is passed into your child’s windpipe and the object is removed. Small pieces to toys, peanuts or small objects like earrings are commonly aspirated. Coughing episodes are common and a foreign body should be considered whenever a previously healthy child has unexplained symptoms of airway obstruction that do not respond to routine asthma treatmentIf your child has a chronic middle ear fluid and is at risk for speech, learning or language problems he will be referred to ENT for tymanostomy (PE Tube) assessment. If your child is not at risk and has had no complications then he will be observed for 3 months before he is referred.
If your child has a suspected cholesteatoma he will be referred to an ENT. A cholesteatoma is a collection of cells that are in the upper anterior part of the eardrum. Although they are rare they are sometimes seen during ear examinations for children who have recurrent ear infections or hearing loss. They are congenital and can block the Eustachian tube opening causing Eustachian tube dysfunction and recurrent serous otitis media and otitis media and can cause other intracranial problems
If your child has a complication of otitis media called mastoiditis he will be referred to an ENT. Mastoiditis can cause brain infections and facial paralysis. Common symptoms include pain, swelling and redness behind the ear with protrusion of the ear.
If your child has a nasal fracture and a septal hematoma he will be referred to an ENT. Most nasal fractures do not require x-rays. If a septal hematoma is present then an ENT will need to evaluate your child for possible incision and drainage to prevent infection which is common several days after the injury.
If your child has orbital cellulitis he will be referred to an ENT. Orbital cellulitis is often a complication of sinusitis and can involve an infection around the eye or a more severe infection. Management is usually with intravenous antibiotics for younger patients with small infections and no complications. A pediatric ophthalmologist will also frequently be involved in the evaluation.
If your child has severe croup (Laryngotracheobronchitis) or stridor (an inspiratory sound due to airway structure collapse or impingement) an ENT referral may be needed. A fiber optic flexible laryngoscopy can be performed to evaluate for possible causes of stridor. All newborns with stridor will be referred to a pediatric otolaryngologist to evaluate for anatomic causes, such as vocal cord paralysis or subglottic stenosis. Older infants with stridor due to laryngomalacia are also frequently referred. In laryngomalacia, the supraglottic structures collapse into the airway during the inspiratory phase of respiration.
If your child has a rare newborn condition involving the ear, nose or throat regions such as a thyroglossal duct cyst, brachial cleft cyst, lymphatic malformation or dermoid cyst an ENT referral will be needed.
If your child has a neck abscess or enlarged lymph node that needs biopsy, drainage or excision an ENT referral may be needed.