Pediatric Otolaryngology

Upper respiratory tract diseases with an infectious origin are the most common in young childhood. In addition to the increasing infections, the age related immaturity of the immune system increases their tendency after entering a community. Although the pathology has a viral origin in the majority of the cases, we also assess the possibility of bacterial origin, or a superinfection in prolonged, more severe cases, or when the symptoms rapidly aggravate.

The age related functional differences of the auditory tubes, make children more prone to middle ear diseases. A simple cold is often accompanied by the deteriorating ventilation of the auditory tubes, and consequently, clogged ears, an audible popping sound during swallowing or yawning, and hearing loss develop. Temporary or constant pain may develop, which can be accompanied by fever. These symptoms suggest the presentation of an acute middle ear inflammation, in which case, the necessity of an antibiotic treatment can be only decided by examining the eardrum.

The first step in investigating the presenting hearing symptoms is to perform a pediatric ear nose throat examination. This is performed after obtaining detailed information about the medical history in terms of the birth, family, and developmental milestones. When eardrum abnormalities indicating a middle ear disease are detected, we also look for the cause of the pathology by examining the nose and the nasopharynx to select the adequate therapy. Additionally, when speech development is delayed or different, it is especially important to look into whether hearing loss with an inner ear origin is present, by using examinations, which are optimized for the children’s age.

The frequency of snoring in childhood along with behavioral and sleeping disturbances have significantly increased in the past decade. As a somatic abnormality, the underlying cause of these is often some sort of an upper respiratory tract narrowing. The most common cause in childhood is the enlargement of the nasal and pharyngeal tonsils, but an allergic swelling of the nasal cavity, developmental disorders of the mid face, morphological or structural changes of the epiglottis, the enlargement of the tonsils at the root of tongue, or when the root of tongue falls back, or a change in the tone of the musculature could also be the cause. Based on this, ear nose throat examination is an important step in the diagnosis of childhood respiratory disorders.

If obstructive sleep apnea is suspected, the modern diagnostic method consists of the objective confirmation of the pathology, and the detection of its severity, which is performed by polygraphy or polysomnography. A portable polygraph is suitable to take measurements with well cooperating children at home too, and it can be a sufficient examination in otherwise healthy children.

The examination of pharyngeal and laryngeal diseases is frequently performed with the help of a thin and flexible fiber endoscope. The painless and safe examination, which is rapid without general anesthesia too, allows us to map regions, which are difficult to evaluate. In addition to the examination of the structural changes of the larynx (congenital disorders, vocal cord nodules), a fiber endoscope is used for the investigation of functional disorders (pathological vocalization, breathing disorders) too.

In terms of the pediatric ear nose throat pathologies, the congenital disorders of the head and neck region have special importance, and its detection, diagnosis, and age related treatment plan necessitate a pediatric ear nose¬ throat focused attitude. The multidisciplinary investigation for congenital facial disorders includes a pediatric ear nose throat examination, which aims to detect abnormalities affecting hearing and speaking, and the width of respiratory tracts along with the individualized treatment.