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American Academy of Pediatrics

American Academy of Pediatrics – Guidelines on Referral to Pediatric Otolaryngology

A pediatric otolaryngologist has completed a 4- to 5-year residency in otolaryngology/head and neck surgery and is certified by the American Board of Otolaryngologic Surgery. In addition, he or she has completed 1 or 2 years of fellowship training in pediatric otolaryngology. For purposes of developing these guidelines, the following age group definitions are used: infant (0–1 year), child (2–12 years), and adolescent (13–18 years).

The following patients should be referred to a pediatric otolaryngologist:

  • Infants, children, and adolescents with congenital malformations of head and neck structures, including the ear, nasal passages, oral cavity, and laryngotracheal airway.
  • Infants and children with sensory impairments, including conductive or sensorineural hearing loss, vertiginous disorders, unilateral and bilateral true vocal fold paralysis, facial nerve paralysis, and oromotor dysfunction as evidenced by speech, swallowing, or drooling problems.
  • Infants and children with acquired otolaryngologic disorders involving the ear (eg, cholesteatoma), the pharynx (eg, obstructive adenotonsillar hypertrophy), the laryngotracheal airway (eg, postintubation laryngotracheal stenosis), the aerodigestive tract (eg, foreign body aspirations), and the facial skeleton (eg, maxillofacial trauma).
  • Infants, children, and adolescents with neoplasms or vascular malformations of the head and neck structures, including the laryngotracheal airway.
  • Infants and children with medical conditions that increase operative risk (eg, congenital heart disease) who must undergo a common otolaryngologic procedure (eg, adenotonsillectomy).
  • Infants and children requiring operative airway endoscopy for the evaluation of stridor.

The following patients are preferably managed by a pediatric otolaryngologist:

  • Infants and children with complicated infections that may require surgery involving the ear (eg, otitis media with effusion and hearing change), the nose and paranasal sinuses (eg, chronic rhinosinusitis), the pharynx (eg, recurrent adenotonsillitis), the airway (eg, epiglottitis), and the neck (eg, retropharyngeal abscess).