Pediatric ENT focuses on diagnosing and treating disorders of the ear, nose, and throat in infants, children, and adolescents.
What are the common ENT problems in children?
In pediatric otolaryngology, the spectrum of ear, nose, and throat disorders spans a wide array of pathologies that uniquely challenge the growing child’s anatomy, physiology, and developmental trajectory.
Adenoiditis and adenoid hypertrophy rank among the most prevalent conditions in childhood, with chronic inflammation or lymphoid tissue overgrowth in the nasopharyngeal vault not only contributing to persistent nasal obstruction and compensatory mouth breathing but also disrupting Eustachian tube ventilation, fostering middle ear effusions, recurrent otalgia, and potential speech delays—often necessitating adenoidectomy with or without tympanostomy tube placement in refractory cases.
Beyond these, breathing difficulties frequently present in infancy and early childhood, manifesting as inspiratory stridor in congenital laryngomalacia or acquired subglottic stenosis, or as chronic nocturnal snoring and sleep-disordered breathing driven by adenotonsillar enlargement, obesity, environmental allergens, or craniofacial syndromes; left untreated, obstructive sleep apnea can impair growth hormone secretion, cognitive development, and cardiovascular health, often necessitating polysomnography and a combination of surgical adenotonsillectomy, positive airway pressure therapy, and lifestyle interventions.
Chronic ear pathology also warrants attention: cholesteatoma, characterized by keratinizing squamous epithelium in the middle ear that can erode the ossicular chain, mastoid bone, and invade the labyrinth, leads to sensorineural hearing loss, vertigo, and intracranial risk unless addressed by meticulous surgical removal via canal-wall up or canal-wall down mastoidectomy and lifelong surveillance.
Congenital abnormalities of the ear—including microtia, anotia, auricular tags, and external auditory canal atresia—often coexist with conductive hearing loss that, if uncorrected by canaloplasty or bone-conduction hearing devices, hampers speech, language, and social development; genetic counseling and three-dimensional imaging are integral to preoperative planning.
Equally significant, cleft lip and palate represent craniofacial clefts that disrupt orofacial integrity, complicating feeding, articulation, resonance, and Eustachian tube function, typically necessitating neonate feeding support, primary repair in the first year, secondary palate surgery, and ongoing speech and audiologic therapy.
Epistaxis, although frequently benign bleeding from Kiesselbach’s plexus, can be a red flag for hereditary hemorrhagic telangiectasia, juvenile nasopharyngeal angiofibroma, or coagulopathies, prompting anterior or posterior nasal packing, topical hemostatics, or endovascular embolization when severe or recurrent.
Facial nerve injuries in children—from birth canal compression, temporal bone fractures, neoplasms like hemangiomas, or iatrogenic trauma—can cause partial or complete facial paralysis, infringing on eyelid closure, oral competence, and emotional expression; multidisciplinary care may include physical therapy, eyelid weighting, nerve grafting, or static slings.
Hearing loss remains a pervasive concern: up to two per thousand newborns experience sensorineural deficits often of genetic or congenital origin and benefit from universal newborn hearing screening, early amplification with hearing aids or bone-anchored implants, and language intervention, while auditory neuropathy spectrum disorder poses unique processing challenges for audiologic management.
Vocal pathologies such as hoarseness or hypernasal speech frequently derive from velopharyngeal insufficiency, laryngopharyngeal reflux causing posterior laryngeal edema, or early-onset vocal fold nodules from overuse; management spans behavioral voice therapy, reflux control, and microlaryngoscopic surgical intervention when necessary.
Laryngopharyngeal reflux may present subtly with chronic cough, throat clearing, dysphagia, globus sensation, or otalgia, requiring dietary modifications, positional therapy, proton pump inhibitors, and close ENT monitoring to protect the delicate laryngeal mucosa.
A lump or mass in the neck may represent branchial cleft anomalies, thyroglossal duct cysts, cystic hygromas, congenital muscular torticollis, reactive lymphadenopathy, or pediatric malignancies such as lymphoma; ultrasonography, contrast-enhanced CT or MRI, fine-needle aspiration, and surgical excision guide diagnosis and treatment.
Nasal deformities and obstruction—from septal deviation, turbinate hypertrophy, congenital choanal atresia, or traumatic fractures—impede nasal breathing, olfaction, and sinus development, often corrected by septoplasty, turbinate reduction, or choanal opening in later childhood.
Sinusitis, whether acute bacterial or chronic with nasal polyposis, stems from mucociliary impairment, allergic rhinitis, or anatomic variations; presenting with facial pain, purulent discharge, and cough, it sometimes requires endoscopic sinus surgery combined with allergy and immunotherapy to enhance drainage and reduce recurrence.
Otitis media, a near-universal pediatric ailment peaking between six months and two years, ranges from acute purulent infections causing ear pain, fever, and irritability to chronic suppurative disease with tympanic membrane perforation, persistent otorrhea, and conductive hearing loss; treatment—watchful waiting, antibiotics, tympanostomy tubes, or myringoplasty—is tailored to the child’s age, risk factors, and recurrence frequency.
Thyroid and parathyroid disorders, though uncommon, may present as congenital hypothyroidism with developmental delays or as hyperparathyroidism causing metabolic imbalances—both requiring endocrine screening, medical stabilization, and often surgical referral.
A tongue tie, or ankyloglossia, restricts lingual mobility and can impair breastfeeding, articulation, and early feeding, often resolved with an in-office frenotomy or frenuloplasty.
Tonsillitis, usually viral or bacterial, can escalate to peritonsillar or retropharyngeal abscess, compromising airway patency and swallowing; indications for tonsillectomy and adenoidectomy include repeated infections, obstructive sleep-disordered breathing, or asymmetric enlargement suggestive of neoplasm.
Traumatic injuries to the head and neck—such as nasal fractures, laryngeal contusions, mandibular dislocations, and temporal bone fractures—demand rapid airway assessment, hemostasis, and targeted management including closed reduction, tracheostomy, or surgical repair to preserve function and facial aesthetics.
Finally, vocal cord paralysis—unilateral or bilateral from congenital neuropathy, surgical injury, or brainstem pathology—may present as a weak cry, aspiration, dysphonia, or respiratory distress; treatment options range from observation in mild cases to injection laryngoplasty, medialization thyroplasty, or reinnervation surgery to restore airway protection, glottic closure, and voice quality.
Collectively, these conditions underscore the necessity for early recognition, nuanced diagnostic evaluation—including endoscopic, audiometric, imaging, and sleep studies—and a collaborative multidisciplinary approach to safeguard the child’s airway, hearing, speech, facial growth, and overall development through evidence-based medical and surgical interventions.
Conclusion
Pediatric ENT sits at the intersection of anatomy, growth, and compassionate care, demanding that clinicians not only master a broad spectrum of surgical and medical interventions but also tune into the subtle developmental and psychosocial needs of each child. From routine ear infections and adenoid hypertrophy to rare congenital anomalies and sleep-disordered breathing, every diagnosis hinges on early recognition, age-appropriate diagnostics, and a seamless team approach that spans audiology, speech therapy, anesthesia, and beyond. Innovations in endoscopic techniques, telehealth-enabled hearing screening, and personalized postoperative rehabilitation continue to refine our ability to protect hearing, optimize airway function, and support speech and language milestones.
Read More