Paediatric ENT Refhelp Principles:
- E-advice via SCI Gateway – please use
- Cancer Risk Calculator / Urgent Suspicion of Cancer (USOC) pathway – not to be used to refer children
- Maximise medical therapy first – Please see summary below:
Management Prior to Referral:
FOR ALL MEDICATION RECOMMENDATIONS, PLEASE SEE THE LOTHIAN JOINT FORMULARY FOR DETAILS.
(1) Ear wax – we are unable to accept referrals for microsuction of wax. This is reserved for children with previous mastoid surgery / hearing aids. Please see Refhelp earwax guidance and undertake in CTACS where available. .
(2) Otitis externa / Chronic otitis media / Grommet associated otorrhoea – antibiotic-steroid eardrops 3 drops bd 1 week before considering referral.
(3) Hearing loss / Glue ear (OME) – refer direct to Paediatric Audiology
(4) Persistent allergic rhinitis – surgery rarely required.
Please use sea water nasal spray/antihistamine/topical steroid for 3 months minimum before referral. Consider referral to allergy service especially if asthmatic with view to Skin Prick Allergy Tests.
(5) Epistaxis – Topical antibiotic cream bd 6 weeks minimum before referral. Only refer if frequent / persistent / significant / interfering with day to day functioning.
- < 2 yrs – refer general medical paediatrics.
- Unilateral with unilateral nasal blockage – refer ENT
(6) Obstructive sleep apnoea – Fluticasone nasal spray bd 3 months before referral. < 2 yrs / syndromic / obese / cardiorespiratory co-morbidity / previous adenotonsillectomy – refer paediatric respiratory medicine
(7) Persistent cervical lymphadenopathy
- Scattered sub-cm lymph nodes bilaterally – reassure /refer for direct access neck US scan to confirm reactive nodes or refer general medical paediatrics if concern re viral aetiology
- Solitary >/= 2cm neck node/mass refer to ENT
(8) Septal issues causing chronic obstruction – defer referral to adult ENT service until age 16 years. Children rarely/never require septal surgery for nasal obstruction
(9) Nasal polyps in children – exceedingly rare.
- Highly suggestive of CF. More likely to be hypertrophied inferior turbinate/s. Treat as per persistent allergic rhinitis.
- Unilateral congenital nasal polyps – refer Paediatric ENT
Paediatric ENT Referrals
There are 3 full and one part time paediatric ENT consultants and one GPSTI (clinics only) at the RHCYP. During the day, a duty on call team is available for advice and review of urgent pathology.
How to refer:
Emergencies should be directed to RHCYP ED (Emergency Department).
There are facilities for assessment of paediatric ENT emergencies at RHCYP (Royal Hospital for Children & Young People, Edinburgh) and SJH (St John’s Hospital, Livingston). At present all patients requiring emergency admission are admitted to RHCYP.
Out of hours a general ENT on call team covers for ENT emergencies only.
Outpatient referrals should be made electronically via SCI gateway and will be triaged appropriately. Paediatric ENT outpatient clinics are based at RHCYP, St John’s Hospital and Musselburgh Primary Care Centre.
