{"id":4246,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatric-ent\/"},"modified":"2024-08-30T15:46:14","modified_gmt":"2024-08-30T14:46:14","slug":"paediatric-ent","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatrics\/paediatric-ent\/","title":{"rendered":"ENT"},"content":{"rendered":"\n<p><strong>Paediatric ENT Refhelp Principles:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>E-advice<\/strong>&nbsp;via SCI Gateway &#8211; please use<strong><\/strong><\/li>\n\n\n\n<li><strong>Cancer Risk Calculator \/ Urgent Suspicion of Cancer (USOC) pathway<\/strong>&nbsp;&#8211;&nbsp;<strong><em>not<\/em><\/strong>&nbsp;to be used to refer children<\/li>\n\n\n\n<li><strong>Maximise medical therapy first<\/strong>&nbsp;&#8211; Please see summary below:<br><\/li>\n<\/ul>\n\n\n\n<p><strong>Management Prior to Referral:<\/strong><\/p>\n\n\n\n<p><strong>FOR ALL MEDICATION RECOMMENDATIONS, PLEASE SEE THE <\/strong><a href=\"https:\/\/formulary.nhs.scot\/east\/\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>LOTHIAN JOINT FORMULARY<\/strong><\/a><strong> FOR DETAILS.<\/strong><\/p>\n\n\n\n<p><strong>(1)<\/strong>\u00a0\u00a0\u00a0\u00a0<strong><em>Ear wax<\/em>\u00a0&#8211;\u00a0<\/strong>we are unable to accept referrals for microsuction of wax. This is reserved for children with previous mastoid surgery \/ hearing aids. Please see Refhelp <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/ear-wax\/\" target=\"_blank\" rel=\"noreferrer noopener\">earwax guidance<\/a> and undertake in <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/community-treatment-and-care-services-ctacs\/\" target=\"_blank\" rel=\"noreferrer noopener\">CTACS<\/a> where available. .<\/p>\n\n\n\n<p><strong>(2)<\/strong>&nbsp;&nbsp;&nbsp;&nbsp;<strong><em>Otitis externa \/ Chronic otitis media \/ Grommet associated otorrhoea<\/em><\/strong>&nbsp;&#8211; antibiotic-steroid eardrops 3 drops bd 1 week before considering referral.<\/p>\n\n\n\n<p><strong>(3)<\/strong>\u00a0\u00a0\u00a0\u00a0<strong><em>Hearing loss \/ Glue ear (OME)<\/em><\/strong>\u00a0&#8211; refer direct to <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatricaudiology\/\" target=\"_blank\" rel=\"noreferrer noopener\">Paediatric Audiology<\/a><\/p>\n\n\n\n<p><strong>(4)<\/strong>&nbsp;&nbsp;&nbsp;&nbsp;<strong><em>Persistent allergic rhinitis<\/em><\/strong>&nbsp;\u2013 surgery rarely required.<br>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.<\/p>\n\n\n\n<p><strong>(5)<\/strong>&nbsp;&nbsp;&nbsp;&nbsp;<strong><em>Epistaxis<\/em><\/strong>&nbsp;&#8211; Topical antibiotic cream bd 6 weeks minimum before referral.&nbsp;Only refer if frequent \/ persistent \/ significant \/ interfering with day to day functioning.&nbsp;&nbsp;<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>&lt; 2 yrs &#8211; refer general medical paediatrics.<\/li>\n\n\n\n<li>&nbsp;Unilateral with unilateral nasal blockage &#8211; refer ENT<\/li>\n<\/ul>\n\n\n\n<p><strong>(6)<\/strong>&nbsp;&nbsp;&nbsp;&nbsp;<strong><em>Obstructive sleep apnoea<\/em><\/strong>&nbsp;&#8211; Fluticasone nasal spray bd 3 months before referral.&nbsp;&lt; 2 yrs \/ syndromic \/ obese \/ cardiorespiratory co-morbidity \/ previous adenotonsillectomy &#8211; refer paediatric respiratory medicine<\/p>\n\n\n\n<p><strong><em>(7)<\/em><\/strong>&nbsp;&nbsp;&nbsp;&nbsp;<strong><em>Persistent cervical lymphadenopathy<\/em><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Scattered sub-cm lymph nodes bilaterally \u2013 reassure \/refer for direct access neck US scan to confirm reactive nodes or refer general medical paediatrics if concern re viral aetiology<\/li>\n\n\n\n<li>Solitary &gt;\/= 2cm neck node\/mass refer to ENT<br><\/li>\n<\/ul>\n\n\n\n<p><strong>(8)<\/strong>&nbsp;&nbsp;&nbsp;&nbsp;<strong><em>Septal issues<\/em><\/strong>&nbsp;causing chronic obstruction &#8211; defer referral to adult ENT service until age 16 years. Children rarely\/never require septal surgery for nasal obstruction<\/p>\n\n\n\n<p><strong><em>(9) Nasal polyps in children<\/em><\/strong>&nbsp;\u2013 exceedingly rare.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Highly suggestive of CF. More likely to be hypertrophied inferior turbinate\/s. Treat as per persistent allergic rhinitis.<\/li>\n\n\n\n<li>Unilateral congenital nasal polyps &#8211; refer Paediatric ENT&nbsp;<\/li>\n<\/ul>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><strong>Paediatric ENT Referrals<\/strong><\/p>\n\n\n\n<p>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.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>How to refer<\/strong>:<\/h4>\n\n\n\n<p>Emergencies should be directed to RHCYP ED (Emergency Department).<\/p>\n\n\n\n<p>There are facilities for assessment of paediatric ENT emergencies at RHCYP (Royal Hospital for&nbsp;Children &amp; Young People, Edinburgh) and SJH (St John\u2019s Hospital, Livingston). At present all patients requiring emergency admission are admitted to RHCYP.<\/p>\n\n\n\n<p>Out of hours a general ENT on call team covers for ENT emergencies only.<\/p>\n\n\n\n<p>Outpatient referrals should be made electronically via SCI gateway and will be triaged appropriately. Paediatric ENT outpatient clinics are based at RHCYP, St John\u2019s Hospital and Musselburgh Primary Care Centre.<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><\/p>\n<\/div><\/div>\n<\/div>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Paediatric ENT Refhelp Principles: Management Prior to Referral: FOR ALL MEDICATION RECOMMENDATIONS, PLEASE SEE THE LOTHIAN JOINT FORMULARY FOR DETAILS. (1)&nbsp;&nbsp;&nbsp;&nbsp;Ear wax&nbsp;&ndash;&nbsp;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. .<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":18302,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[163],"class_list":["post-4246","page","type-page","status-publish","hentry","category-entpaediatric"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/entpaediatric\/\" rel=\"tag\">ENT (Paediatric)<\/a>","rttpg_excerpt":"Paediatric ENT Refhelp Principles: Management Prior to Referral: FOR ALL MEDICATION RECOMMENDATIONS, PLEASE SEE THE LOTHIAN JOINT FORMULARY FOR DETAILS. (1)&nbsp;&nbsp;&nbsp;&nbsp;Ear wax&nbsp;&ndash;&nbsp;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. .","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4246","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=4246"}],"version-history":[{"count":9,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4246\/revisions"}],"predecessor-version":[{"id":20152,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4246\/revisions\/20152"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/18302"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=4246"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=4246"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}