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 Group 4 Pediatric ORL
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Content

• About group
• About procedure
• Programme
• Literature
• Discussion

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Members

• Gaetano Motta
• Harriet Akre
• Peter Robb
• Klaus albegger
• Thomas Somers
• Eugene Panosetti
• Tomislav Baudoin

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• Dear Maria,
• Say to president and secretary not to be
  concerned.
• Pediatric ORL group chose the literature, and
  very soon we will finish up the logbook.
• Everything is under control,
• All the best,
• Tomislav

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Tasks
 1.      a logbook / curriculum  2.    recommenda
tions regarding suggested relevant textbooks/
guidelines  3.       recommendations regarding
existing courses available
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•  
• PEDIATRIC OTOLARYNGOLOGY FELLOWSHIP
• MONTHLY CLINIC, OR, AND MULTI-DISCIPLINARY
  SCHEDULES
• AND FELLOW ASSIGNEMENTS 
• UK PED ORL curriculum

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• A General Principles of Ped ORL
• B Pediatric Otology
• C Pediatric Rhinology and Facial Plastics
• D Pediatric Laryngology and Phoniatrics
• E Pediatric HN Surgery

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A General Principles of Ped ORL

• 1 Anatomy
• 2 Preoperative assessment and postoperative care
  of children
• 3 Management of bleeding and fluid replacement in
  children
• 4 Safe prescribing in children
• 5 Communications and consent
• 6 Child protection and safeguarding isues
• 7 Infectious diseases
• 8 Neonatology
• 9 Critical care medicine
• 10 Syndromes associated with ORL
• 11 Multidisciplinary working with colleagues

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9 Critical care medicine

• Multidisciplinary approach to patient management
  in PICU
• Multidisciplinary approach to the airway
  management PICU
• All aspects of ORL management of ptients in PICU
• Multidisciplinary approach to patients with
  specific pulmonary disorders
• Tracheostomy
• Upper airway reconstruction

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B Pediatric Otology

• 1 Neonatal hearing screening
• 2 Congenital ear disease
• 3 Acute otitis media and otitis media with
  effusion
• 4 COM
• 5 Sensorineural hearing loss
• 6 Balance disorders
• 7 Facial palsy
• 8 Trauma and foreign body

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3 AOM and OME
Evaluate and manage AOM/RAOM Evaluate and manage
OME Understand principles of medical treatment
and monitoring Principles of antibiotic
resistance Principles and complications of
surgical treatment
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C Pediatric Rhinology and Facial Plastics

• 1 Rhinitis
• 2 Rhinosinusitis
• 3 Epistaxis
• 4 Nasal Trauma, fracture and foreign body
• 5 Nasal masses
• 6 Facial plastics

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2 Rhinosinusitis

• AR
• Anatomy and embryology
• Knowledge of nasal physiology
• Pathophysiology, epidemiology, symptomatology of
  rhinits
• Clinical and endoscopic assessment of the nose
• Association with atopy and koncept of united
  airways
• Diagnosis of AR
• Appropriate investigations including SPT and RAST
• Ciliary function testing
• Appropriate imaging
• Medical management of AR
• Multidisciplinary working with pediatridians and
  immunologists
• Association with other related conditions
• Age-appropriate medical and surgical management

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D Pediatric laryngology and phoniatrics

• 1 Stridor and airway obstruction
• 2 Pharyngeal, laryngeal, tracheal, bronchial and
  esophageal foreign body
• 3 Trauma
• 4 Phoniatrics and voice disorders
• 5 Cleft lip and palate

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1 Stridor and airway obstruction

• Anatomy of the larynx, pharynx and upper
  digestive tract
• Surgical anatomy of the neck
• Airway physiology
• Understand differences between adult and
  pediatric airway structure and function
• Assessment and differential diagnosis of airway
  obstruction
• Understand differentiation between stertor and
  stridor
• Differential diagnosis of airway obstruction
• Clinical and endoscopic assessment of the pharynx
  and larynx
• Appropriate imaging of the airway
• Emergency medical management of airway
  obstruction

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E Pediatric head and neck surgery

• 1 Adenotonsillar disease
• 2 Neck masses
• 3 Head and neck tumours

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1 Adenotonsillar disease
Anatomy and physiology Immune role of the adenoid
and tonsils Knowledge of respiratory
physiology Assessment of acute and chronic
inflammatory and infective conditions Assessment
of upper airway obstruction Investigation
including laboratory and imaging Assessment of
SRDB and OSA Understanding of overnight pulse
oximetry and polysomnography Knowledge of risks
and complications of anaesthesia and analgesia
in children with OSA and SRDB Understanding of
specific risks in syndromic children and those
with comorbidities Understanding of systemic
conditions affecting the tonsils
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Skills

• Clinical guidelines
• Cancer service guidance
• Interventional Procedures (NICE)
• Technology Appraisals (NICE)

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Clinical guidelines
Preoperative tests Referral for suspected
cancer Surgical management of OME Venous
thromboembolism (surgical) Profilaxis against
infective endocarditis Surgical site
infection When to suspect child
maltreatment Management of sore throat and
indications for tonsillectomy
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Interventional procedures

• Coblation tonsillectomy
• Endoscopic stapling of pharyngeal pouch
• Customised titanium implants for orofacial
  reconstruction
• Endoscopic transphenoidal pituitary adenoma
  resection
• Radiofrequency volumetric tissue reduction of
  turbinate
• Auditory brain stem implants
• Endoscopic dacryocystorhinostomy
• Radiofrequency ablation of the soft palate for
  snorig
• Collagen injection for vocal cord augmentation

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• Division of ankylloglossia for breastfeeding
• Electrosurgery for tonsillectomy guidance
• Tonsillectomy using laser
• Catheterless oesophageal pH monitoring
• Patient safety and reduction of risk of
  transmission of Kreutzfeldt-Jakob disease via
  interventional prodedures
• Therapeutic sialoendoscopy
• Soft-palate implants for simple snoring
• Soft-palate implants for OSA
• Thoracoscopis excision.

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Technology Appraisals

• Examples
• Dyspepsia proton pump inhibitors
• Sleep apnoea CPAP
• Head and neck cancer - cetuximab
• Hearing impairment cochlear implants
• Vibrant soundbridge

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Literature

• Pediatric Otolaryngology -  Principles and
  Practice Pathways,  Ralph F. Wetmore -  Harlan R.
  Muntz - Trevor J. McGill
• Surgical Pediatric Otolaryngology, William
  Potsic, Robin T. Cotton, Steven D. Handler
•  UK PED ORL guidance 
•  Pediatric Otolaryngology for the
  Clinician, Mitchell RB et al.2009.   
• Otolaryngology, HN Surgery, Anniko M et al.
• Cummings - Flint PW et al. Cummings
  Otolaryngology - Head and Neck Surgery, 3-Volume
  Set, 5th Edition, 2010.

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Discussion

• Competency level
• Collaboration with ESPO
• Duration of training
• Examination

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Vilnius Group Discussion 1

• WHO definition of paediatric lt 18 years of age
• Target group of trainees highly motivated
• Sub-specialist post-CCT only
• In each subspecialty area, the surgeon must be
• emergency-safe

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Vilnius Group Discussion 2

• Trainee should attend no less than four relevant
  courses
• Courses must be UEMS accredited or accreditation
  sought
• Ideally, the course should have a competency
  sign-off
• There is no proposal for a super-specialty
  examination

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Vilnius Group Discussion 3

• The outcome of the group work has produced a
  syllabus
• We have not defined the number of operations in
  each
• area (Different for different super-specialties)
• The super-specialty fellowship should be no
  longer than
• two years
• The competency and skills are the responsibility
  of the
• local supervisor

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Vilnius Group Discussion 4

• Co-operation with ESPO
• ESPO Education Committee to review of syllabus
• Invite ESPO EC Chairman to next UEMS ORL meeting
• Invite ESPO to advise/propose Log Book
• Invite ESPO to recommend courses