Group 4: Pediatric ORL
Content
About group
About procedure
Programme
Literature
Discussion
Members:
Gaetano Motta
Harriet Akre
Peter Robb
Klaus albegger
Thomas Somers
Eugene Panosetti
Tomislav Baudoin
*
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
Tasks
1.
a logbook / curriculum
2.
recommendations regarding suggested relevant
textbooks/ guidelines
3.
recommendations regarding existing courses
available
PEDIATRIC OTOLARYNGOLOGY FELLOWSHIP
MONTHLY CLINIC, OR, AND MULTI-DISCIPLINARY SCHEDULES
AND FELLOW ASSIGNEMENTS
UK PED ORL curriculum
A General Principles of Ped ORL
B Pediatric Otology
C Pediatric Rhinology and Facial Plastics
D Pediatric Laryngology and Phoniatrics
E Pediatric H&N Surgery
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
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
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
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
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
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
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
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…
E Pediatric head and neck surgery
1 Adenotonsillar disease
2 Neck masses
3 Head and neck tumours
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
Skills
Clinical guidelines
Cancer service guidance
Interventional Procedures (NICE)
Technology Appraisals (NICE)
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
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
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….
Technology Appraisals
Examples:
Dyspepsia – proton pump inhibitors
Sleep apnoea – CPAP
Head and neck cancer - cetuximab
Hearing impairment – cochlear implants
Vibrant soundbridge
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, H&N Surgery, Anniko M et al.
Cummings - Flint PW et al. Cummings Otolaryngology - Head and
Neck Surgery, 3-Volume Set, 5th Edition, 2010.
Discussion
Competency level
Collaboration with ESPO
Duration of training
Examination
Vilnius Group Discussion 1
WHO definition of paediatric = < 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”
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
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
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