ENT contitions

Nasal foreign bodies occur mostly in children; a one-sided foul-smelling nasal discharge in a child is a foreign body until proven otherwise. Restrain the child and remove it with a cerumen hook, using sedation if the child cannot be restrained.

Congenital hearing loss is present at birth and hereditary hearing loss is genetic, appearing at birth or later; they may be syndromic or isolated. Screen every newborn with OAE/ABR in the first month, intervene before 6 months with hearing aids or cochlear implants and speech therapy, and refer any infant who fails screening.

Obstructive sleep apnoea is repeated upper-airway obstruction during sleep with loud snoring, witnessed apnoeas and daytime sleepiness, caused mainly by adenotonsillar hypertrophy in children and obesity and nasal or palatal obstruction in adults. Confirm with polysomnography or overnight oximetry; adenotonsillectomy is first-line in children and CPAP or surgery in adults.

Laryngopharyngeal reflux is gastric contents reaching the larynx through upper oesophageal sphincter dysfunction, causing hoarseness, globus, chronic throat clearing and sometimes vocal cord nodules or polyps. Treat with lifestyle change and voice rest plus 8–12 weeks of a PPI, with microlaryngeal surgery for polyps or cysts.

Subglottic stenosis is narrowing of the airway just below the vocal cords, congenital or acquired after intubation, trauma or infection, causing biphasic stridor, failed extubation or recurrent 'croup'. Refer all suspected cases early for laryngotracheobronchoscopy and endoscopic or open airway surgery.