Aerodigestive Programs Enhance Outcomes in Pediatric Patients The early efforts of pediatric airway surgeons, gastroenterologists, and pulmonologists to optimize surgical outcomes involved evaluating multiple organ systems for diseases negatively affecting surgery. This resulted in coordinated clinics with multiple services, ancillary testing, and endoscopic procedures, known as aerodigestive programs. These programs have nationally increased the value of care, with multidisciplinary experts delivering organized and efficient care to children with complex needs. This article describes the origin and value of aerodigestive programs within the modern health care landscape, serving as a primer for providers and administrators investigating how to facilitate aerodigestive or similar programs.

Professionalism, Quality, and Safety for Pediatric Otolaryngologists Professionalism, quality, and safety have become essential components of pediatric otolaryngology. Professionalism, as defined by Osler, refers to the long tradition of physicians carrying out the noble cause of providing health care to patients and families. The importance of professionalism cannot be overstated and now is widely understood to be a core competency of every practicing physician. The attention to quality and safety is also a central tenet of current surgical practice. Quality is doing the right thing at the right time for the right persons. Safety is providing care to patients that is free from undue harm.

Principles of Pediatric Endoscopic Ear Surgery The article describes the unique benefits and challenges of transcanal (and transmastoid) endoscopic ear surgery (EES) for management of middle ear disease in children. It provides a rationale for EES in children and describes differences in anatomy between the pediatric and adult ear. The basic principles of EES, from operating room layout, choice of surgical instruments, and tips and pearls to avoid complications specific to the endoscope, are reviewed. Finally, techniques and outcomes in pediatric EES for tympanic membrane perforation, congenital cholesteatoma, and acquired cholesteatoma are summarized.

Assessment and Management of Thyroid Disease in Children This article summarizes the current management of pediatric thyroid disease, with an emphasis on surgical management. Medical and surgical approaches to hyperthyroidism are reviewed as well as pathways for evaluation of nodules and malignancy. Differences between pediatric and adult thyroid management are highlighted.

Ankyloglossia and Other Oral Ties Ankyloglossia and other oral ties have been recognized for centuries, but interest in and literature on these topics has recently increased. This article presents the latest evidence on the diagnosis and management of tongue-tie and outlines some of the controversies and gaps in the existing evidence. Anterior tongue-tie is accepted in most clinical practices as a potential risk for breastfeeding difficulty, and good evidence exists that division of an anterior tongue-tie leads to improved breastfeeding outcomes. Posterior tongue ties and upper lip-ties are being studied more intensively to provide sound, evidence-based recommendations on their diagnosis and treatment.

Beyond Nodules—Diagnostic and Treatment Options in Pediatric Voice Disorders Pediatric dysphonia is common; however, not all vocal fold pathology in children is due to nodules. Laryngeal stroboscopy (transoral or transnasal) often is essential for the diagnosis of other not-nodule lesions. As in adults, multidisciplinary care with a speech language pathologist helps with patient buy-in for therapy. Breathy dysphonia due to glottic incompetence may be related to vocal fold movement impairment (VFMI) or posterior glottic insufficiency. There are several medialization procedures available for children with VFMI due to recurrent laryngeal nerve injury.

Innovations in Endonasal Sinus Surgery in Children Although there have been many advances in new tools and procedures for endonasal sinus surgery in children, the management and care for pediatric chronic rhinosinusitis has remained relatively unchanged. However, there have been advances in skull base surgery and tumor removal and new knowledge about perioperative concerns in children. This article discusses the role and risks of endoscopic sinus surgery, the use of balloon sinuplasty in children, management of complicated rhinosinusitis, and advances in skull base tumors and choanal atresia repair.

Craniofacial Interventions in Children Craniofacial interventions are common and the surgical options continue to grow. The issues encountered include micrognathia, macroglossia, midface hypoplasia, hearing loss, facial nerve palsy, hemifacial microsomia, and microtia. In addition, a unifying theme is complex upper airway obstruction. Throughout a child’s life the focus of interventions may change from airway management to speech, hearing, and language optimization, and finally to decannulation and procedures aimed at social integration and self-esteem. Otolaryngologists play an important role is this arena and provide high-quality care while continuing to expand what can be done for our patients.

Allergy and the Pediatric Otolaryngologist Food allergy and allergic rhinitis are childhood diseases with special relevance to the pediatric otolaryngologist. Much of the diagnosis of food allergy can be made on history alone; strict avoidance is the mainstay treatment. Skin prick testing and serum-specific IgE testing play a stronger role in allergic rhinitis diagnosis. If pharmacotherapy fails, allergen immunotherapy is an option. Currently, there is intense investigation on diagnostic tests, novel treatments, and prevention strategies that could dramatically affect the way these diseases are identified and managed. This article summarizes the epidemiology, pathophysiology, diagnosis, and management of food allergy and allergic rhinitis.