Group 4: Ped iatric ORL

1. Group 4: Pediatric ORL

2. Content • Aboutgroup • About procedure • Programme • Literature • Discussion

3. Members: • GaetanoMotta • HarrietAkre • PeterRobb • Klausalbegger • ThomasSomers • Eugene Panosetti • Tomislav Baudoin

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

5. Tasks  1.      a logbook / curriculum  2.    recommendations regarding suggested relevant textbooks/ guidelines  3.       recommendations regarding existing courses available

6. PEDIATRIC OTOLARYNGOLOGY FELLOWSHIP MONTHLY CLINIC, OR, AND MULTI-DISCIPLINARY SCHEDULES AND FELLOW ASSIGNEMENTS UK PED ORL curriculum

7. A General PrinciplesofPed ORL B Pediatric Otology C Pediatric Rhinology andFacialPlastics D Pediatric Laryngology and Phoniatrics E Pediatric H&N Surgery

8. A General PrinciplesofPed ORL • 1 Anatomy • 2 Preoperativeassessmentandpostoperative care ofchildren • 3 Management ofbleedingand fluid replacementinchildren • 4 Safe prescribinginchildren • 5 Communications andconsent • 6 Childprotectionandsafeguardingisues • 7 Infectious diseases • 8 Neonatology • 9 Critical care medicine • 10 Syndromes associated with ORL • 11 Multidisciplinaryworkingwithcolleagues

9. 9 Critical care medicine Multidisciplinaryapproach to patientmanagementin PICU Multidisciplinaryapproach to theairwaymanagement PICU Allaspectsof ORL managementofptientsin PICU Multidisciplinaryapproach to patientswithspecificpulmonarydisorders Tracheostomy Upperairwayreconstruction

10. B Pediatric Otology • 1 Neonatalhearingscreening • 2 Congenitaleardisease • 3 Acuteotitismediaandotitismediawitheffusion • 4 COM • 5 Sensorineuralhearingloss • 6 Balancedisorders • 7 Facialpalsy • 8 Trauma andforeignbody

11. 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

12. C Pediatric Rhinology andFacialPlastics • 1 Rhinitis • 2 Rhinosinusitis • 3 Epistaxis • 4 Nasal Trauma, fractureandforeignbody • 5 Nasalmasses • 6 Facialplastics

13. 2 Rhinosinusitis • AR • Anatomyandembryology • Knowledgeofnasalphysiology • Pathophysiology, epidemiology, symptomatologyofrhinits • Clinicalandendoscopicassessmentofthe nose • Associationwithatopyand koncept ofunited airways • Diagnosisof AR • Appropriateinvestigationsincluding SPT and RAST • Ciliaryfunctiontesting • Appropriateimaging • Medicalmanagementof AR • Multidisciplinaryworkingwithpediatridiansand immunologists • Associationwithotherrelatedconditions • Age-appropriatemedicalandsurgicalmanagement

14. D Pediatric laryngologyandphoniatrics • 1 Stridorandairwayobstruction • 2 Pharyngeal, laryngeal, tracheal, bronchialandesophagealforeignbody • 3 Trauma • 4 Phoniatricsandvoicedisorders • 5 Cleft lip andpalate

15. 1 Stridorandairwayobstruction • Anatomyofthelarynx, pharynxandupper digestive tract • Surgicalanatomyoftheneck • Airwayphysiology • Understand differencesbetweenadultand pediatric airwaystructureandfunction • Assessmentanddifferentialdiagnosisofairwayobstruction • Understand differentiationbetweenstertorandstridor • Differentialdiagnosisofairwayobstruction • Clinicalandendoscopicassessmentofthepharynxandlarynx • Appropriateimagingoftheairway • Emergencymedicalmanagementofairwayobstruction…

16. E Pediatric head and neck surgery • 1 Adenotonsillardisease • 2 Neckmasses • 3 Headandnecktumours

17. 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

18. Skills • Clinicalguidelines • Cancerserviceguidance • Interventional Procedures (NICE) • Technology Appraisals (NICE)

19. 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

20. Interventional procedures • Coblationtonsillectomy • Endoscopicstaplingofpharyngealpouch • Customisedtitaniumimplants for orofacialreconstruction • Endoscopictransphenoidalpituitaryadenomaresection • Radiofrequencyvolumetrictissuereductionofturbinate • Auditorybrainstemimplants • Endoscopicdacryocystorhinostomy • Radiofrequencyablationofthe soft palate for snorig • Collageninjection for vocalcordaugmentation

21. Divisionofankylloglossia for breastfeeding Electrosurgery for tonsillectomy – guidance Tonsillectomyusing laser Catheterlessoesophageal pH monitoring PatientsafetyandreductionofriskoftransmissionofKreutzfeldt-Jakob diseaseviainterventionalprodedures Therapeuticsialoendoscopy Soft-palateimplants for simplesnoring Soft-palateimplants for OSA Thoracoscopisexcision….

22. Technology Appraisals Examples: Dyspepsia – proton pump inhibitors Sleepapnoea – CPAP Headandneckcancer - cetuximab Hearingimpairment – cochlearimplants Vibrantsoundbridge

23. 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.

24. Discussion • Competencylevel • Collaborationwith ESPO • Durationoftraining • Examination

25. 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”

26. 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

27. 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

28. 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