Childhood ENT disorders. When to refer to specialists.
BACKGROUND
Ear, nose and throat (ENT) are among the commonest reasons for attendance in general practice. Acute problems are managed by the general practitioner, but chronic and recurrent conditions are often referred for surgical intervention. Tonsillectomy and insertion of tympanostomy tubes are two of the most frequently performed paediatric surgical procedures in Australia yet rates of admission vary across geographic areas and socioeconomic strata. Referral patterns and criteria for surgery vary widely.


OBJECTIVE
This article reviews the natural history of some common childhood ENT conditions and the evidence of effectiveness of traditional surgical interventions in order to address the question: 'When should GPs refer to an ENT surgeon (or conversely, when should they not refer)?'


CONCLUSIONS
Recurrent and chronic ear and throat conditions in children will usually resolve spontaneously. There is no good evidence of long term benefit from surgical interventions for several common ENT conditions. General practitioners need to weigh up the disadvantages and risks of the surgery with the likely benefit to the individual patient.
Research and Education Unit, Royal Children's Hospital Melbourne, Victoria.
Claire
C
Harris
D000208:Acute Disease; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D006801:Humans; D008876:Middle Ear Ventilation; D010033:Otitis Media / Q000175:diagnosis* / Q000628:therapy*; D010034:Otitis Media with Effusion / Q000175:diagnosis / Q000601:surgery; D010612:Pharyngitis / Q000175:diagnosis* / Q000628:therapy*; D012017:Referral and Consultation; D014068:Tonsillectomy