
Contents
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General considerations General considerations
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Paediatric consultation Paediatric consultation
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Setting Setting
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Optimize the consultation Optimize the consultation
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Discussing the management Discussing the management
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Children and consent Children and consent
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Competency Competency
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Key points in UK Law Key points in UK Law
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Others may acquire responsibility by Others may acquire responsibility by
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The local authority can acquire it by The local authority can acquire it by
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Further reading Further reading
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Imaging in children Imaging in children
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Feeding disorders Feeding disorders
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History History
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Examination Examination
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Investigation Investigation
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Management Management
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Alternatives Alternatives
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Paediatric gastro-oesophageal reflux disease (GORD) Paediatric gastro-oesophageal reflux disease (GORD)
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Presentation Presentation
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Investigations Investigations
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Treatment Treatment
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Conservative treatment Conservative treatment
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Surgical treatment Surgical treatment
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Drooling Drooling
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Conservative treatment Conservative treatment
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Speech therapy Speech therapy
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Anticholinergic drugs Anticholinergic drugs
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Radiotherapy Radiotherapy
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Surgery Surgery
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Salivary gland surgery aimed at redistribution of saliva. Salivary gland surgery aimed at redistribution of saliva.
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Bilateral submandibular duct transposition Bilateral submandibular duct transposition
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Salivary gland surgery aimed at reducing flow of saliva. Salivary gland surgery aimed at reducing flow of saliva.
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Management of haemorrhage in children Management of haemorrhage in children
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History History
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Examination Examination
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Management Management
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Access Access
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Fluid replacement Fluid replacement
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Types of fluid Types of fluid
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Paediatric airway assessment Paediatric airway assessment
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Management of the paediatric airway Management of the paediatric airway
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History History
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Examination Examination
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Stertor vs stridor vs wheeze Stertor vs stridor vs wheeze
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Investigations Investigations
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Management Management
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Endoscopy Endoscopy
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Flexible, fibre-optic endoscopy Flexible, fibre-optic endoscopy
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Advantages Advantages
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Disadvantages Disadvantages
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Microlaryngobronchoscopy (MLB) Microlaryngobronchoscopy (MLB)
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Advantages Advantages
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Disadvantages Disadvantages
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MLB operative notes MLB operative notes
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Equipment Equipment
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Tools for endoscopic treatment Tools for endoscopic treatment
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Paediatric tracheostomy Paediatric tracheostomy
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Indications Indications
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Operative notes Operative notes
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Preparation Preparation
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Positioning Positioning
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Landmarks Landmarks
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Surgery Surgery
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Early complications Early complications
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Bleeding Bleeding
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Surgical emphysema Surgical emphysema
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Damage to lateral structures Damage to lateral structures
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Tracheotomy tube problems Tracheotomy tube problems
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Respiratory arrest Respiratory arrest
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Pulmonary oedema Pulmonary oedema
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Late complications Late complications
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Congenital abnormalities of the larynx Congenital abnormalities of the larynx
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Laryngomalacia Laryngomalacia
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Aetiology Aetiology
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Presentation Presentation
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Investigations Investigations
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Treatment Treatment
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Operative notes Operative notes
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Aryepiglottoplasty Aryepiglottoplasty
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Complications Complications
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Vocal cord palsy Vocal cord palsy
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Unilateral Unilateral
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Presentation Presentation
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Investigations Investigations
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Management Management
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Bilateral Bilateral
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Presentation Presentation
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Investigations Investigations
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Management Management
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Laryngeal cleft Laryngeal cleft
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Presentation Presentation
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Investigations Investigations
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Management Management
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Surgery Surgery
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Complications Complications
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Saccular cysts and laryngoceles Saccular cysts and laryngoceles
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Presentation Presentation
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Investigations Investigations
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Treatment Treatment
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Laryngeal webs Laryngeal webs
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Presentation Presentation
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Investigations Investigations
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Treatment Treatment
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Subglottic cysts Subglottic cysts
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Presentation Presentation
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Investigations Investigations
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Management Management
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Vocal cord granuloma Vocal cord granuloma
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Subglottic haemangioma Subglottic haemangioma
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Presentation Presentation
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Investigation Investigation
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Management Management
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Steroids Steroids
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Endoscopic debulking Endoscopic debulking
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Open excision Open excision
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Tracheomalacia Tracheomalacia
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Presentation Presentation
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Investigations Investigations
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Treatment Treatment
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Mild tracheomalacia Mild tracheomalacia
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Severe tracheomalacia Severe tracheomalacia
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Subglottic stenosis Subglottic stenosis
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Diagnosis Diagnosis
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Classification Classification
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Congenital Congenital
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Acquired Acquired
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Risk factors for acquired stenosis Risk factors for acquired stenosis
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Presentation Presentation
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Investigations. Investigations.
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Subglottic Stenosis grading system Subglottic Stenosis grading system
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Management Management
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Anterior cricoid split Anterior cricoid split
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Laryngotracheal reconstruction Laryngotracheal reconstruction
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Anterior laryngofissure with anterior graft Anterior laryngofissure with anterior graft
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Technique Technique
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Posterior laryngofissure with posterior graft Posterior laryngofissure with posterior graft
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Crico-tracheal resection Crico-tracheal resection
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Further reading Further reading
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Inflammatory/infective diseases of the larynx and trachea Inflammatory/infective diseases of the larynx and trachea
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Epiglottitis Epiglottitis
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Definition Definition
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Presentation Presentation
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Management Management
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Croup (acute laryngotracheobronchitis) Croup (acute laryngotracheobronchitis)
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Presentation Presentation
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Management Management
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Bacterial tracheitis Bacterial tracheitis
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Management Management
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Juvenile respiratory papillomatosis (JVP) Juvenile respiratory papillomatosis (JVP)
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Presentation Presentation
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Investigations Investigations
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Management Management
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Surgical treatment Surgical treatment
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Adjuvant therapy Adjuvant therapy
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Congenital ear deformities Congenital ear deformities
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External ear: auricle External ear: auricle
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Embryology Embryology
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Congenital malformations of the auricle Congenital malformations of the auricle
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Skin tags Skin tags
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Pre-auricular sinuses Pre-auricular sinuses
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Operative notes Operative notes
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Collaural sinuses/fistula Collaural sinuses/fistula
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Microtia and anotia Microtia and anotia
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External auditory canal (EAC) malformations External auditory canal (EAC) malformations
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Embryology Embryology
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Congenital malformations Congenital malformations
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Investigation Investigation
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Management Management
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Atresia/stenosis of EAC Atresia/stenosis of EAC
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Microtia/anotia Microtia/anotia
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Middle-ear malformations Middle-ear malformations
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Embryology Embryology
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Ossicular-chain malformations Ossicular-chain malformations
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Inner-ear malformations Inner-ear malformations
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Embryology Embryology
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Spontaneous CSF fistula Spontaneous CSF fistula
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Investigations Investigations
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Management Management
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Paediatric audiology Paediatric audiology
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Paediatric hearing assessment Paediatric hearing assessment
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Objective tests Objective tests
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Subjective tests Subjective tests
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Newborn/neonatal screening Newborn/neonatal screening
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6–24months: distraction tests 6–24months: distraction tests
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6–24 months: visual response audiometry 6–24 months: visual response audiometry
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>24 months: performance/play audiometry >24 months: performance/play audiometry
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2–5 years: speech audiometry 2–5 years: speech audiometry
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>5years: pure-tone audiometry >5years: pure-tone audiometry
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Congenital hearing loss Congenital hearing loss
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Management Management
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Investigation Investigation
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Failed neonatal screening Failed neonatal screening
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Environmental causes Environmental causes
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Genetic causes Genetic causes
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Examination Examination
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Infection screen Infection screen
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Cytomegalovirus (cmV) Cytomegalovirus (cmV)
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ECG ECG
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Imaging Imaging
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Ophthalmology Ophthalmology
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Genetics Genetics
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Genetic hearing loss Genetic hearing loss
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Syndromic hearing loss Syndromic hearing loss
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Pendred’s syndrome Pendred’s syndrome
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Clinical features Clinical features
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Genetic defect Genetic defect
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Usher’s syndrome Usher’s syndrome
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Clinical features Clinical features
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Genetic defect Genetic defect
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Treacher-Collins syndrome Treacher-Collins syndrome
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Waardenburg syndrome Waardenburg syndrome
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Clinical features Clinical features
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Genetic defects Genetic defects
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Jervell and Lange-Neilsen sydromes Jervell and Lange-Neilsen sydromes
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Alport syndrome Alport syndrome
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Clinical features Clinical features
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Genetic defect Genetic defect
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Brancho-oto-renal syndrome Brancho-oto-renal syndrome
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Clinical features Clinical features
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Genetic defect Genetic defect
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Neurofibromatosis NF2 Neurofibromatosis NF2
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Clinical features Clinical features
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Genetic defect Genetic defect
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Non-syndromic hearing loss Non-syndromic hearing loss
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Connexin 26, GJB2 (gap junction
2) Connexin 26, GJB2 (gap junction
2)
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A1555G mitochondrial mutation A1555G mitochondrial mutation
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Further reading Further reading
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Syndromes in paediatric ENT Syndromes in paediatric ENT
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Definitions Definitions
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Down syndrome Down syndrome
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Treacher–Collins syndrome Treacher–Collins syndrome
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Goldenhar syndrome Goldenhar syndrome
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Velo-cardio-facial syndrome Velo-cardio-facial syndrome
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Pierre–Robin sequence Pierre–Robin sequence
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Charge association Charge association
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Craniosynostoses Craniosynostoses
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Crouzon’s syndrome Crouzon’s syndrome
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Apert’s syndrome Apert’s syndrome
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Pfeiffer’s syndrome Pfeiffer’s syndrome
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Mucopolysaccharidoses Mucopolysaccharidoses
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Osteogenesis imperfecta Osteogenesis imperfecta
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Paediatric neck masses Paediatric neck masses
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Congenital neck masses Congenital neck masses
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Presentation Presentation
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Investigations Investigations
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Thyroglossal cysts and sinuses Thyroglossal cysts and sinuses
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Presentation Presentation
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Investigation Investigation
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Treatment Treatment
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Operative notes Operative notes
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Complications Complications
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Thyroglossal cyst carcinoma Thyroglossal cyst carcinoma
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Dermoid cysts Dermoid cysts
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Laryngocele Laryngocele
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Presentation Presentation
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Management Management
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Operative notes Operative notes
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Branchial system anomalies Branchial system anomalies
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Branchial cysts Branchial cysts
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Presentation Presentation
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Investigations Investigations
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Differential diagnosis Differential diagnosis
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Management Management
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Operative notes Operative notes
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Complications Complications
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Branchial fistula/sinus Branchial fistula/sinus
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Operative notes Operative notes
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1st Branchial system anomalies 1st Branchial system anomalies
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3rd/4th Branchial system anomalies 3rd/4th Branchial system anomalies
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Thymic cysts/ectopic thymic tissue Thymic cysts/ectopic thymic tissue
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Congenital vascular anomalies of the head and neck Congenital vascular anomalies of the head and neck
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Haemangiomas Haemangiomas
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Histology Histology
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Presentation Presentation
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Investigation Investigation
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Treatment Treatment
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Vascular malformations Vascular malformations
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Capillary malformations (CMs) Capillary malformations (CMs)
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Histology Histology
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Investigations Investigations
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Natural history Natural history
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Treatment Treatment
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Venous malformations (VMs) Venous malformations (VMs)
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Presentation Presentation
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Histology Histology
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Imaging Imaging
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Treatment Treatment
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Lymphatic malformations (LMs) Lymphatic malformations (LMs)
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Presentation Presentation
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Histology Histology
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Imaging Imaging
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Natural history Natural history
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Treatment Treatment
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Arteriovenous malformations (AVMs) Arteriovenous malformations (AVMs)
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Histology Histology
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Imaging Imaging
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Natural history Natural history
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Treatment Treatment
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Paediatric cervical lymphadenopathy Paediatric cervical lymphadenopathy
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History History
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Investigations Investigations
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Node imaging Node imaging
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Fine-needle aspirate cytology (FNAC) Fine-needle aspirate cytology (FNAC)
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Causes of cervical lymphadenopathy Causes of cervical lymphadenopathy
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Infection Infection
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Viral Viral
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Acute bacterial Acute bacterial
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Mycobacterium tuberculosis Mycobacterium tuberculosis
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Atypical mycobacterium Atypical mycobacterium
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Catscratch disease Catscratch disease
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Toxoplasmosis Toxoplasmosis
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Inflammatory disorders Inflammatory disorders
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Kawasaki’s disease Kawasaki’s disease
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Rosai dorfman disease Rosai dorfman disease
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Neoplasic Neoplasic
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Paediatric neoplasia Paediatric neoplasia
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Benign neoplasms Benign neoplasms
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Sternocleidomastoid tumour of infancy Sternocleidomastoid tumour of infancy
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Lymphoma Lymphoma
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Hodgkin’s lymphoma Hodgkin’s lymphoma
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Presentation Presentation
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Investigation Investigation
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Classification Classification
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Treatment Treatment
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Non-Hodgkin’s lymphoma Non-Hodgkin’s lymphoma
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Presentation Presentation
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Classification Classification
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Investigation and Management Investigation and Management
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Rhabdomyosarcoma Rhabdomyosarcoma
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Histological types Histological types
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Site Site
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Presentation Presentation
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Classification system Classification system
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Investigations Investigations
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Management Management
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Neuroblastoma Neuroblastoma
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Presentation Presentation
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Investigation Investigation
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Classification system Classification system
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Management Management
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Nasopharyngeal carcinoma Nasopharyngeal carcinoma
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Salivary gland tumours Salivary gland tumours
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Paediatric nasal obstruction Paediatric nasal obstruction
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History History
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Physical examination Physical examination
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Investigations Investigations
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Nasendoscopy Nasendoscopy
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Imaging Imaging
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Skin tests Skin tests
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Blood tests Blood tests
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Nasal swabs/smears Nasal swabs/smears
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Nasal brushings Nasal brushings
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Sleep study Sleep study
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Management of specific nasal conditions Management of specific nasal conditions
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Idiopathic neonatal rhinitis Idiopathic neonatal rhinitis
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Choanal atresia Choanal atresia
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Presentation Presentation
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Treatment Treatment
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Operative notes Operative notes
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Overall complications Overall complications
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Piriform aperture stenosis Piriform aperture stenosis
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Bilateral congenital dacrocystoceles Bilateral congenital dacrocystoceles
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Nasal malformations Nasal malformations
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Nasal masses Nasal masses
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Nasal dermoids Nasal dermoids
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Nasal gliomas and meningoencephalocoeles Nasal gliomas and meningoencephalocoeles
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Nasal gliomas Nasal gliomas
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Meningoencephaloceles Meningoencephaloceles
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Childhood nasal obstruction Childhood nasal obstruction
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Adenoidal hypertrophy Adenoidal hypertrophy
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Antibiotics Antibiotics
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Nasal steroids Nasal steroids
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Adenoidectomy Adenoidectomy
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Indications for adenoidectomy Indications for adenoidectomy
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Obstruction Obstruction
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Infection Infection
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Neoplasia Neoplasia
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Operative notes Operative notes
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Cold-steel technique Cold-steel technique
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Suction diathermy technique Suction diathermy technique
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Complications of adenoidectomy Complications of adenoidectomy
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Post-adenoidectomy haemorrhage Post-adenoidectomy haemorrhage
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Rhinitis in children Rhinitis in children
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Causes of allergic rhinitis Causes of allergic rhinitis
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Presentation Presentation
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Management Management
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Medical conditions associated with nasal symptoms Medical conditions associated with nasal symptoms
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Cystic fibrosis Cystic fibrosis
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Immotile cilia syndrome Immotile cilia syndrome
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Juvenile angiofibromatosis Juvenile angiofibromatosis
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Nasal tumours Nasal tumours
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Cite
Extract
General considerations
Paediatric consultation
Setting
...
Optimize the consultation
...
Discussing the management
...
Children and consent
(See also p. 11).
Doctors who care for children need to be familiar with the law relating to parental responsibility and consent within the jurisdiction in which they practice.
Competency
Competence implies that a child has the capacity to comprehend and retain information material to a decision, and the ability to weigh this information in decision making.
At 16 years of age, children are deemed competent to give consent. Below 16 years, the consent is given by parents or guardian. There are certain circumstances where this may change:
...
Key points in UK Law
Unless adopted a mother will always have parental responsibility for her child.
A father has parental responsibility if:
...
After 1 December 2003, a father named on the birth certificate has parental responsibility, regardless if he is married to the mother.
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