1. Understand how to determine whether a child is normal or has a pathological otolaryngological condition

Demonstrate anatomic and physiologic understanding of normal development of the ear, sinuses, nose, pharynx, hearing, speech, and language from birth to adolescence. b. Recognize when a child's otolaryngological dysfunction (e.g., hoarse voice, nasal discharge) is a temporary state caused by some minor problem or represents a potentially serious pathological process.

2. Understand how to diagnose and manage otolaryngological problems which do not require referral.

1. Allergic rhinitis; 2. Blunt nasal trauma; 3. Cervical adenitis; 4. Epistaxis; 5. Otitis media and externa, uncomplicated; 6. Parotitis (mild); 7. Pharyngitis (viral and streptococcal); 8. Routine care for the child with a tracheostomy; 9. Simple nasal and ear canal foreign bodies; 10. Sinusitis; 11. Stridor mild (Croup tracheomalacia); 12. Uvulitis; 13. Viral enanthems (herpetic, herpangina, measles).

3. Understand how to recognize, provide initial management of, and refer otolaryngological problems which generally require consultation or referral:

1. Abscess (retropharyngeal, peritonsillar); 2. Airway obstruction (acute, chronic, tonsillar, adenoidal, nasal, and lower airway); 3. Cholesteatoma; 4. Congenital anomalies of the pinna, nose, lip, palate, jaw; 5. Complicated otitis media, sinusitis, epistaxis, parotitis; 6. Epiglottitis; 7. Facial nerve palsy; 8. Foreign body of the aerodigestive tract; 9. Head and neck masses; 10. Nasal polyp; 11. Significant hearing loss; 12. Significant trauma to the middle or external ear, nose, lip, palate, pharynx; 13. Sleep apnea; 14. Tympanic membrane perforation (traumatic or persistent).

4. Understand how to diagnose and manage acute and chronic suppurative otitis media and middle ear effusions:

a. Explain the physical findings, the pathophysiology, and appropriate terminology for inflammatory processes in the middle ear. b. Describe current standards of care for these conditions; c. Demonstrate knowledge of the typical pathogens, antibiotic treatment options, and resistance patterns in otitis media; d. Perform hearing evaluation as indicated for otitis media; e. Recognize and treat chronic otitis media with effusion including appropriate referral; f. Recognize and treat acute suppurative otitis media; g. Manage chronic, recurrent suppurative otitis media including prophylactic antibiotics, monitor for hearing loss and language delay and recognize indications for referral; h. Define indications for PE (ventilatory) tubes and general issues related to the risks and benefits of the procedures.

5. Understand how to diagnose and manage sinusitis:

a. Describe the symptoms, signs, and pathophysiology of sinusitis. b. Identify the indications for the appropriate use of radiologic tests to identify sinusitis (x-rays and CT scan). c. List the pathogenic organisms associated with sinusitis, suitable antibiotics, duration of therapy and appropriate follow up, and indications for referral.

6. Understand how to recognize and manage hearing loss:

a. Explain strategies and timing for routine hearing screening. b. Perform in-office hearing screening using pure tone audiometry and tympanometry. c. List the medical indications for hearing testing; and describe the methods available to test hearing (pure tone audiometry, tympanometry, acoustic emissions, brainstem evoked potentials, etc.). d. Recognize and refer the following conditions associated with hearing loss: congenital syphilis, congenital CMV, hereditary deafness, acoustic neuroma, atresia of the ear, ototoxicity, noise-induced hearing loss, bacterial meningitis, and vestibular disorders. e. Describe appropriate services for the hearing impaired child, including school, speech, and psychologic support. f. Demonstrate ability to remove cerumen.

7. Understand preventive steps the pediatrician can take related to otolaryngologic disorders:

a. Counsel families and adolescents about reducing noise-related hearing loss; b. Counsel parents about ways to prevent nasal, airway, and ear foreign bodies; c. Counsel parents in smoking cessation to decrease respiratory symptomatology; d. Screen children for hearing loss.