Paediatric Otorhinolaryngology Service at RCWMCH

This clinical service consists of a full time ENT trained specialist, with the support of two trainees (in the process of specialising in Otorhinolaryngology) that rotate from Groote Schuur Hospital every 4 months, so that they may get exposure to paediatric ear, nose and throat problems. An otologist from Groote Schuur also provides some sessional specialised ear surgery services.

The service is busy due to the lack of ENT services for children in the uninsured population and the large demand for these procedures.  Since 2005 the average number of patients seen in the outpatient clinic 7500 per annum, and on average 690 minor surgical cases were performed (adenotonsillectomies and grommets etc) and on average 560 more complex surgeries per year are carried out by the service.

The main burden of disease involves the management of sleep disordered breathing due to adenotonsillar hypertrophy, and the management of persistent middle ear effusions with the placement of ventilation tubes.

Other surgeries involve middle ear surgery for chronic middle ear disease including tympanomastoidectomies for cholesteatoma. There is also a proactive management of airway pathologies with a complex airway surgery service supported by an effective home based tracheostomy care program. As an example: recurrent respiratory papillomatosis constitutes a large portion of the airway surgery, thought the disease is rare, the consequences for the family are significant and multiple admissions and operations are the norm. Between procedures the children frequently live at home with their families despite having a tracheostomy.

Head and neck paediatric pathologies such as lymphatic and hemangiomatous malformations, congenital neck masses, and salivary gland masses and tumours are all seen and managed by the ENT service.

The symptomatic relief from sialorrhea for cerebral palsied children is a possibility with the transposition of the submandibular duct and excision of the sublingual glands surgery being offered by this service.

A large number of life threatening emergencies are managed, especially the airway emergencies either from congenital anomalies, through to infectious processes such as laryngotracheobronchitis, as well as compressive neck  or oral cavity masses. Complications of sepsis in the middle ear or the sinuses often involve the cranial cavity with severe morbidity for the patients, and these a frequently seen and managed in the unit.

The ENT clinic also acts as a referral service for the tertiary diagnostic phase of the New Born Hearing Screening for hearing loss which is being rolled out at Midwife Obstetric Units in the City of Cape Town area.