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Thyroid disease is uncommon in children. The most commonly encountered surgical pathologies of the thyroid apparatus in children are thyroglossal duct cysts and fistulae. These and the management of ectopic thyroid tissue are discussed elsewhere (Chapter 19). This chapter reviews the embryology, anatomy and physiology of the thyroid gland, investigation of thyroid disease, functional thyroid diseases and thyroid neoplasia in the paediatric population. It assumes in the reader a knowledge of the management of adult thyroid disease.

This chapter covers the common childhood conditions of nasal foreign bodies, epistaxis and nasal trauma. In general, patients with these conditions can be managed in the outpatient setting without requirement for follow up.

Choanal atresia, a malformation in which the nasal fossae do not open onto the aerodigestive pathway, was first described as early as 1755, by Roederer. A variety of corrective surgical approaches, transmaxillary, transseptal, transpalatine and sublabial intranasal, have been developed over the subsequent 250 years. Surgical management has recently made significant progress, thanks to developments in endonasal surgery.

Allergic rhinitis (AR) is a prevalent, yet underappreciated, inflammatory condition of the nasal mucosa, characterized by pruritus, sneezing, rhinorrhea, and nasal congestion. It is mediated by early- and late-phase hypersensitivity responses to indoor and outdoor environmental allergens. AR affects a large portion of children in the developed world. Both basic science and epidemiological studies have demonstrated that AR is part of a systemic inflammatory process and is associated with other inflammatory conditions of the mucous membranes. These include otitis media with effusion, rhinosinusitis, allergic conjunctivitis (AC), and asthma. The ARIA guidelines (Allergic Rhinitis and its Impact on Asthma) have provided a pragmatic, stepwise approach to treating AR. Allergen avoidance remains one of the guiding principles of treatment, although it may sometimes be difficult to implement. While there is an ever-increasing armamentarium of pharmacotherapeutic agents available to the clinician, intranasal corticosteroids remain the single most effective class of medications for treating AR.

Rhinitis and sinusitis usually coexist and are concurrent in most individuals. Therefore, rhinosinusitis is a more appropriate term. The clinical definition of rhinosinusitis in children is an inflammation of the nose and paranasal sinuses, characterised by nasal blockage (congestion, discharge) and one or more of these signs and symptoms (i.e. anterior/posterior secretions, or post-nasal drip, facial pain or pressure, and reduction or loss of smell).

Management of any child with a hearing loss will depend on several factors including the age at which the child presents, the cause of the hearing loss and its degree. The most common cause of deafness in childhood, otitis media with effusion (OME), is the subject of a separate chapter and will not be referred to further in this chapter other than in the context of OME being superimposed on a sensorineural hearing loss. It is fundamental that the paediatric otologist involve other agencies, both medical and non-medical, in the management of patients in his or her care; these will include the paediatric audiologist, teacher of the deaf, geneticist, general medical paediatrician and developmental paediatrician. Large numbers of children with congenital deafness may also have visual difficulties and the paediatric ophthalmologist will also be a part of the team managing such children, partly to exclude visual problems, but also to manage those discovered. Some children with complex hearing disorders such as auditory neuropathy (auditory dysynchrony) or central auditory processing disorders (APD) may also need the involvement of the paediatric neurologist.

The assessment of hearing in children requires several different testing techniques to be available. The choice of test will depend upon the age of the child, his or her medical state and whether an objective or behavioural investigation is needed.

The auricle is often a point of fixation as well as one of the most eye-catching parts of the body. This may be the reason why the desire for an aesthetically shaped ear has developed in humans. Another reason might be that from ancient times, personality traits have been attributed to the shape of the auricle. Whereas Aristotle (384–322 BC) stated that persons with big ears have good memories and sagacity, nowadays this shape may be defined in some societies as a symbol of stupidity. Protruding ears are common. About one out of five children have them. Usually parents seek consultation for correction directly after birth or at the age of 4–5 years when children may begin to be teased by their peers. The next group of patients consists mainly of young ladies at puberty or between 20 and 25 years complaining about their limitations in hairstyling. Traumatic lesions are the second most common type of auricular deformity. They often result from fights, dog bites or accidents. Because many of the auricular lesions may result in disfigurement of the shape, an appropriate treatment plan has to be followed from the very beginning.

The main types of congenital abnormality of the middle and external ear will be discussed in this chapter. In many cases, a single child may well have congenital malformations in two or three of the separate parts of the ear. It is relatively uncommon, however, for congenital problems in the middle and outer ear to be accompanied by parallel malformations in the inner ear (in about 8%), since this is formed in the embryo at a different period of intrauterine development. In discussing this group of congenital anomalies, there is still some variation in the use of descriptive terms. For this reason we begin with definitions of the terms to be used in this chapter.

Deafness is the most common sensory deficit, and more than 50% of all childhood deafness is due to hereditary disorders. The prevalence of permanent hearing impairment (>40 dB hearing threshold) is approximately 1.3 per 1000 children (Parker et al. 1999).