Pediatric Otolaryngology (ENT) Referral Guidelines

Our pediatric Otolaryngology – Head and Neck Surgery (Ear, Nose and Throat) practice covers all areas of medical and surgical diseases involving the head, neck and aerodigestive tract.

Our team of board-certified, fellowship-trained head and neck surgeons performs about 3,500 operations a year. Most surgeries are outpatient, or day-surgery cases, which reduce stress on the child and family. Our team performs all advanced surgical procedures and keeps abreast of current treatments by participating in lecturing, publishing and teaching to ensure the best care for your patient.

As the only dedicated pediatric head and neck surgery group in the area, we provide management of all disease processes involving the head and neck:

Salivary gland tumors
Linfoma
Orbital masses
Hipoacusia
Complex ear masses/infections
Complex airway lesions
Complex respiratory issues
Thyroid masses

Our pediatric ear, nose and throat specialists are always available for consultations and urgent patient appointments.

Refer to Otolaryngology (ENT)

Refer to pediatric otolaryngology (ENT) at Valley Children's online through CareLink or our referral portal, or refer via fax.

Refer a patient to ENT

ENT Office Numbers

Contact Pediatric Otolaryngology (ENT) via phone (559-353-6453) or fax (559-353-6457).

Póngase en contacto con un médico de enlace

Los médicos pueden comunicarse con un enlace médico para obtener ayuda con referencias u otras preguntas llamando al 559-353-7229.

Download the pediatric otolaryngology referral guidelines as a PDF

Condición	Pre-referral Work-up	Cuándo se debe remitir al paciente
Epitaxis	History and physical Labs (PT, PTT), if indicated by history or physical examination	Work-up is positive for allergic rhinitis and no improvement after six weeks of topical allergy medications (daily nasal steroid) Work-up negative for allergic rhinitis and no improvement after four weeks of [1% hydrocortisone ointment to anterior septum nightly]
Ronquera	History and physical Gastroenterology consult to rule out Enfermedad por reflujo gastroesofágico	Three or more months of moderate to severe hoarseness not responsive to one month trial of ranitidine or PPI therapy. Any hoarseness associated with stridor not compatible with croup Hoarseness with moderate or severe stridor or respiratory distress should be seen urgently in the ED
Lateral Neck Mass / Branchial Cleft Sinus	Deep cystic or solid masses not associated with thyroid gland requires neck CT with contrast If suspected thyroid mass, ultrasound of neck with notation of thyroid gland If atypical TB suspected, patient should have PPD prior to visit Persistent inflammatory lymph nodes should have CBC with diff/momospot/bartonnella titers/toxoplasmosis	Pit in neck with history of drainage Lateral neck mass > 4 cm in diameter Asymptomatic lateral neck mass < 4 cm in diameter present greater than one month, not responsive to one course of oral antibióticos Any lateral mass with overlying erythema or signs of fluctuance
Cysts/Masses (Neck mass, Thyroid mass, Parotid mass, Dermoid cyst)	History and physical (including antibiotic history)	Positive physical findings
Branchial Cleft Sinus	History and physical	Positive physical findings
Obstructive Adenotonsillar Hyperplasia	History and physical	History of three or more months of frequent loud snoring with suspected sleep disturbance Dificultades para tragar
Rhinorrhea / Nasal Congestion	Rule out allergic rhinitis (history of atopic dermatitis, family history, referral to allergist PRN, rule out adenohyperplasia)	Work-up positive for allergic rhinitis and no improvement after six weeks of topical allergy medications (daily nasal steroid) Symptoms of nasal obstruction/sleep apnea
Sinusitis	Physical examination consistent with sinusitis Positive imaging Three to six weeks broad-spectrum oral antibiotics Nasal steroids x six weeks Nasal irrigation with antibiotic solution x six weeks	Persistent symptoms despite six weeks of appropriate treatment
Tonsils / Adenoids	History and physical Ancillary tests Throat culture, monospot as appropriate, CBC Lateral neck X-ray	Three or more infections per year despite adequate therapy Hypertrophy causing upper airway obstruction, severe dysphagia or sleep disorders Suspected peritonsillar abscess Unilateral tonsillar hypertrophy
Nasal Trauma	Physical examination to rule out associated injuries, septal hematomoa, significant lacerations or persistent epistaxis CT for diagnostic confirmation of associated injuries	Evidence of septal hematomoa, complex laceration or uncontrolled epistaxis Complaints of significant nasal obstruction less than 10 days from trauma Significant cosmetic deformity less than 10 days from trauma Nasal fractures - call practice directly
Colesteatoma	History and physical Comprehensive audiology evaluation	Positive physical finding
Pérdida de audición	History and physical Comprehensive audiology evaluation	Positive physical finding
Estridor	History and physical	Contact practice directly or send to Valley Children’s Emergency Department for immediate evaluation