1. OFFICE BASED ENT PRACTISE IN CHILDREN:DIFFICULT SITUATIONS & RECENT TRENDS DR SHEELU SRINIVAS CONSULTANT ENT SURGEON

2. We Can Only Refine Our Therapeutics When We Refine Our Diagnostic Abilities

7. Standard Equipment Assess nares / choanae Assess adenoid and lingual tonsil Assess TVC mobility Assess laryngeal structures

11. Nasoaryngoscopy video

16. Table 1. Clinical Differences in Sleep-disordered Breathing between Children and Adults Variables Children Adults Sex distribution Male: Female = 1:1 Male: Female = 8:1 Weight Underweight Commonly obese Snoring Continuous Intermittent with pause Mouth breathing Common Less common Chief complaint Snoring,difficult Daytime sleepiness breathing Enlarged tonsils/ Common Uncommon adenoids Obstructive pattern Mostly apneas Mostly hypopneas State with most REM REM or non-REM obstruction Clinical arousal Uncommon Common Sleep architecture Preserved Fragmented Sequelae Behavioral changes Daytime sleepiness Neurocognitive Cardiovascular deficits disease Primary treatment Adenotonsillectomy CPAP therapy Abbreviations: SDB: sleep-disordered breathing; REM: rapid eye movement; CPAP: continuous positive airway pressure.

19. Physical examination

31. Proper Equipment Assess nares/choanae Assess adenoid and lingual tonsil Assess true vocal cord mobility Assess laryngeal structures

48. We Can Only Refine Our Therapeutics When We Refine Our Diagnostic Abilities THANK YOU SHEELU SRINIVAS [email_address] 9900176770