AN OVERVIEW OF THE SPECIALTY

Pediatric otolaryngology, or Peds ENT, is a field in which all aspects of ear, nose, throat, and head and neck disease are taken care of in children. It is truly a general ENT subspecialty for the pediatric population. Disorders that are treated range from the simple (e.g. otitis media, adenotonsillar hypertrophy) to the complex (e.g. laryngotracheal reconstruction, craniofacial surgery, vascular anomalies, cochlear implantation). If it occurs in the head and neck of a child, a pediatric otolaryngologist may be able to take care of it.

The variety and the patient population are what drew me to the field. Peds ENT is the one subspecialty in ENT in which I can truly practice every aspect of the field. Of course I place ear tubes, take out tonsils and adenoids, and perform endoscopic airway procedures; but, among other things, I also do cochlear implants in infants and children, repair cleft lips and palates, reconstruct airways, resect head and neck tumors and vascular malformations, and do sinus surgery and anterior skull base surgery. My operating day can be quite varied, and keeps things from getting boring for me. I see more complex than simple things because that is how I wanted to shape my practice, and that is what my department has encouraged me to do.

As a pediatric otolaryngologist, I interact with many different pediatric subspecialists outside the department as we share complex patients, including pulmonology, gastroenterology, neurology/neurosurgery, surgery, plastic surgery, etc. I have the opportunity to participate in several multidisciplinary clinics, which helps improve the care of these children. I love interacting with colleagues in other departments to share ideas and coordinate the care of the kids we take care of. I am in an academic practice, and my typical week consists of 2-2.5 clinic days, 1.5-2 OR days, and 1 academic/administrative day. I advise medical students, teach residents, and have time set aside for multidisciplinary team meetings. Since I see children, in-office procedures are usually limited to flexible fiberoptic endoscopies, lingual frenotomies, and cerumen cleaning. Almost anything else needs to be done in the operating room, unless you get the rare cooperative child who can handle more.

Peds ENT fellowships can vary quite a bit in their scopes of practice and what they will offer you. When applying for fellowship, it is important to know what interests you. I was very interested in cleft surgery, among everything else, and chose where to apply accordingly. Some fellowships will have a larger volume of complex airway cases than others, while other fellowships may have a higher volume of otologic cases than others. Not every fellowship offers experience in craniofacial surgery or microtia repair. There are also some fellowships that can give you a decent volume of every aspect of peds ENT. The fellowship listing on the American Society of Pediatric Otolaryngology (ASPO) website will give details about what each of the fellowships offers. When applying, it is important to have done some research in the field – and with peds ENT being such a broad field, it should be easy enough to find research projects. Applications are due around the end of December of PGY-4 year, and the process is coordinated by the SF Match. Typically 3-4 letters of recommendation are required, and these should be from attendings who know you well as a resident. Rank lists are due sometime in the early spring of the PGY-4 year, and match results typically come out in late spring. Peds ENT fellowships can be 1 or 2 years long. The 2-year programs tend to have more of a research component for the 2nd year.

There is a lot of variety in peds ENT, and lots of different ways in which you can shape your practice. I loved every aspect of ENT during residency, and am happy I get to practice it all. I enjoy being able to treat any aspect of head and neck disease in children, which means switching gears between airway, otology, facial plastics, rhinology, laryngology, and head and neck. I enjoy the challenge of keeping my knowledge and skill set up to encompass the entire breadth of the field of otolaryngology.