Recommendations for Referral regarding Adenotonsillar hypertrophy and obstructive sleep apnea:

Please refer patients to the Pediatric Otolaryngology clinic who have:

1. a history of heavy snoring, apneic pauses, gasping, restless sleep, chronic mouth breathing, daytime sleepiness, attention deficit/hyperactivity disorder
2. obstructive sleep apnea on polysomnography (obstructive AHI > 1 or desaturations below 90%)

Suggested Testing Prior to Referral:
Consider obtaining an overnight sleep study (polysomnography) for patients with a history suggestive of OSA and one or more of the following criteria:

• Age < 2 yrs
• Obese children
• Craniofacial anomalies
• Down syndrome
• Neuromuscular disorders
• Bleeding disorders
• History inconsistent with physical exam (e.g. small tonsils with convincing history of OSA)

Clinic Contact Information
Phone: 503-494-5350
Fax: 503-346-6826

Doernbecher patient consult line for referring providers: 503 346-0644 or 888 346-0644.

Click here to download a copy of these guidelines

Recommendations for Referral regarding epistaxis:

1. Prior to referring to our clinic for management of epistaxis, please treat in the following manner: Have the parent place a pea-sized amount of Saline Gel (Ayr, for example) or Bactroban ointment in each nostril at bedtime for 30 days. This will treat any concomitant vestibulitis and crusting and allow the excoriated anterior septum to heal, thus decreasing the episodes of epistaxis.
2. If these measures fail, we will be happy to see for possible cautery. Please be aware that cautery is not usually well tolerated in the very young patient.
3. Coagulation labs are usually not necessary unless the nosebleeds last more than 30 minutes and there are other signs of coagulopathy such as petechiae, bleeding from other sites. It is rare for a child to be anemic from run of the mill nosebleeds, but if there is concern, a CBC with platelets may be a good screening lab to order.

Clinic Contact Information
Phone: 503-494-5350
Fax: 503-346-6826

Doernbecher patient consult line for referring providers: 503 346-0644 or 888 346-0644.

Click here to download a copy of these guidelines. 

Recommendations for Referral regarding hearing loss:

1. Patients who fail hearing screening should be scheduled for a formal audiogram to confirm the presence of hearing loss. If hearing loss is confirmed, they should undergo an evaluation in Pediatric Otolaryngology. The audiogram can be coordinated with their appointment with us in one visit. If needed, an ABR can also be coordinated with their visit, with or without sedation, if we are alerted to the need for such testing.
2. If there is a cerumen impaction present, please either remove the wax prior to audiogram, or recommend a course of Debrox drops (over-the-counter; 5 drops into affected ear(s) nightly until bottle is empty).
3. Consider additional speech/language evaluation as appropriate.
4. Neither CT nor MR imaging are necessary for referral.

Clinic Contact Information
Phone: 503-494-5350
Fax: 503-346-6826

Doernbecher patient consult line for referring providers: 503 346-0644 or 888 346-0644.

Click here to download a copy of these guidelines.

Recommendations for Referral regarding a Neck Mass:

1. If the neck mass appears to be cervical adenitis and is inflamed (red, tender, or larger than 2 centimeters) then a course of oral antibiotics should be administered.
2. If the mass does not respond to oral antibiotics or if the overlying skin is a red-violet color, this may represent a non-tuberculous mycobacteria infection.
3. If the mass is not inflamed, either in the midline or anterior to the stenocleidomastoid, this may represent a congenital cyst.

Suggested Testing or Imaging:

1. For any of the above, an ultrasound of the neck should be done, preferably through OHSU Doernbecher radiology. If not done through OHSU Doernbecher, the images must be put into the OHSU radiology system.
2. An enlarged lymph node for greater than 6 months should have a CBC with a differential, Monospot, Toxoplasma gondii , Bartonella hensele.
3. Thyroid function test and Nuclear Medicine thyroid scan are not needed for midline neck masses.

Clinic Contact Information
Phone: 503-494-5350
Fax: 503-346-6826

Doernbecher patient consult line for referring providers: 503 346-0644 or 888 346-0644.

Click here to download a copy of these guidelines.

Recommendations for Referral regarding Otitis Media:

1. Recurrent acute otitis media:
2. • Children with more than 3 infections in 6 months or more than 4 infections in a year may be referred for myringotomy tube candidacy evaluation. Please note that current recommendations for PE tube placement do not include such children unless there is associated hearing loss or speech and language delay or other complicating factors.
   • Laterality and treatment should be documented for each infection.
3. Otitis media with effusion:
4. • Persistent middle ear effusions are very common following an episode of otitis media. Most children will clear the fluid within 3 months. Therapies such as decongestants and antibiotics do not improve the rate of clearance of effusion.
   • Children may be managed conservatively for 3 months in the case of a bilateral effusion, and 6 months for unilateral effusion. If fluid persists after that period, they should be referred for a Pediatric Otolaryngology evaluation with a pre-clinic audiogram.
   • Children at risk for speech or developmental delay, as well as those with pre-existing hearing loss, should be referred earlier

Clinic Contact Information
Phone: 503-494-5350
Fax: 503-346-6826

Doernbecher patient consult line for referring providers: 503 346-0644 or 888 346-0644.

Click here to download a copy of these guidelines