Pain relief for ENT procedures in children at the otolaryngologist’s office

During an examination by an ENT doctor or minor procedures (ear irrigation, earwax removal, removing a foreign body from the nose, superficial biopsy, endoscopy), the doctor’s task is to reduce the child’s pain and fear while keeping the ability to communicate and breathe independently. This is done with a combination of non-drug and drug methods: proper preparation, parental involvement, local anesthesia and, if needed, light or moderate sedation.

Non-drug comfort methods

• Explaining the procedure to the child and parents in plain language, using play metaphors and pictures
• A parent being present during the examination and minor procedure, if safe
• Distraction techniques: toys, books, a tablet, videos, music
• A parent’s hug

These methods reduce the need for sedative medication and help the child cope with the procedure more easily.

Local anesthesia at the ENT office

• Topical anesthesia — an anesthetic (lidocaine spray or gel) is applied to the mucosa of the nose, throat or ear canal; used for endoscopy, removal of small growths and preparation for infiltration anesthesia
• Infiltration anesthesia — a local anesthetic solution (lidocaine, mepivacaine, bupivacaine, ropivacaine) is injected with a needle into the treatment area; used for mini-biopsies, small skin incisions and abscess drainage

Doses are calculated strictly by the child’s body weight, and the doctor watches for possible signs of anesthetic toxicity.

Light and moderate sedation for ENT procedures

• Oral midazolam — given as a syrup 20–30 minutes before the procedure to reduce anxiety; the child stays conscious but becomes calmer
• Intranasal dexmedetomidine — nasal drops or spray dosed by body weight; provides gentle sedation and is used as premedication before instrumental examinations
• Nitrous oxide (“laughing gas”) — inhalation of an oxygen and nitrous oxide mixture through a mask; suitable for short, superficial procedures in cooperative children

The general principle: with light or moderate sedation, the child breathes independently, while the doctor and nurse continuously monitor breathing, oxygen saturation and pulse.

Safety and the role of parents

• Before sedation is prescribed, the child is examined and any comorbidities, allergies and developmental features are clarified
• Parents are told which medicines will be used, how long the sedation will last and how to watch the child at home
• The room must have equipment for monitoring vital functions and an emergency kit