Child Protection Evidence - Ear, nose and throat

Child Protection Evidence is a resource available for clinicians across the UK and internationally to inform clinical practice, child protection procedures and professional and expert opinion in the legal system. This systematic review evaluates the literature on abusive and non-abusive ear, nose and throat injuries.

About the review

This systematic review evaluates the scientific literature on the presentations of injuries to the ear, nose and throat in the context of physical child abuse published up until June 2021.

It aims to answer the following clinical questions:

  • What are the identified characteristics of epistaxis indicative of asphyxiation in children less than 2 years of age?
  • What are the ear, nose and throat manifestations of physical abuse or fabricated or induced illness?

The 2021 update includes two new studies on manifestations of physical abuse, a case report of a neonate with stridor and subcutaneous emphysema and a case series of nasal erosion as a sign of physical abuse.

The key evidence statements, research implications and other useful references are included in the review.

Key findings

  • Epistaxis is a rare presentation in children aged less than 2 years, however when present it is significantly associated with asphyxiation, either intentional or unintentional
  • Some young children presenting with asphyxia may have no overt symptoms; those that were symptomatic included altered skin colour, respiratory distress, altered heart rate, and a possible history of Apparent Life-Threatening Events (ALTE)
  • Pharyngeal injuries (laceration and perforation) are the most frequently reported ENT injury, predominantly affecting neonates and infants who present with dysphagia, drooling, haemoptysis, and surgical emphysema
  • Ear injuries most commonly affect the external ear and include auricular deformity, abrasions, petechial lacerations, and burns
  • Fabrication and induction of ENT signs and symptoms most commonly involves recurrent unexplained otorrhoea or ENT lesions which fail to heal despite appropriate therapy

Disclaimer: This is a summary of the systematic review findings up to the date of our most recent literature search. If you have a specific clinical case, we strongly recommend you read all of the relevant references as cited and look for additional material published outside our search dates

Original reviews and content © Cardiff University, funded by NSPCC
Updates and new material by RCPCH July 2021

While the format of each review has been revised to fit the style of the College and amalgamated into a comprehensive document, the content remains unchanged until reviewed and new evidence is identified and added to the evidence-base. Updated content will be indicated on individual review pages.