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Head and Neck (Semester 5) > 11.2 Disorders of the pharynx > Flashcards

11.2 Disorders of the pharynx Flashcards

1
Q

How can we view the adenoids?

A

Fibre-optic endoscope

X-ray/MRI or theatre (if concerned about post-nasal space)

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2
Q

What is the arrow pointing too?

A

Adenoids

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3
Q

Give some common conditions which occur in each part of the pharynx

A
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4
Q

If our adenoids enlarge where may be get obstruction?

A

Nasal obstruction OR Eustachian tube obstruction

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5
Q

Give 4 consequences of nasal obstruction

A

Mouth breathing
Hyponasal speech
Feeding difficulty (esp. infants)
Snoring/Obstructive Sleep Apnoea

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6
Q

Give 2 consequences of eustachian tube obstruction

A

Recurrent acute otitis media (earache)

Chronic otitis media with effusion (glue ear, reduced hearing)

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7
Q

What MUST we think if we see a teenage boy with enlarged adenoids?

A

angiofibroma!! (vascular fibrous tumour in post-nasal space)

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8
Q

What MUST we think if we see an adult with enlarged adenoids?

A

Nasopharyngeal carcinoma or lymphoma

(remember: our adenoids should regress after puberty)

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9
Q

Lecture 6 revision

A
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10
Q

What is acute pharyngitis?

A

Inflamation of the oropharynx

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11
Q

What is Tonsillitis?

A

Inflamation of the tonsils

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12
Q

Acute pharyngitis and tonsilitis are usually bacteria or viral cause?

A

Viral or bacterial. Self limiting 3 - 7 days

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13
Q

What ‘score’ system can we use to determine whether a sore throat is likley to be bacterial or viral?

A

Centor Clinical presentation score:

  • Fever
  • Anterior cervical nodes
  • Exudate
  • Absent cough

3 out of 4 → 40-60% chance of bacterial Group A beta haemolytic streptococcus → treat with antibiotics

BUT most sore throats are viral!! → NO antibiotics

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14
Q

Give 3 local streptococcal sore throat complications

A

Otitis media

Sinusitis

Chest infection

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15
Q

Give 4 systemic streptococcal sore throat complications

A

Rheumatic fever

Glomerulonephritis

Meningitis

Toxic shock syndrome

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16
Q

Give 5 Sore throat Red flags!!

A
  1. Difficulty breathing
  2. Difficulty swallowing saliva/drooling
  3. Difficulty opening mouth (trismus)
  4. Severe pain (especially unilateral)
  5. Persistent high fever
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17
Q

What usually causes Tonsillitis?

A

Viral or beta haemolytic strep

(can also be strep pneumonia, haemophilus influenza or others)

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18
Q

Give 2 complications of tonsilitis

A

1) abcess formation- peritonsillar ( quinsy)
2) retropharyngeal or parapharyngeal abscess

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19
Q

What is the antibiotic of choise used to treat tonsilitis?

A

phenoxymethylpenicillin or macroglycoside eg. erythromycin

20
Q

What other serious condition may present similarly to tonsilitis?

A

MUST consider Glandular fever (EBV). This is longer and more severe

21
Q

Give 4 indications for a Tonsillectomy?

A

1) Recurrent tonsillitis (5/year for at least 2 years)
2) Previous peritonsillar abscess (quinsy)
3) Suspected cancer (unilateral enlargement/ulceration)
4) Obstructive sleep apnoea syndrome

22
Q

Give 3 risks of a tonsillectomy

A
  1. GA (general anaesthetics)
  2. Bleeding (primary (within 24 hours) or secondary)
  3. Infection
23
Q

Give 3 other tonsil conditions

A
24
Q

What causes Snoring?

A

Vibration of pharyngeal structures such as the tongue, soft palate and pharyngeal walls

25
Q

Give 5 things that cause/worsen snoring

A

1) nasal or nasopharyngeal obstruction
2) large tongue or tongue falling back into throat
3) obesity (MAJOR)
4) excessive tiredness / alcohol
5) 60% men over 60

26
Q

Give 4 managements of snoring

A

1) Lifestyle: lose weight, less alcohol, stop smoking)
2) Treat nasal obstruction
3) Mandibular advancement device
4) Surgery: adenotonsillectomy or uvulopalatopharyngoplasty

27
Q

What is obstructive sleep apnoea?

A

When people stop breathing in their sleep causing oxygen desaturation (decrease blood O2) because O2 isn’t suffiencently reaching lungs

Results from partial/complete airway obstruction during sleep which therfore causes turbulent airflow

Spectrum ranging from mild snoring to OSA

28
Q

What defines abnormal sleep apnoea?

A

Over 30 apnoeic episodes in 7 hours of sleep (5 apnoeic episodes/hour)

29
Q

List 3 symptoms of sleep apnoea and why these occur

A

Daytime lethargy, sleepiness and reduced concentration

This occur because each time we stop breathing during sleep, the brain detects O2 is desaturated and wakes us up to take a breath.

BUT this means we are constantly waking in the night, resulting in the symptoms above

30
Q

Sever sleep apnoea can lead to what?

A

If severe can cause hypoxia and increase CVS strain: pulmonary hypertension → right heart failure → cor pulmonale

31
Q

Give 2 investigations for sleep apnoea

A

1) nasendoscopic examination of pharynx
2) sleep studies

32
Q

Give 4 treatments for sleep apnoea

A

1) Weight loss
2) Surgery for structural causes eg nasal polyps; adenoids/ adenotonsillectomy
3) CPAP-Continuous Positive Airways Pressure

33
Q

Define dysphagia and give 4 signs/symptoms

A

Difficulty swallowing:

Signs/symptoms

  • Food or fluid getting stuck
  • Choking
  • Pain swallowing (odynophagia)
  • Regurgitation of food
  • Feeling of something in throat (FOSIT)
34
Q

Give 4 causes of Acute dysphagia?

A

tonsillitis, pharyngitis, aphthous ulcers foreign bodies , ingestion of caustic liquids

35
Q

Give 4 causes of chronic dysphagia?

A
36
Q

Give 4 red flags associated with dysphagia

A
  • True dysphagia (solids more than liquids)
  • Hoarse/ breathing difficulties
  • Pain
  • Otalgia
  • Weight and appetite loss • Neck nodes
  • Neurological deficit
  • Drooling
  • Rapid onset
  • Risk factors: smoking, HPV
37
Q

How do we investigate dysphagia

A

FBC, ESR

Nasendoscopy

Upper GI endoscopy

Barium swallow

38
Q

What is Pharyngeal Pouch?

Give 3 reasons it may occur?

A

Posterior herniation of pharyngeal mucosa that occurs through Killian’s dehiscence

Reasons:

  • Weaker area
  • Incoordination of pharyngeal phase of swallowing
  • Cricopharyngeal spasm
39
Q

Where is Killian’s dehiscence?

What is its anatomical significance?

A

Between thyropharyngeus and cricopharyngeus parts of inferior constrictor

Here is a weaker area of the posterior pharyngeal muscles which can result in Pharyngeal Pouch

40
Q

How would you diagnose Pharyngeal Pouch?

A

Barium swallow

41
Q

What is Globus pharyngeus?

A

A benign condition that is characterised by a feeling of something in throat. Worse swallowing own saliva (no probems with eating or drinking)

Patient will usually be seen throat clearing

Associated with Acid reflux

NO red flag symptoms

42
Q

How would you treat Globus pharyngeus?

A

Reassurance and Treat acid reflux

43
Q

Give 3 common sites for a Foreign body to lodge

A

Tonsil, piriform fossa, cricopharyngeus

44
Q

Give some symptoms/history of someone with a stuck foreign body

What else MUST we think?

A
  • Well localised
  • Immediate sensation
  • Inability to swallow saliva
  • drooling

THINK!? Underlying oesophageal narrowing?

45
Q

How would we dianose a foreign body

A

Lateral soft tissue neck xray

Head and Neck (Semester 5) (22 decks)

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