39. Nose + Throat Presentations

Question 1

Outline the aetiology and pathophysiology of adenotonsillar hypertrophy

Answer 1

The exact mechanisms leading to the adenotonsillar cell proliferation are still not fully understood

Possible bacterial and inflammatory aetiology has been suggested for AH

Question 2

How does adenotonsillar hypertrophy present?

Answer 2

Short term = mouth breathing, nasal congestion, hyponasal speech, snoring, obstructive sleep apnoea (OSA), chronic sinusitis and recurrent otitis media

Long term = serious complications related to OSA including growth failure, cardiovascular morbidity and neurocognitive abnormalities such as low intelligence quotient, learning and behavioural problems, hyperactivity and poor attention span

Question 3

How should adenotonsillar hypertrophy be investigated?

Answer 3

Diagnostic nasal endoscopy = rigid or a flexible nasopharyngoscope

CT scan of nasopharynx

X-ray lateral view of nasopharynx

Question 4

Outline the management of adenotonsillar hypertrophy

Answer 4

Tonsillectomy

Adenoidectomy

Question 5

What is a DDx for adenotonsillar hypertrophy?

Answer 5

Choanal atresia

Pyriform aperture stenosis

Question 6

Discuss the aetiology and pathophysiology of allergic rhinitis

Answer 6

Aetiology = dust mites, pollen/spores, animal skin, urine and saliva

Pathophysiology: exposure to allergen = recognised by antigen-IgE receptors on mast cells and basophils = mast cell degranulation = histamine release = acute nasal symptoms (sneezing and rhinorrhoea) and ocular symptoms (itching, redness, and watering)

Histamine release + leukotrienes, prostaglandins and kinins = increases vascular permeability = oedema formation

Question 7

What are the signs and symptoms of allergic rhinitis?

Answer 7

Nasal = sneezing, rhinorrhoea, obstruction, pruritus

Ocular = itching, redness, and watering, eyelid oedema

Oedema

Sleep disruption sec to Sx

Question 8

How should suspected allergic rhinitis be investigated?

Answer 8

Allergen skin prick testing

IgE levels

Total blood eosinophil count

Question 9

What is a DDx for allergic rhinitis?

Answer 9

Infective rhinitis = short hx of one week or less, with cough, fever, sore throat, lymphadenopathy

Irritant rhinitis = usually when Sx follow known physical (temperature or humidity) or chemical irritant (volatile chemicals and odours)

Question 10

What is a DDx for allergic rhinitis?

Answer 10

Infective rhinitis = short hx of one week or less, with cough, fever, sore throat, lymphadenopathy

Irritant rhinitis = usually when Sx follow known physical (temperature or humidity) or chemical irritant (volatile chemicals and odours)

Structural or mechanical factors = deviated nasal septum, nasal polypls, adenoidal hypertrophy, foreign bodies