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Surgery > Adenoidal Enlargement & Tonsilitis > Flashcards

Adenoidal Enlargement & Tonsilitis Flashcards

1
Q

What is the Waldayer’s ring and list the components.

A

It is a collection of lymphatic tissues located within the pharynx. It is also known as tonsils arranged in a ringed form.
COMPONENTS
1) nasopharyngeal tonsils (adenoids)
2) tubal tonsils (x2)
3) palatine tonsils (x2)
4) lingual tonsils

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2
Q

What is the greatest complication of tonsillectomy?

A

Hemorrhage (due to its proximity to the paratonsilar vein)

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3
Q

At what age does adenoids start enlarging in children?

A

2 years

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4
Q

The adenoids is largest at what age?

A

7 years

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5
Q

At what age do you expect the adenoids to almost disappear?

A

13 years

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6
Q

What are the symptoms of adenoidal enlargement?

A

•Symptoms

•Snoring
•Mouth Breathing
•Hyponasal speech
•Obstructive sleep apnoea syndrome
•Day-time hypersomnolence
•Aproxesia (inability to fix and sustain attention mainly due to nasal disorders)
•Recurrent nasal discharge
•Cough
•Aural fullness/ Hearing difficulty
•Recurrent ear discharge

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7
Q

The palatine tonsils are bounded anteriorly and posteriorly by

A

Anteriorly — Anterior tonsilar pillar
Posteriorly — Posterior tonsilar pillar

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8
Q

What are the signs of adenoidal enlargement

A

Dull tympanic membrane
Ear discharge
Reduced nasal patency
Nasal discharge + engorged turbinate
Adenoidal facies

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9
Q

What are the features of adenoidal facies?

A
  • Pinched nose
  • Open mouth
  • Dull expression
  • Elongated face
  • Prominent and crowded upper central teeth
  • High arched palate
  • Hitched-up upper lip
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10
Q

What is the management protocol for adenoidal enlargement

A
  • Detailed history
  • Physical examination
  • Investigations (post nasal space x-ray, chest x-ray, FBC, E/U/Cr, ECG, Echo)
  • Treatment
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11
Q

Treatment options for adenoidal enlargement

A

Conservative
•Infection and Allergy control
•Broad-spectrum antibiotics (Cephalosporins, Penicillin-based)
•Antihistamines (Systemic/ local)
•Nasal steroids (Fluticasone, Betamethasone)
•Decongestants (Xylometazoline, Pseudoephedrine)

Surgery

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12
Q

What are the indications for surgery in adenoidal enlargement?

A

•Failure of medical treatment
•Obstructive sleep apnoea symptoms
•Associated Otitis media (with effusion)
•Associated speech and swallowing defects
•Recurrent rhinosinusitis

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13
Q

What are the complications of adenoidal enlargement?

A

•Failure to thrive
•Poor school performance and social integration
•Gnathopathy
•Pulmonary hypertension
•Cor-pulmonale (Rt side heart failure)

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14
Q

What is tonsillitis

A

This is the inflammation of the palatine tonsils

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15
Q

What is the aetiology of tonsillitis?

A

Infectious
•Viral (Rhinovirus, corona, Adeno, parainfluenza, Measles, EBV, HIV)
•Bacterial (GABHS pyogenes, C. diphtheriae, S. aureus, H. Influenza, T. pallidum, Fusobacterium)
•Fungal (C. albicans)
•Protozoan (T. gondii)

Non-Infectious
•Laryngo-pharyngeal reflux
•Trauma
•Foreign body
•Others (Sarcoidosis, Crohn’s, SJ syndrome etc.)

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16
Q

Discuss the aetio-pathogenesis of tonsillitis

A
  • Presence of inciting factor (infectious or non-infectious)
  • Inflammatory response — obstructive symptoms
  • Complications arise if not addressed
17
Q

What is the natural history of tonsillitis?

A

1) Catarrhal
2) Parenchymatous
3) Follicular
4) Membranous

CPFM

18
Q

What are the symptoms of tonsillitis

A

•Sore throat
•Odynophagia (difficulty swallowing)
•Dysphagia (painful swallowing)
•Fever
•Otalgia

19
Q

What are the investigations done for tonsillitis

A

NB:- Diagnosis is clinical thus investigations are to determine the causative infection (bacteria, viral, fungal) and direct drug therapy after sensitivity. Also for monitoring complications.

  • Throat swab with m/c/s
  • FBC (with differentials) to know if it’s bacterial and to rule out differentials
  • FBS to rule out DM and possible immunocompromised state
  • E/U/Cr for kidney dx (AGN from GABHSp), acute renal failure (from dehydration)
  • LVS (lenti viral screening) to rule out HIV that can cause immune suppression
  • ECG and Echo to rule out rheumatic heart disease from GABHSp
20
Q

What are the treatment options for tonsillitis

A

Non surgical

•Warm saline gargles
•Broad-spectrum antibiotics (Penicillin-based, Macrolides, Cephalosporins± anaerobe cover)
•Anti-inflammatory (NSAIDS, Short-dose steroids)
•Analgesics/ Antipyretics

Surgery

21
Q

What are the indications for tonsillectomy

A

1) Failure of non-operative management (Acute Recurrent Tonsillitis) which is determined by
• ≥7 episodes in previous year or
• ≥5 episodes in previous 2
consecutive years or
• ≥3 episodes in the previous 3
consecutive years
Each characterized by:
●Fever ≥ 38.3°C
●Pain in the throat
●Tonsillar exudates with positive culture of GABHS
●Tender cervical lymphadenopathy

2) Less frequent episodes but severe symptoms affecting school, work and daily activities

3) Chronic Tonsillitis

4) Peritonsillar abscess

22
Q

What is the modified CENTOR’s criteria and what is it used for?

A

Since most of the causes of acute tonsillitis are viral which is in turn self limiting, the centor’s criteria is used to know when it’s bacterial so as not to prescribe antibiotics unnecessarily.

•Cough (Absence +1, Presence -1)
•Exudates (Absence -1, Presence +1)
•Nodes (Swollen/tender +1, Absence-1)
•Temperature (>38 +1, Absence -1)
•Old OR Young (under 15years +1, over 44years -1). NB:- 15 - 44 years = 0

• -1 to +1: No antibiotics or throat swab required
•2 to 3: Throat swab required, with antibiotics given if positive for β-Hemolytic strep
• 4-5: Empiric antibiotic Rx/ Rapid antigen testing for β-Hemolytic strep and/or culture and antibiotics subsequently

23
Q

What are the complications of tonsillitis

A

•Peritonsillar abscess
•Parapharyngeal abscess
•Deep neck space abscesses
•Rheumatic fever
•Acute Glomerulonephritis

Surgery (29 decks)

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