adenotonsillar disease Flashcards
what is waldeyer’s ring
ring of lymphoid aggregation in the subepithelial layer of oropharynx and nasopharynx
-comprised of tonsils, adenoids and lingual tonsil
what epithelium is tonsils
specialized squamous
what epithelium is the adenoids
ciliated pseudostratified columnar
and some stratified squamous in the folds
cause of tonsilitis
- EBV
- rhinovirus, influenza etc
- group A beta-haemolytic strep important because of potential sequelae
what are the most common organisms cultured from patients with chronic tonsillar disease
- strep pyogenes
- H.influenza
- S.aureus
- strep pneumonia
- BLPO
viral symptoms of tonsillitis
- malaise
- sore throat, mild analgesia required
- temperature
- able to undertake normal activity
- possible lymphadenopathy
- lasts 3-4 days
bacterial symptoms of tonsillitis
- systemic upset
- fever
- odynophagia
- halitosis
- unable to work
- lymphadenopathy
- lasts around 1 week
feverPAIN criteria
- fever
- Purulence
- Attend rapidly (within 3 days after onset of symptoms)
- severely inflamed tonsils
- No cough or coryza
what does a higher feverPAIN score mean
highest association with streptococcus so antibiotics needed
supportive treatment for tonsillitis
- eat and drink
- rest
- OTC analgesia (paracetamol, NSAIDS)
antibiotic treatment for tonsillitis
- penicillin 500mg qid for 10 days
- clarithromycin if allergic
hospital treatment for tonsillitis
- IV fluids
- IV antibiotics
- steroids
what are the criteria for tonsillectomy
- sore throats are due to acute tonsillitis
- the episodes are disabling and prevent normal functioning
- seven or more well documented, clinically significant, adequately treated sore throats in the preceding year
- five or more such episodes in each preceding two years
- three or more episodes in each of the preceding three years
what is a peritonsilar abscess
bacteria gets in between the muscle and tonsil and produces pus
-complication of tonsillitis
presentation of peritonsilar abscess
- unilateral throat pain and odynophagia
- trismus
- 3-7 days of preceding acute tonsilitis
- medial displacement of tonsil and uvula
- concavity of palate lost
treatment for peritonsilar abscess
aspiration and antibiotics
what is glandular fever
infectious mononucleosis
-EBV
signs of glandular fever
- gross tonsillar enlargement with membranous exudate
- marked cervical lymphadenopathy
- palatal petechial haemorrhages
- generalised lymphadenopathy
- hepatosplenomegaly
diagnosis of glandular fever
- atypical lymphocytes in peripheral blood
- low CRP (<100)
- +ve monospot or paul-bunnell test
management of glandular fever
- symptomatic treatment
- do not prescribe ampicillin (macular rash will result)
- antibiotics
- steroids
what antibiotic should not be given in tonsillitis
amoxicillin
signs of adenoidal enlargement (hyperplasia)
- obligate mouth breathing
- hyponasal voice
- snoring and other signs of sleep disturbance
- AOM/OME
signs of tonils enlargement
- snoring
- muffled voice
- potential dysphagia
what is glue ear
otitis media with effusion
-inflammation of the middle ear accompanied by accumulation of fluid without the symptoms and signs of acute inflammation
what is acute otitis media
inflammation of the middle ear accompanied by the symptoms and signs of acute inflammation with/without an accumulation of fluid
what are the differences in OME and AOM
who gets OME
most commonly children
- males
- day care
- older siblings
- smoking household
- recurrent URTI
causes of OME
- recurrent URTI
- recurrent AOM
- prematurity
- craniofacial abnormalities
- genetic abnormalities
- immunodeficiency
symptoms of OME
- deafness
- poor school performance
- behavioural problems
- speech delay
- potential balance problems
- TV volume raised
- NOT otalgia
diagnosis of OME
- history
- otoscopy
- tuning fork tests
- audiometry
- tympanometry
signs of OME
- TM retraction
- reduced TM mobility
- altered TM colour
- visible ME fluid/bubbles
- CHL tuning fork tests
is this a normal or abnormal tympanogram?
normal
what does this tympanogram show about the ear
there is fluid in it
what does this audiometry mean?
conductive hearing loss of 40-30
what is normal hearing in an audiometry
20
treatment for OME
- watchful waiting (3months)
- after 3 months there is a review (otoscopy, tympanometry etc)
- then referral if needed
treatment fr OME that has persisted over 3 months and is symptomatic
- autoinflation (5 to 10 times a day)
- referral
surgical management of OME
if under 3yrs
-grommets
over 3 and first intervention
-grommets
over 3, second intervention
-grommets and adenoidectomy
complications of grommets
- infection/discharge
- early extrusion
- retention
- persistent perforation
- swimming/bathing issues
