adenotonsillar disease

Question 1

what is waldeyer’s ring?

Answer 1

Ring of lymphoid aggregation in the subepithelial layer of oropharynx and nasopharynx

Question 2

what is waldeyer’s ring comprised of?

Answer 2

Tonsils (Palatine Tonsil)
Adenoids (Pharyngeal Tonsil)
Lingual Tonsil

Question 3

describe the histology of the palatine tonsils

Answer 3

Specialized squamous
Deep crypts
Lymphoid follicles
Posterior capsule

Question 4

describe the histology of the adenoids

Answer 4

Ciliated pseudostratified columnar
Stratified squamous
Transitional
Deep folds

Question 5

what are the most common causes of acute tonsillitis?

Answer 5

viral- Rhinovirus, Influenza, Parainfluenza, Enterovirus, Adenovirus

Question 6

what is the most common bacterial cause of acute tonsillitis?

Answer 6

group a beta haemolytic strep (strep pyogenes)

Question 7

what are the differences in symptoms of viral and bacterial tonsillitis?

Answer 7

viral has milder symptoms, only lasts 3-4 days
bacterial has more severe symptoms, lasts over a week, requires antibiotics to settle

Question 8

what is the FeverPAIN criteria for tonsillitis?

Answer 8

Fever(during previous 24 hours)
Purulence (pus on tonsils)
Attend rapidly (within 3 days after onset of symptoms)
Severelyinflamed tonsils
No cough or coryza (inflammation of mucus membranes in the nose)
Each of the FeverPAIN criteria score 1 point (maximum score of 5) high score suggests strep

score 0-1- no antibiotics
score 2-3 consider delayed antibiotic prescription
score 4-5 give antibiotics

Question 9

what is the treatment for bacterial tonsillitis?

Answer 9

Penicillin 500mg qid for 10 days
Clarithromycin if allergic

Question 10

how do you diagnose glandular fever?

Answer 10

Atypical lymphocytes in peripheral blood
+ve Monospot or Paul-Bunnell test
Low CRP (<100)

Question 11

what sign can be concerning in the tonsils?

Answer 11

unilateral tonsillar enlargement

Question 12

what are risk factors for OME (glue ear)?

Answer 12

Recurrent URTI
Recurrent AOM
Prematurity
Craniofacial abnormalities / Genetic abnormalities
Immunodeficiency
household smoking
day care
seasonal

Question 13

what are the symptoms of OME (glue ear)?

Answer 13

Deafness
Poor school performance
Behavioural problems
Speech delay
(not otalgia)

Question 14

how do you diagnose glue ear?

Answer 14

History
Otoscopy
Tuning fork tests
Audiometry
Tympanometry

Question 15

what are the signs of glue ear on the tympanic membrane?

Answer 15

TM retraction
Reduced TM mobility
Altered TM colour
Visible ME fluid/bubbles

Question 16

what is the treatment for glue ear?

Answer 16

watch and wait for 3 months
after 3 months can refer, grommets for children <3 or >3 as first intervention
grommets + adenoidectomy in >3 if second intervention or there is associated nasal symptoms

Question 17

what are the complications of grommets?

Answer 17

Infection/discharge
Early extrusion
Retention
Persistent perforation
Swimming/bathing issues