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adenotonsillar disease Flashcards

1
Q

what are the common diseases of the tonsils and adenoids?

A 
Acute tonsillitis 
Recurrent/chronic adenoiditis/tonsillitis
Obstructive hyperplasia
Malignancy
Tonsil crypt debris / tonsiliths
(Otitis Media with effusion)
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2
Q

what is the etiology of acute tonsillitis?

A

Majority Viral
EBV
Rhinovirus, Influenza, Parainfluenza, Enterovirus, Adenovirus
5-30% bacterial
GABHS important pathogen because of potential sequelae

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3
Q

what is peritonsilar abscess?

A

it is a complication of acute tonsillitis

bacteria between muscle and tonsil produce pus

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4
Q

what are the symptoms of peritonsilar abscess?

A

Unilateral throat pain and odynophagia
Trismus
3-7 days of preceding acute tonsillitis
Affects muscles of mastication and cant open mouth wide

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5
Q

what is seen on examination in a patient with peritonsilar abscess?

A

medial displacement of tonsil and uvula

concavity of palate lost

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6
Q

what is the treatment for quinsy?

A

aspiration and antibiotics

difference noted quickly

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7
Q

what is glandular fever?

A

infectious mononucleosis caused by EBV

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8
Q

what are the signs of glandular fever?

A

Gross tonsillar enlargement with membranous exudate
systemic infection - groins, etc. affected
Marked cervical lymphadenopathy
Palatal petechial haemorrhages
Generalised lymphadenopathy
Hepatosplenomegaly
chronic fatigue

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9
Q

how do you diagnose glandular fever?

A

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

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10
Q

what is the CRP range of someone with tonsillitis?

A

> 100

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11
Q

what is the management of glandular fever?

A

Symptomatic treatment

Do NOT prescribe ampicillin
diagnostic generalised macular rash will result!

Antibiotics - secondary bacterial infection

Steroids- kicks start metabolism, a patient that is finding it difficult to cope

avoid contact sport - can rupture

no alcohol

pain relief and rest

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12
Q

what should you not give for someone with tonsillitis?

A

amoxicillin

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13
Q

what is chronic tonsillitis?

A 
chronic sore throat 
malodorous breath 
presence of tonsillitis 
peritonsillar erythema 
persistent tender cervical lymphadenopathy
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14
Q

what is rarely offered to patients with chronic tonsillitis?

A

surgery as it has a controversial role

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15
Q

who is seen with chronic tonsillitis more often?

A

females more than males

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16
Q

what is seen in the adenoids in obstructive hyperplasia?

A

Obligate mouth breathing
Hyponasal voice
Snoring and other signs of sleep disturbance
AOM / OME

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17
Q

what is seen in the tonsils in obstructive hyperplasia?

A

Snoring and other symptoms of sleep disturbance
Muffled voice
?Dysphagia

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18
Q

large size without symptoms…..

A

means nothing

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19
Q

what are the causes of unilateral tonsillar enlargement?

A 
Apparent enlargement vs true enlargement
Non-neoplastic: 
Acute infective
Chronic infective 
Hypertrophy
Congenital
Neoplastic
20
Q

what is apparent enlargement?

A

tonsil sits in more medial position, displacement medially by PTA or parapharyngeal space mass.

21
Q

what are chronic infections seen in unilateral tonsillar enlargement?

A

tubercular tonsillitis, actinomycosis, and congenital syphilis

22
Q

red flags for abnormalities in tonsils:

A

unilateral
ulcerated
hard and craggy

23
Q

what are congenital causes of unilateral tonsillar enlargement?

A

teratoma, hemangioma, lymphangioma, and cystic hygroma.

24
Q

what are neoplastic causes of unilateral enlargement of tonsils?

A

Benign papillomas

Lymphoma (usually non-Hodgkins B-cell) and squamous cell

25
what is the definition of glue ear, OME, SOM?
Inflammation of the middle ear accompanied by accumulation of fluid without the symptoms and signs of acute inflammation
26
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 systemic symptoms
27
describe the spectrum between OME and AOM?
AOM - no fluid, No HL AOM and OME - Fluid OME - fluid, HL
28
what is the incidence of OME?
age - any child (but decreasing with age) M>F 30% children <4yrs at any time
29
where is there increased incidence of OME?
Day care Older siblings Smoking household Recurrent URTI
30
what are patient related etiologies of OME?
``` Recurrent URTI Recurrent AOM Prematurity Craniofacial abnormalities / Genetic abnormalities Immunodeficiency ```
31
what are environmental aetiological factors of OME?
``` Household smoking Day care Allergy ?Nutrition Bottle feeding Seasonal ```
32
what are the symptoms of OME?
``` Deafness Poor school performance - first place to pick up hearing loss Behavioural problems Speech delay ?Balance problems - occasional ?TV volume - unreliable symptom ``` NOT otalgia
33
how do you diagnose OME?
``` History Otoscopy Tuning fork tests Audiometry Tympanometry - pressure test ```
34
what are the signs of OME?
``` TM retraction Reduced TM mobility Altered TM colour Visible ME fluid/bubbles CHL tuning fork tests ```
35
what are the investigations used to diagnose OME?
Age appropriate hearing assessment” ``` Audiometry OAE Distraction testing COR PTA Tympanometry - pressure test ```
36
what is seen in the tympanogram in a patient with OME?
it is flat it signifies fluid in the middle ear
37
which ages do you not get an audiogram?
0-4 years
38
what assessment for 0-4 year olds?
age appropriate hearing assessment
39
what is the treatment of OME?
``` Watchful waiting” 60% resolved @ 1/12 90% resolved @ 3/12 Review @ 3/12 Otoscopy PTA Tympanometry Explanation ```
40
when is OME persistent?
OME persistent for > 3/12 with symptoms Deafness Speech Balance
41
what might have some benefit in someone with persistent OME?
autoinflation - sqeeze nose and allow pressure equalizing | and urgent referral
42
when do you refer a patient with OME?
Persistent (> 3/12), bilateral OME CHL >25dB Speech/language problems Developmental behavioral problems
43
what is the surgical management for someone with chronic/persistent OME?
< 3yrs Grommets > 3yrs, first intervention Grommets > 3yrs, second intervention Grommets and adenoidectomy If nasal symptoms, adenoids may be considered earlier
44
are hearing aids indicated in patients with OME?
yes and always present that as an option to parents
45
what are the complications of OME?
Weak evidence of short term speech, language and behavioral development problems No clear evidence of long term problems
46
what are the complications of grommets?
``` Infection/discharge Early extrusion Retention Persistent perforation Swimming/bathing issues - can't dive into cold water with grommets - loss of mounting mechanism and potential drowning ```

ENT (13 decks)

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