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ENT > adenotonsillar disease > Flashcards

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
Q

what is the definition of glue ear, OME, SOM?

A

Inflammation of the middle ear accompanied by accumulation of fluid without the symptoms and signs of acute inflammation

26
Q

what is acute otitis media?

A

Inflammation of the middle ear accompanied by the symptoms and signs of acute inflammation with / without an accumulation of fluid
systemic symptoms

27
Q

describe the spectrum between OME and AOM?

A

AOM - no fluid, No HL
AOM and OME - Fluid
OME - fluid, HL

28
Q

what is the incidence of OME?

A

age - any child (but decreasing with age)

M>F
30% children <4yrs at any time

29
Q

where is there increased incidence of OME?

A

Day care
Older siblings
Smoking household
Recurrent URTI

30
Q

what are patient related etiologies of OME?

A 
Recurrent URTI
Recurrent AOM
Prematurity
Craniofacial abnormalities / Genetic abnormalities
Immunodeficiency
31
Q

what are environmental aetiological factors of OME?

A 
Household smoking
Day care
Allergy
?Nutrition
Bottle feeding
Seasonal
32
Q

what are the symptoms of OME?

A 
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
Q

how do you diagnose OME?

A 
History
Otoscopy
Tuning fork tests
Audiometry
Tympanometry - pressure test
34
Q

what are the signs of OME?

A 
TM retraction
Reduced TM mobility
Altered TM colour
Visible ME fluid/bubbles
CHL tuning fork tests
35
Q

what are the investigations used to diagnose OME?

A

Age appropriate hearing assessment”

Audiometry
OAE
Distraction testing
COR
PTA
Tympanometry - pressure test
36
Q

what is seen in the tympanogram in a patient with OME?

A

it is flat it signifies fluid in the middle ear

37
Q

which ages do you not get an audiogram?

A

0-4 years

38
Q

what assessment for 0-4 year olds?

A

age appropriate hearing assessment

39
Q

what is the treatment of OME?

A 
Watchful waiting”
60% resolved @ 1/12
90% resolved @ 3/12
Review @ 3/12
Otoscopy
PTA
Tympanometry
Explanation
40
Q

when is OME persistent?

A

OME persistent for > 3/12 with symptoms
Deafness
Speech
Balance

41
Q

what might have some benefit in someone with persistent OME?

A

autoinflation - sqeeze nose and allow pressure equalizing

and urgent referral

42
Q

when do you refer a patient with OME?

A

Persistent (> 3/12), bilateral OME
CHL >25dB
Speech/language problems
Developmental behavioral problems

43
Q

what is the surgical management for someone with chronic/persistent OME?

A

< 3yrs
Grommets

> 3yrs, first intervention
Grommets

> 3yrs, second intervention
Grommets and adenoidectomy
If nasal symptoms, adenoids may be considered earlier

44
Q

are hearing aids indicated in patients with OME?

A

yes and always present that as an option to parents

45
Q

what are the complications of OME?

A

Weak evidence of short term speech, language and behavioral development problems
No clear evidence of long term problems

46
Q

what are the complications of grommets?

A 
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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