adenotonsillar disease Flashcards
what are the common diseases of the tonsils and adenoids?
Acute tonsillitis Recurrent/chronic adenoiditis/tonsillitis Obstructive hyperplasia Malignancy Tonsil crypt debris / tonsiliths (Otitis Media with effusion)
what is the etiology of acute tonsillitis?
Majority Viral
EBV
Rhinovirus, Influenza, Parainfluenza, Enterovirus, Adenovirus
5-30% bacterial
GABHS important pathogen because of potential sequelae
what is peritonsilar abscess?
it is a complication of acute tonsillitis
bacteria between muscle and tonsil produce pus
what are the symptoms of peritonsilar abscess?
Unilateral throat pain and odynophagia
Trismus
3-7 days of preceding acute tonsillitis
Affects muscles of mastication and cant open mouth wide
what is seen on examination in a patient with peritonsilar abscess?
medial displacement of tonsil and uvula
concavity of palate lost
what is the treatment for quinsy?
aspiration and antibiotics
difference noted quickly
what is glandular fever?
infectious mononucleosis caused by EBV
what are the signs of glandular fever?
Gross tonsillar enlargement with membranous exudate
systemic infection - groins, etc. affected
Marked cervical lymphadenopathy
Palatal petechial haemorrhages
Generalised lymphadenopathy
Hepatosplenomegaly
chronic fatigue
how do you diagnose glandular fever?
Atypical lymphocytes in peripheral blood
+ve Monospot or Paul-Bunnell test
Low CRP (<100)
what is the CRP range of someone with tonsillitis?
> 100
what is the management of glandular fever?
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
what should you not give for someone with tonsillitis?
amoxicillin
what is chronic tonsillitis?
chronic sore throat malodorous breath presence of tonsillitis peritonsillar erythema persistent tender cervical lymphadenopathy
what is rarely offered to patients with chronic tonsillitis?
surgery as it has a controversial role
who is seen with chronic tonsillitis more often?
females more than males
what is seen in the adenoids in obstructive hyperplasia?
Obligate mouth breathing
Hyponasal voice
Snoring and other signs of sleep disturbance
AOM / OME
what is seen in the tonsils in obstructive hyperplasia?
Snoring and other symptoms of sleep disturbance
Muffled voice
?Dysphagia
large size without symptoms…..
means nothing
what are the causes of unilateral tonsillar enlargement?
Apparent enlargement vs true enlargement Non-neoplastic: Acute infective Chronic infective Hypertrophy Congenital Neoplastic
what is apparent enlargement?
tonsil sits in more medial position, displacement medially by PTA or parapharyngeal space mass.
what are chronic infections seen in unilateral tonsillar enlargement?
tubercular tonsillitis, actinomycosis, and congenital syphilis
red flags for abnormalities in tonsils:
unilateral
ulcerated
hard and craggy
what are congenital causes of unilateral tonsillar enlargement?
teratoma, hemangioma, lymphangioma, and cystic hygroma.
what are neoplastic causes of unilateral enlargement of tonsils?
Benign papillomas
Lymphoma (usually non-Hodgkins B-cell) and squamous cell
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
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
describe the spectrum between OME and AOM?
AOM - no fluid, No HL
AOM and OME - Fluid
OME - fluid, HL
what is the incidence of OME?
age - any child (but decreasing with age)
M>F
30% children <4yrs at any time
where is there increased incidence of OME?
Day care
Older siblings
Smoking household
Recurrent URTI
what are patient related etiologies of OME?
Recurrent URTI Recurrent AOM Prematurity Craniofacial abnormalities / Genetic abnormalities Immunodeficiency
what are environmental aetiological factors of OME?
Household smoking Day care Allergy ?Nutrition Bottle feeding Seasonal
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
how do you diagnose OME?
History Otoscopy Tuning fork tests Audiometry Tympanometry - pressure test
what are the signs of OME?
TM retraction Reduced TM mobility Altered TM colour Visible ME fluid/bubbles CHL tuning fork tests
what are the investigations used to diagnose OME?
Age appropriate hearing assessment”
Audiometry OAE Distraction testing COR PTA Tympanometry - pressure test
what is seen in the tympanogram in a patient with OME?
it is flat it signifies fluid in the middle ear
which ages do you not get an audiogram?
0-4 years
what assessment for 0-4 year olds?
age appropriate hearing assessment
what is the treatment of OME?
Watchful waiting” 60% resolved @ 1/12 90% resolved @ 3/12 Review @ 3/12 Otoscopy PTA Tympanometry Explanation
when is OME persistent?
OME persistent for > 3/12 with symptoms
Deafness
Speech
Balance
what might have some benefit in someone with persistent OME?
autoinflation - sqeeze nose and allow pressure equalizing
and urgent referral
when do you refer a patient with OME?
Persistent (> 3/12), bilateral OME
CHL >25dB
Speech/language problems
Developmental behavioral problems
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
are hearing aids indicated in patients with OME?
yes and always present that as an option to parents
what are the complications of OME?
Weak evidence of short term speech, language and behavioral development problems
No clear evidence of long term problems
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
