Adenotonsillar disease and OME Flashcards
What is the main function of the adenoids and tonsils?
Trap viruses and bacteria on inhalation and expose to the immune system: “prime” the immune system and prevent subsequent infection
What is Waldeyer’s ring?
Ring of lymphoid aggregation in the sub-epithelial layer of oropharynx and nasopharynx
What comprises Waldeyer’s ring?
Tonsils (palatine tonsil)
Adenoids (pharyngeal tonsil)
Lingual tonsil
Describe the aetiology of acute tonsillitis.
Mainly viral; 5-30% bacterial
Which viruses are often responsible for acute tonsillitis?
EBV, rhinoviruses, influenza, enterovirus
Why is strep pyogenes an important bacterial pathogen?
Potential sequelae- rheumatic fever, glomerulonephritis
What are the most common bacterial causes of chronic tonsillitis?
Group A strep
H. influenziae
S. aureus
Strep pneumoniae
What should be considered in the DDx of acute tonsillitis?
Viral URTI Diphtheria Glandular fever Peritonsillar abscess Malignancy
How do the symptoms of bacterial tonsillitis differ from viral?
Bacterial- more of a systemic upset- fever, odynophagia, usually unable to work/school, lymphadenopathy, lasts around a week (compared to 4 days), halitosis, requires antibiotics to settle
What is the purpose of the Centor criteria?
Help distinguish bacterial from viral tonsillitis
What is the empirical antibiotic treatment regimen for bacterial tonsillitis?
Penicillin 500mg qid for 10 days (clarithryomycin if allergic)
What are the SIGN guidelines for tonsillectomy?
Tonsillectomy should only be considered if:
a) 7 or more episodes in previous year
b) 5 or more episodes in each of two previous years
c) 3 or more episodes in each of three previous years
What is the classic history of a peritonsillar abscess?
Unilateral throat pain, trouble swallowing and trismus (unable to open mouth properly) and preceding case of acute tonsilitis
How is quinsy treated?
Aspiration of abscess and antibiotics
What do the tonsils look like in glandular fever?
Grossly enlarged with membranous exudate
What other signs are seen in glandular fever?
Marked cervical lymphadenopathy; generalised lymphadenopathy; hepatosplenomegaly; palatal petechial haemorrhage
How is mono diagnosed?
Atypical lymphocytes on blood film
+ve Monospot or Paul-Bunnell test
Low CRP
Why should ampicillin and amoxicillin never be used in glandular fever (or tonsillitis)?
Often causes a severe generalised macular rash in patients infected with EBV
What symptoms/signs are seen in chronic tonsillitis?
Chronic sore throat, halitosis, persistent tender cervical lymph nodes, peritonsillar erythema, presence of tonsilloliths
What is the definition of otitis media with effusion/glue ear/serous otitis media?
Inflammation of the middle ear with accumulation of fluid, without the symptoms and signs of acute inflammation
How does OME differ from AOM?
Fever/otalgia and bulging tympanic membrane are usually absent in OME
How does OME often present?
Conductive hearing loss; speech delay; behavioural problems; poor school performance
How is OME diagnosed?
Otoscopy; tuning fork tests; audiometry (conductive hearing loss); tympanometry
What is the general approach to treatment in OME?
“watchful waiting”- most clear up by 3/12
What are the criteria for referral in OME?
Persistent bilateral OME; conductive hearing loss >25dB; speech/language/behavioural problems
How is OME managed surgically?
Grommet; adenoidectomy if >3 years and second intervention
