Adenotonsillar disease and OME Flashcards
How do the adenoids develop?
subepithelial infiltration of lymphocytes
What age is significant adenotonsilar enlargement unsual?
under 2
When do the tonsils and sdenoids decrease in bulk?
after early teenage years
What is Waldeyer’s ring?
a ring of lymphoid aggregation in the subepithelial layer of oropharynx and nasopharynx
What does Waldeyer’s ring comprise of?
palatine tonsil; adenoids; lingual tonsil
What muscle forms the anterior tonsillar pillar?
palatoglossus
What muscle forms the posterior tonsillar pillar?
palatopharyngeus
What covers the surface of the tonsil?
stratified squamous epithelium
What separates the base of the tonsil from underlying muscle?
dense collagenous hemi-capsule
What is the surface of the adenoids?
pseudo-stratified columnar epithelium which functions in mucociliary clearnance and stratified squamous underneath this
What mainly causes adenotonsilitis?
viral- EBV; rhinovirus; influenza; parainfluenzae; enterovirus
What are the main bacteria in tonsilitis?
s. pyogenes; h. influenzae; s. aureus; s. pneumoniae
What are hte symtpoms of bacterial tonsilitis?
systemic upset; fever; odynophagia; halitosis; unable to work/cshool; lymphadenpathy
What is the centor criteria?
hx of fever; tonsillar exudates; tender anterior cervical lymphadenopthy; absence of cough
What antibiotic is used in tonsilitis?
penicillin
What is the “bad day” post tonsillectomy?
day 5
What is a quinsy?
a peritonsillar abscess- complication of acute tonsilitis
What is the classic history of peritonsilar abscess?
unilateral throat pain and odynophagia; trismus; 3-7 days preceding acute tonsilitis
What is trismus?
difficulty opening the mouth
What is the treatment of a quinsy?
aspiration and antibiotics
What is seen on exam of a quinsy?
medial displacement of tonsil and uvula and concavity of palate lost
What are the signs of infectious mononucleosis?
groos tonsillar enlargement with membranous exudate; marked cervical lymphadenopathy; palatal petechial haemorrhages; generalised lymphadenopathy; hepatosplenomegaly
How is glandular fever diagnosed?
atyi=pical lymphocytes in peripheral blood; +ve monospot; low CRP
What is chronic tonsilitis?
chronic sore throat; malodorous breath; presence of tonsilliths; peritonsillar erythema; persistent tender cervical lymphadenopathy
What does obstructive hyperplasia of the adenoids result in?
obligate mouth breathing; hyponasal voice; snoring and other sleep disturbance; AOM/OME
What are the signs of tonsillar obstructive hyperplasia?
snoring; muffled voice; dysphagia
What is important to identify in unilateral tonsillar enlargement?
if the enlargemnet is apparent or true
What are reasons for apparent enlargement?
tonsil sits in more medial position; displacement medially by PTA or parapharyngeal space masss
What are the causes of unilateral tonsillar enlargement?
non-neoplastic= acute or chronic infective; hypertrophy; congential
neoplastic- papilloma; lymphoma; SCC
What is OME?
inflam of the middle ear accompanied by the accumulation of fluid without signs of acute inflam
Who gets OME?
boys more than girls; incidence decreases with age
What are the risk factors for OME?
day care; older siblings; smoking household; recurrrent URTI
