Adenotonsillar Disease and Otitis Media with Effusion Flashcards
Where does the tonsillar fossa and palatine tonsils develop from
The 1st pharyngeal pouch and the 2 pouch
What is the main function of the tonsils
To trap bacteria and viruses on inhalation
Help to prime immune system and prevent subsequent infections
At what age is significant adenotonsilar enlargement unusual?
under 2 years
What structures make up Waldeyer’s ring
Tonsils (palatine)
Adenoids
Lingual tonsil
Where is the Waldeyer’s ring located
In the sub epithelial layer of oropharynx and nasopharynx
The tonsil is nestled in a fossa formed by muscles. What muscles are they
anterior and posterior tonsillar pillars (palatoglossus and palatopharyngeus)
Describe the anatomical location of the adenoid
In the midline of the posterior wall of the Nasopharynx immediately inferior to the rostrum of the sphenoid
It makes up most of the Waldeyer’s ring
What type of cells cover the surface of the tonsil
Stratified squamous epithelium
How does the surface of the adenoids differ from the surface of the tonsils
Adenoids have deep folds and few crypts
Tonsils have from 10-30 crypts
What type of cells are found where air goes e.g. nose, PNS, larynx and trachea
columnar
What type of cells are found where food goes e.g. oral, pharyngeal, vocal cords, oesophagus
Squamous
What type of cells are found in the upper aerodigestive
Ciliated columnar respiratory type mucosa and squamous epithelium
Name some common diseases of the tonsils and adenoids
acute tonsillitis recurrent/ chronic adenoiditis / tonsilitis Obstructive hyperplasia malignancy tonsil crypt debris / tonsiliths
What are the main causes of acute tonsillitis
Majority viral (EBV or Rhinovirus, influenza etc) Some bacterial (up to 30%)
Why are throat swabs discouraged
Core species do not always correlate with surface bacteria - does not confirm causative organism
What are some of the most commonly cultured organisms from patients with chronic tonsillar disease
Strep pyogenes
H influenza
S aureus
Strep pneumonia
What else should be included in a differential diagnosis of Acute tonsillitis
URTI viral infection Infectious mononucleosi Peritonsilar abscess Candida infection Malignancy: lymphoma, leukaemia, carcinoma Diptheria Scarlet fever
What are symptoms of viral tonsillitis
Malaise Sore throat Temperature Lasts 3-4 days lymphadenopathy (possibility) Able to undertake normal activity
What are symptoms of bacterial symptoms of tonsillitis
Systemic upset fever odynophagia halitosis unable to work/ school lymphadenopathy (tonsilar nodes particularly) lasts 1 week Requires antibiotics
What criteria helps us to differentiate between viral and bacterial tonsillitis
Centor Criteria
What are the 4 major points in the centor criteria
History of fever
Tonsillar exudates
Tender anterior cervical adenopathy
Absence of cough
What is the supportive treatment for tonsillitis
Eat and drink
Rest
TOC analgesia
What antibiotic should be prescribed if necessary for tonsilitis
Penicillin 500mg qid for 10 days
Clarithromycin if allergic
If hospital admission is required for tonsillitis, wha would be involved
IV fluids
IV antibiotics
Steroids
What are the downfalls of surgical management of tonsillitis
Very sore after
Bad day around day 5 then get better
strong opiates can be required
Lots of scarring post op
How does a peritonsilar abscess arise
A complication of acute tonsillitis
Bacteria between muscle and tonsil produce pus
What is a classic history of a peritonsilar abscess
Unilateral throat pain and odynophagia (pain on swallowing in the mouth)
Trismus (mouth tightly closed)
3-7 days of preceding acute tonsillitis
What is the treatment for a peritonsilar abscess
Aspiration and antibiotics
What are some signs of glandular fever
Fross tonsillar enlargement with membranous exudate Marked cervical lymphadenopathy Palatal petechial haemorrhages Generalised lymphadenopathy Hepatosplenomegaly
How is a diagnosis of Glandular fever made
Atypical lymphcocytes in peripheral blood
+ve monospot or paul bunnell test
low CRP
What should not be prescribed in a patient with glandular fever and why
Amoxicillin - it causes a generalised macular rash
What are some symptoms of chronic tonsillitis
Chronic sore throat Malodorous breath Presence of tonsilliths Peritonsillar erythema Persistent tender cervical lymphadenopathy
What are some symptoms of obstructive hyperplasia of the adenoids
Obligate mouth breathing
Hypo nasal voice
Snoring and other signs of sleep disturbance
What are some symptoms of obstructive hyperplasia of the tonsils
Snoring and other symptoms of sleep disturbance
Muffled voice
Dysphagia
What is glue ear
Fluid in the middle ear space
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 of acute inflammation with or without an accumulation of fluid
What sex is more likely to develop OME
Males
Why is there an increased incidence of children with OME
Day care
older siblings
smoking household
recurrent URTI
What are some symptoms of OME
Deafness
poor school performance
behavioural problems
speech delay - low frequency problems
NOT otalgia
What does tympanometry measure
Pressure
How is a diagnosis of OME made
History Otoscopy Tuning fork tests Audiometry Tympanometry
What are some signs of OME
TM retraction
reduced TM mobility
Altered TM colour
Visible ME fluid/ bubbbles
What is the treatment for OME
Watchful waiting and review at 3 months
At 3 months: otoscopy, PTA, tympanometry
Explanaiton
What is the surgical management for
grommets
What are some complications of OME
Weak evidence of short term speech language and behavioural development problems
No clear evidence of long term problems
What are some complications of grommets
Infection / dishcarge Early extrusion Retention Persistent perforation Swimming /bathing issues
