Benign ENT Disease

Question 1

Problems with the oral cavity (preparation)

Answer 1

-Weak tongue
-Poor teeth
-Facial weakness
-Obstructing pathology

Question 2

Problems with oropharyngeal (initiation)

Answer 2

-Velopharyngeal insufficiency
-Altered sensation
-Tumour
-Surgery

Question 3

Hypopharyngeal problems (often aspiration)

Answer 3

-Vocal cord palsy (vocal cord medialisation in recurrent laryngeal nerve injury)
-Reduced supraglottic sensation
-Tumour
-Radiotherapy/ surgery
-Neurological
-Cricopharyngeal spasm

Question 4

Problems with pharyngeal pouch/ oesophageal (dysphagia) and management

Answer 4

-Stricture
-Reflux
-Extrinsic compression
-Tumour
-Dysmotility

=Endoscopic stapling/ open repair

Question 5

Examples of inflammatory/ infective causes of sore throat

Answer 5

-Tonsillitis
-Pharyngitis
-Reflux
-Smoking
-Alcohol
-Mouth breathing

Question 6

Common head and neck infections

Answer 6

-Tonsillitis
-Quinsy/ parapharyngeal abscess
-Pharyngitis
-Supraglottitis/ epiglottitis
-Sialadenitis (trapped saliva in parotid duct)
-Role of throat swab

Question 7

Overview of tonsillitis

Answer 7

-Presentation: fever, malaise, lymphadenopathy, pharyngitis, oedematous pustules (strep pyogenes). No stridor!
-Investigation:
-Management: analgesia, abx, hydration, surgery (tonsillectomy if 7x1 yr, 5x2 yr, 3x3 yr)

Question 8

Overview of quinsy/ peritonsillar abscess

Answer 8

-Presentation: one sided, referred otalgia, trismus, pyrexia. uvular and soft palatal shift
-Investigation:
-Management: IV fluids, IV abx, needle aspiration of pus

Question 9

Overview of parapharyngeal abscess/ deep neck space infection

Answer 9

-Presentation: history of URTI/ tonsillitis, throat pain, odynophagia, fever, neck swelling and tenderness, lymphadenopathy, neck stiffness, occasionally airway compromise
-Investigation: USS, CT, MRI
-Management: IV fluids and abx, airway protection, needle/ open surgical drainage.

Question 10

Overview of glandular fever

Answer 10

-Presentation: can look like tonsillitis, lymphadenopathy, hepatosplenomegaly
-Investigation: EBV serology
-Management: IV fluids, ?abx, IV steroids, LFT, avoid contact sports

Question 11

Overview of laryngitis/ Supraglottitis

Answer 11

-Presentation: fever, very sore throat with not much to see, odynophagia/ drooling, stridor, neck stiffness
-Investigation:
-Management: hospitalisation, IVI, IV abx and steroid, nebulised adrenaline, airway assessment

Question 12

Roles of the larynx

Answer 12

-Airway
-Airway protection
-Increasing intra-thoracic/ intra-abdominal pressure
-Voice

Question 13

Describe hoarseness and causes

Answer 13

-Form of dysphonia
-Usually multifactorial
-Hoarseness >3 weeks needs investigated in context
=Older= cancer

-Silent reflux
-Laryngitis
-Reinke’s oedema (inflammation of false cords)
-Lung malignancy needs to be ruled out

Question 14

Complications of GORD with laryngopharyngeal reflux

Answer 14

-Rhinitis
-Post nasal discharge
-Pharyngitis
-Halitosis
-Hoarseness
-Globus
-DUE TO PEPSIN

Question 15

Features of airway obstruction

Answer 15

-Stertor (noisy breathing due to obstruction above the larynx)
-Stridor (due to obstruction below or at larynx)
-Ronchi (due to narrowing of the lower respiratory airways)

Question 16

Classification of neck trauma

Answer 16

-Sharp (superficial, penetrating)
-Blunt
-Burn/ scald
-Foreign body

Question 17

Management of superficial sharp trauma

Answer 17

-Require careful assessment to exclude damage to important deep structures
-If there is any doubt on simple examination the wound requires formal surgical exploration
-If no deep involvement: wound can be thoroughly cleaned and closed primarily
-Multiple superficial slashes or scratches are often a feature of self inflicted inj

Question 18

Management of penetrating/ deep sharp trauma

Answer 18

-Require emergency surgical exploration under GA with primary repair of injuries to deep structures
-Antibiotic and tetanus cover are require

Question 19

Management of blunt trauma

Answer 19

-Consider c spine injury
-Risk of crush trauma to larynx > significant oedema
=assessment to establish likely severity of injury
=external signs bruising/swelling/crepitus
=endoscopic examination of laryngopharynx
=laryngeal oedema- intervention required

-Protect airway by laryngeal intubation with ENT ready for tracheostomy
-Following intubation CT scanning
-Planned extubating once oedema settled

Question 20

Management of burns and scalds

Answer 20

-Dyspnoea and dysphagia
-Intubation or tracheostomy
-Steroids, antibiotics and analgesia
-Severe injury often fatal

Question 21

Overview of inhaled foreign body

Answer 21

-Presentation: shortness of breath, stridor, hoarseness, reduced air entry, often nothing in small children initially
-Investigation and management: flexible laryngopharyngoscopy, lateral soft tissue neck x-ray, CXR

Question 22

Overview of ingested foreign bodies

Answer 22

-Presentation: dysphagia, drooling
-Management: flexible laryngopharyngoscopy, CXR, lateral soft tissue neck x ray, emergency endoscopy and removal for sharp objects, soft food bolus= conservation with buscopan and endoscopy

Question 23

Management of stridor

Answer 23

-Resus
-Dexamethasone IV
-IV abx (ceftriaxone and metronidazole)
-Adrenaline nebs
-Oxygen

-Assess airway using fibreoptic endoscope= are they tubable? Does it need to be secured?