Disorders of the Pharynx

Question 1

Tell me a bit about adenoids.

Answer 1

Mass of lymphoid tissue
Produce IgA, IgG, IgM
Maximal size 3-8 years (then regress)
Enlargement with viral/bacterial infections

Question 2

What are the effects of adenoid enlargement?

Answer 2

Nasal obstruction

• Mouth breathing
• Hyponasal speech
• Feeding difficulty (esp. infants)
• Snoring/Obstructive Sleep Apnoea

Eustachian tube obstruction
- Recurrent acute otitis media (earache)
- Chronic otitis media with effusion (glue ear, reduced
hearing)

Question 3

How do you asses adenoids?

Answer 3

Difficult.

Post-nasal space x-ray
Post-nasal mirror
Fibre-optic endoscope
Theatre

Question 4

What is Obstructive Sleep Apnoea?

Answer 4

Spectrum from mild snoring to OSA
Partial/complete airway obstruction during sleep - turbulent airflow
Over 30 apnoeic episodes in 7 hours of sleep
5 apnoeic episodes/hour
Daytime tiredness
If severe can cause hypoxia and increase cardiovascular strain

Question 5

What is an adenoidectomy and what are the complications?

Answer 5

Removal of the adenoids
Curettage (blind)
Suction diathermy (mirror)

Complications:

• Bleeding
• Atlanto-occipital joint dislocation (from infection)
• Eustachian tube stenosis

Question 6

Tell me about nasopharyngeal carcinomas.

Answer 6

More common in Chinese population
Usually squamous cell carcinoma
TNM staging
Radiotherapy
Limited role fro chemotherapy & surgery

Question 7

What indications are there to require a tonsillectomy?

Answer 7

Recurrent tonsillitis (5/year for at least 2 years)
Previous peritonsillar abscess (quinsy)
Suspected cancer (unilateral enlargement/ulceration)
Obstructive sleep apnoea syndrome

Question 8

What are the risks of a tonsillectomy?

Answer 8

General anaesthetics
Bleeding (primary or secondary) approx. 3%
Infection

Question 9

What techniques are used in a tonsillectomy?

Answer 9

Cold steel instruments
Guillotine
electro surgery
Diathermy
Radio wave

Question 10

What is a pharyngeal pouch and why does it happen?

Answer 10

Posterior herniation of pharyngeal mucosa
Occurs through Killian’s dehiscence
- Between inferior constrictor and cricopharyngeus

Because:

• Weaker area
• Incoordination of pharyngeal phase of swallowing
• Cricopharyngeal spasm