Disorders of the pharynx Flashcards
How can we view the adenoids?
Fibre-optic endoscope
X-ray/MRI or theatre (if concerned about post-nasal space)
What is the arrow pointing too?
Adenoids
Give some common conditions which occur in each part of the pharynx
If our adenoids enlarge where may be get obstruction?
Nasal obstruction OR Eustachian tube obstruction
Give 4 consequences of nasal obstruction
Mouth breathing
Hyponasal speech
Feeding difficulty (esp. infants)
Snoring/Obstructive Sleep Apnoea
Give 2 consequences of eustachian tube obstruction
Recurrent acute otitis media (earache)
Chronic otitis media with effusion (glue ear, reduced hearing)
What MUST we think if we see a teenage boy with enlarged adenoids?
angiofibroma!! (vascular fibrous tumour in post-nasal space)
What MUST we think if we see an adult with enlarged adenoids?
Nasopharyngeal carcinoma or lymphoma
(remember: our adenoids should regress after puberty)
Lecture 6 revision
What is acute pharyngitis?
Inflamation of the oropharynx
What is Tonsillitis?
Inflamation of the tonsils
Acute pharyngitis and tonsilitis are usually bacteria or viral cause?
Viral or bacterial. Self limiting 3 - 7 days
What ‘score’ system can we use to determine whether a sore throat is likley to be bacterial or viral?
Centor Clinical presentation score:
- Fever
- Anterior cervical nodes
- Exudate
- Absent cough
3 out of 4 → 40-60% chance of bacterial Group A beta haemolytic streptococcus → treat with antibiotics
BUT most sore throats are viral!! → NO antibiotics
Give 3 local streptococcal sore throat complications
Otitis media
Sinusitis
Chest infection
Give 4 systemic streptococcal sore throat complications
Rheumatic fever
Glomerulonephritis
Meningitis
Toxic shock syndrome
Give 5 Sore throat Red flags!!
- Difficulty breathing
- Difficulty swallowing saliva/drooling
- Difficulty opening mouth (trismus)
- Severe pain (especially unilateral)
- Persistent high fever
What usually causes Tonsillitis?
Viral or beta haemolytic strep
(can also be strep pneumonia, haemophilus influenza or others)
Give 2 complications of tonsilitis
1) abcess formation- peritonsillar ( quinsy)
2) retropharyngeal or parapharyngeal abscess
What is the antibiotic of choise used to treat tonsilitis?
phenoxymethylpenicillin or macroglycoside eg. erythromycin
What other serious condition may present similarly to tonsilitis?
MUST consider Glandular fever (EBV). This is longer and more severe
Give 4 indications for a Tonsillectomy?
1) Recurrent tonsillitis (5/year for at least 2 years)
2) Previous peritonsillar abscess (quinsy)
3) Suspected cancer (unilateral enlargement/ulceration)
4) Obstructive sleep apnoea syndrome
Give 3 risks of a tonsillectomy
- GA (general anaesthetics)
- Bleeding (primary (within 24 hours) or secondary)
- Infection
Give 3 other tonsil conditions
What causes Snoring?
Vibration of pharyngeal structures such as the tongue, soft palate and pharyngeal walls
Give 5 things that cause/worsen snoring
1) nasal or nasopharyngeal obstruction
2) large tongue or tongue falling back into throat
3) obesity (MAJOR)
4) excessive tiredness / alcohol
5) 60% men over 60
Give 4 managements of snoring
1) Lifestyle: lose weight, less alcohol, stop smoking)
2) Treat nasal obstruction
3) Mandibular advancement device
4) Surgery: adenotonsillectomy or uvulopalatopharyngoplasty
What is obstructive sleep apnoea?
When people stop breathing in their sleep causing oxygen desaturation (decrease blood O2) because O2 isn’t suffiencently reaching lungs
Results from partial/complete airway obstruction during sleep which therfore causes turbulent airflow
Spectrum ranging from mild snoring to OSA
What defines abnormal sleep apnoea?
Over 30 apnoeic episodes in 7 hours of sleep (5 apnoeic episodes/hour)
List 3 symptoms of sleep apnoea and why these occur
Daytime lethargy, sleepiness and reduced concentration
This occur because each time we stop breathing during sleep, the brain detects O2 is desaturated and wakes us up to take a breath.
BUT this means we are constantly waking in the night, resulting in the symptoms above
Sever sleep apnoea can lead to what?
If severe can cause hypoxia and increase CVS strain: pulmonary hypertension → right heart failure → cor pulmonale
Give 2 investigations for sleep apnoea
1) nasendoscopic examination of pharynx
2) sleep studies
Give 4 treatments for sleep apnoea
1) Weight loss
2) Surgery for structural causes eg nasal polyps; adenoids/ adenotonsillectomy
3) CPAP-Continuous Positive Airways Pressure
Define dysphagia and give 4 signs/symptoms
Difficulty swallowing:
Signs/symptoms
- Food or fluid getting stuck
- Choking
- Pain swallowing (odynophagia)
- Regurgitation of food
- Feeling of something in throat (FOSIT)
Give 4 causes of Acute dysphagia?
tonsillitis, pharyngitis, aphthous ulcers foreign bodies , ingestion of caustic liquids
Give 4 causes of chronic dysphagia?
Give 4 red flags associated with dysphagia
- True dysphagia (solids more than liquids)
- Hoarse/ breathing difficulties
- Pain
- Otalgia
- Weight and appetite loss • Neck nodes
- Neurological deficit
- Drooling
- Rapid onset
- Risk factors: smoking, HPV
How do we investigate dysphagia
FBC, ESR
Nasendoscopy
Upper GI endoscopy
Barium swallow
What is Pharyngeal Pouch?
Give 3 reasons it may occur?
Posterior herniation of pharyngeal mucosa that occurs through Killian’s dehiscence
Reasons:
- Weaker area
- Incoordination of pharyngeal phase of swallowing
- Cricopharyngeal spasm
Where is Killian’s dehiscence?
What is its anatomical significance?
Between thyropharyngeus and cricopharyngeus parts of inferior constrictor
Here is a weaker area of the posterior pharyngeal muscles which can result in Pharyngeal Pouch
How would you diagnose Pharyngeal Pouch?
Barium swallow
What is Globus pharyngeus?
A benign condition that is characterised by a feeling of something in throat. Worse swallowing own saliva (no probems with eating or drinking)
Patient will usually be seen throat clearing
Associated with Acid reflux
NO red flag symptoms
How would you treat Globus pharyngeus?
Reassurance and Treat acid reflux
Give 3 common sites for a Foreign body to lodge
Tonsil, piriform fossa, cricopharyngeus
Give some symptoms/history of someone with a stuck foreign body
What else MUST we think?
- Well localised
- Immediate sensation
- Inability to swallow saliva
- drooling
THINK!? Underlying oesophageal narrowing?
How would we dianose a foreign body
Lateral soft tissue neck xray
