Ear, nose, and throat pathology Flashcards
1
Q
Chrondrodermatitis nodularis helicis (CNH- cauliflower ear))
A
- Inflammatory condition of the skin and cartilage of the ear cause by minor trauma, sun damage, prolonged and excessive pressure or cold
- Appears as painful nodule on helix or anti helix of ear
- Nodules are firm, tender, round-oval, and may show ulceration
- Mostly middle aged to elderly mean and fair skinned people (from sun damage)
- Due to trauma + infection-> necrosis + fibrosis
- Hematomas to the ear from trauma develop btwn perichondrium and elastic cartilage
2
Q
Otitis externa
A
- External auditory canal inflammation cause by saprophytic fungi (usually aspergillus)
- Causes pain and thick discharge
- Excessive exposure to water or retention of foreign bodies in canal predispose the infection
- Associated w/ altered immune status- diabetes
- Swimmers ear (an ex of otitis externa) is due to trapping of moisture and debris in, causing disruption of the protective layer and alkalization of the ear leading to pseudomonas, staph, and fungal infections
3
Q
Acute otitis media
A
- Occurs mostly in infants and children, may be viral or bacterial
- Most common bacteria: H flu, strep pneumo, moraxella cat, strep pyogenes, staph epidermidis
- Tympanic membrane may be seen as red and bulging, possibly w/ pus in middle ear
- Stages: hyperemia, congestion/exudate formation, TM rupture, spread to mastoid or intracranial cavity
- Otitis media often due to eustachian tube dysfxn in children, leading to inability to drain middle ear (can insert ventilation tube to help drain)
- Cleft palate associated w/ eustachian tube dysfxn
- Other predisposing factors: young age, male, bottle feeding, crowded living conditions
4
Q
Chronic otitis media
A
- Chronic infection may lead to perforation of the tympanic membrane and can lead to hearing loss
- If pt is diabetic think pseudomonas
- Retraction pockets created in the tympanic membrane may lead to formation of cholesteatomas (cystic lesions lined by keratinizing squamous epithelium)
- Cholesteatomas are characterized by skin from outer ear gets into middle ear and usually a polyp forms on the outside of the retraction pocket
5
Q
Labyrinthitis
A
- Acute inflammation of the inner ear structures
- May result in nausea, vomiting, vertigo, or hearing loss
- Usually viral cause, causing a proteinaceous precipitate
6
Q
Carcinomas of the ear
A
- Can be either basal (deeper in dermis) or squamous cell (superficial in dermis)
- Basal cell is more common, squamous more likely to met
- Grossly (basal): pearly raised border of epithelium surrounding a rodent ulceration thats covered by crusty material
- Grossly (squamous): papule that enlarges and ulcerates, may also be pearly and look like basal cell
- Micro the squamous cell CA show keratin pearls and intracellular bridges
- Lesions tend to be in elderly men, associated w/ sun exposure
- Mets from basal cell are rare, more common in squamous cell (always biopsy things thought to be infectious that don’t resolve)
- Squamous cell of the ear and lower lip have >2x the met rate than squamous cell CA on other areas
- Keratoses (premalignant): irregular scaly plaque varying from gray to brown
7
Q
Fibrous proliferative lesions of oral cavity 1
A
- Irritation fibroma: usually arises at bite line of mouth or gingivodental junction
- Nodular mass of fibrous tissue w/ minimal inflammation
- Pyogenic granuloma (misnomer): arises in gingiva of children/young adults, commonly in pregnant women
- Is a type of hemangioma, demonstrating dense vascular proliferation similar to granulation tissue
- Lesions are typically solitary, rapidly growing bright red papules
- Hallmark is ulceration/bleeding w/ little provocation
8
Q
Fibrous proliferative lesions of oral cavity 2
A
- Peripheral ossifying fibroma: reactive gingival growth of uncertain etiology
- Has a red ulcerated nodular appearance, seen as bone surrounded by fibrous tissue (often in young females)
- Aphthous ulcers (canker sore): usually arises in first two decades, lesions are painful, shallow red ulcers covered w/ thin mononuclear exudate
- Resolve in 1-2 wks and often are recurrent
9
Q
HSV infection of oral cavity
A
- Usually HSV1, primary infection occurs in 2-4 year (usually ASx)
- Some have abrupt eruption of vesicles and ulcerations throughout the oral cavity (particularly gingiva)
- Reactivation of HSV associated w/ allergies, URTI, UV light, immunosuppression, heat/cold
10
Q
Oral candidiasis
A
- 3 kinds: pseudomembranous (thrush), erythematous, hyperplastic
- Thrush: thick, superficial white-gray membranous exudate on tongue that is easily scraped away (able to scrape it away distinguishes it from leukoplakia)
- Thrush looks like spaghetti and meatballs under LM
11
Q
Hairy leukoplakia (benign)
A
- Caused by EBV, but is indicative of underlying systemic disease (AIDS)
- Characterized by white confluent hyperkeratotic thick patches w/ a feathery or fluffy pattern that usually is present on lateral borders of the tongue
- Histo: hyperparakeratosis and acanthosis w/ koilocytosis (clear circles w/ inclusion in middle)
- Is not able to be scraped off
12
Q
Leukoplakia
A
- Precancerous lesion: patchy white plaque that cannot be scraped off (differentiates from oral candidiasis)
- All lesions considered premalignant till proven otherwise
- The lesions are highly variable, his to shows hyperkeratosis ranging from orderly squamous mucosa to dysplastic epithelium
- Not associated w/ HIV/AIDS
- Erythroplakia: red velvety plaque in oral cavity (usually on tongue for women or floor of mouth in men)
- Histo is more atypical then leukoplakia, thus has higher rate of malignancy
- Both leukoplakia and erythroplakia are associated w/ tobacco use
13
Q
Squamous cell CA (SCC) of oral cavity
A
- Usually presents as late stage and thus has poor 5 yr survival
- Associated w/ alcohol and tobacco use, HPV infection
- Occurs largely in middle aged men
- Most common site of presentation is under the tongue
- Histo: dysplasia +/- epithelial thickness and invasion
- Grossly the lesions are pearly plaques that may ulcerate
- Local mets to cervical LNs, distant mets to mediastinum, lungs, liver, bones
14
Q
Inflammation of nose, sinus, nasopharynx 1
A
- Infectious rhinitis: common cold caused by adenovirus or rhinovirus
- Leads to thickened red edematous nasal mucosa w/ narrowed nasal cavity
- Secondary bacterial infection may occur
- Allergic rhinitis: due to plant/animal pollens, fungi, dust
- Causes an IgE mediated reaction, hyperemia, edema, and mucus secretion characterized by abundant eosinophils
- Nasal polyps: recurrent rhinitis can lead to pale grey polyps, which may ulcerated and become bacterially infected
- Polyps can also impair sinus drainage (usually on middle meatus) and are often seen in CF pts
- Sinusitis: commonly follows acute or chronic rhinitis, usually due to normal oral flora
- Empyema may occur due to blockage of sinus drainage
15
Q
Inflammation of nose, sinus, nasopharynx 2
A
- Mucormycosis fungal infection may cause a serious chronic sinusitis particularly in diabetics
- Another possibly etiology is aspergillus
- Chronic sinusitis may spread to orbit, bones (osteomyelitis), cranium (septic thrombophlebitis of dural sinuses)
- Pharyngitis/tonsillitis: usually due to rhinoviruses, RSV, adenoviruses, influenza
- Bacterial infections may occur as primary or superimposed infections (think strep pyogenes or staph aureus)
- Exudates are more commonly seen with bacterial etiologies
