ENT Flashcards
What is torus palatinus?
A benign bony growth (exostosis) located on the midline suture of the hard palate.
It can be congenital or develop later in life. More common in women and Asian individuals.
Typically chronic and asymptomatic, usually <2cm but can gradually enlarge over time.
Dx: clinical
Tx: surgery (symptomatic mass that interferes with speech or eating, or causes problems with fitting dentures later in life)
What is a nasal septal perforation?
Less common, but more serious complication of rhinoplasty.
Etiology: likely resulting from a septal hematoma
Presentation: whistling noise during respiration following rhinoplasty
What is infectious epiglottitis?
A cellulitis of epiglottis, aryepiglottic folds, and other adjacent tissue
Epi: s. pneumo, h. influenzae; risk reduced with h. influ vaccination
RF: DM, obesity, preceding URI
Presentation: rapidly progressive and life threatening; fever, sore throat, drooling, muffled voice; airway obstruction (stridor, dyspnea); pooled oropharynx secretions, laryngotracheal tenderness
Dx: direct visualization; imaging (lateral neck XR)
Tx: early artificial airway (if needed); IV abx (ceftriaxone plus vancomycin)
What is oropharyngeal squamous cell carcinoma?
Ulcerated tonsillar lesion in smoker is likely due to oropharyngeal SCC
RF: >40yo, tobacco use, etoh use, immunocompromised state, HPV in younger pts and absence of smoking hx
Presentation: sore throat, odynophagia due to tumor invasion or local irritation, halitosis; referred otalgia (CN 9 has afferent fibers innervating base of tongue, afferent sensory input from ext aud canal; CN 10 innervates parts of larynx and hypopharynx, provides sensory innervation to ext aud canal) or an isolated neck mass (representing regional nodal spread of disease/cervical lymphadenopathy; may be first and only apparent manifestation)
Dx: biopsy of tonsil lesion, evaluation of HPV status, neck imaging (CT scan), flexible laryngopharyngoscopy (endoscopic visualization) to identify primary tumor site
What is nasopharyngeal carcinoma?
Facial pain, wt loss, mass typically unilateral, dx in pts >50y
Assoc. w/ reactivation of Epstein-Barr virus; most commonly occurs in Asians (southern China), parts of Africa and the Middle East
RF: diet (salty fish), smoking, genetics
Presentation: obstruction - nasal congestion w/ epistaxis, headaches; mass effect - cranial nerve palsies, otitis media; spread - neck mass (cervical lymphadenopathy)
Early spread to the cervical lymph nodes is common and may cause a nontender neck mass
Dx: endoscope-guided biopsy of primary tumor
Tx: radiation therapy, chemotherapy
What is a peritonsillar abscess?
An acute bacterial infection of the region between the tonsil and pharyngeal muscles
Presentation: fever, sore throat, difficulty swallowing, trismus (spasm of the jaw muscles), muffled “hot potato” voice, swelling of peritonsillar tissues, uvula deviation away from enlarged tonsil, pooling of saliva
Tx: needle aspiration or incision and drainage + antibiotic therapy to cover group A hemolytic streptococci and respiratory anaerobes
What is a retropharyngeal abscess?
Presentation: neck pain, odynophagia, fever following penetrating trauma to posterior pharynx
Infection w/in the retropharyngeal space can drain into the superior mediastinum; spread to carotid sheath can cause thrombosis of internal jugular vein and deficits in CN 9, 10, 11, 12
Extension through the alar fascia into the “danger space” can transmit infection into the posterior mediastinum and result in acute necrotizing mediastinitis, a life threatening complication characterized by fever, chest pain, dyspnea, and odynophagia, and requires urgent surgical intervention
Infection can drain into the superior mediastinum. Extension through the alar fascia into the “danger space” can transmit infection into the posterior mediastinum and result in acute necrotizing mediastinitis.
What is sialadenosis?
A benign, noninflammatory enlargement of the salivary glands.
Presentation: bilateral non-tender enlargement of submandibular glands
Commonly found in pts with advanced liver disease (e.g., alcoholic and nonalcoholic cirrhosis); also seen in pts with altered dietary patterns or malnutrition (eg diabetes, bulimia)
Tx: no mgmt needed other than to address any underlying nutritional disorders
What is leukoplakia?
A reactive precancerous lesion that represents hyperplasia of the squamous epithelium.
RF: smokeless tobacco and alcohol use; 1-20% progress to squamous carcinoma
Plaques CANNOT be easily scraped off
What is recurrent respiratory papillomatosis?
Results in larygneal papillomas presenting as irregular, exophytic growths in clusters on surface of true vocal cords
Due to HPV 6 + 11
Tx: mainstay is surgical debridement
What is Lemierre syndrome?
Etiology: fusobacterium necrophorum
A life-threatening deep neck space infection progressing to supporative thrombophlebitis of the internal jugular vein
Presents with acute (<1 week) painful pharyngitis, odynophagia, toxicity (higher fevers >102), rigors, respiratory distress from assoc. septic pulmonary emboli
What is acute otitis media?
Infection of middle ear fluid
Often follows URI
Presentation: decreased mobility on pneumatic insufflation (indicates middle ear effusion), bulging tympanic membrane (reflects middle ear inflammation)
What is chronic suppurative otitis media?
> 6 weeks; middle ear inflammation in addition to hearing loss + otorrhea.
What is serous otitis media?
Otitis media w/ effusion, lack of acute inflammatory signs (fever, tympanic membrane bulging).
Can be asx and present weeks following AOM treatment or if chronic can lead to hearing loss.
What is cholesteatoma?
Congenital or acquired secondary to chronic middle ear disease
Benign growth of squamous epithelium w/ accumulation of keratin debris w/in middle ear;
dx should be suspected in any pt w/ continued ear drainage for several weeks despite appropriate abx
chronic middle ear disease leads to formation of a retraction pocket in the TM, which can fill w/ granulation tissue and skin debris, leading to chronic otorrhea and conductive hearing loss
Exam: pearly white mass
Complications: hearing loss, CN palsies, vertigo, life-threatening infections
Dx: CT and/or surgical visualization to confirm dx
Tx: surgical excision
