ENT flashcards
at risk of second primary cancerization
entire upper aerodigestive tract
high risk pts for head and neck cancer
tabacco and alocohol users
leukoplakia
white plaque cannot be easily scraped off without bleeding. 5% chance of becoming cancerous
erythroplasia
More severe than leukoplakia. 75% chance of becoming cancerous
stridor
noisy breathing ingeneral. Oftenassociated with croup.
2 most common premalignant signs in the oropharynx
erythroplakia and leukoplakia
oral lesion persisting more than 3 weeks…
needs a biopsy
Most common type of cancer of the oropharynx.
squamous cell carcinoma
most common lip cancer located..
lower lip – tobacco, alcohol, chronic sun exposure
cancer of the upper lip is most commonly…
BCCA – basal cell carcinoma
neck mass referral if longer than…
3 weeks
adenoid cystic carcinoma
bucal mucosa
HPV associated oropharyngeal cancer
has gone up. 50% of SCCA oropharynx is HPV +
considered non-smoker
<10 pack year
HPV basaloid squamous cell ca
younger pts, with cystic neck mass, low tobacco and OH utilization.
HPV high risk
more than 7 sexual partners, more than 4 oro-genital sex partners. Associated with open mouth kissing.
How come HPV?
dysregulation of molecules. E6 decreases P53 activity. E7 decreases RB activity
HPV possitive cancers have an ______ survival rate when compared with other oropharyngeal cancers.
increased
what structure are you most likely to injure when operating on parotid gland?
VII – facial
Stensen’s duct …
pierces buccinator at the 2nd molar
parotid, submandibular, and sublingual glands
parotid has the highest proportion of neoplasms, minor salivary glads have highest proportions of malignancy.
Bicellular theory
neoplastic development within the salivary glands originates from basal cells seen in excretory and intercalated ducts.
excretory duct neoplasms
SCCA and mucopeidermoid carcinoma.
intercalated duct neoplasms
pleomorphic adenoma, warthin’s tumor, oncocytoma, acinic cell carcinoma, and adenoid cystic carcinoma.
Multicellular theory
neoplasm development is from DIFFERENTIATED cells within the salivary gland unit.
striated duct neoplasms
oncocytic tumors
acinar cell neoplasms
acinic cell carcinoms
parotid tumors
mostly painless, if painful – pain, facial nerve paralysis or numbness, trismus.
pleomorphic adenoma
benign mixed tumor, parotid, 30s-50s, women, slow growing, painless, firm. Solitary, tail of superficial lobe – no effect on CN VII. Well encapsulated – demarcated. Chondroid stroma.
Warthins tumor
2nd most common benign parotid neoplasm. Papillary cystadenoma lymphomatosum. Males 30+. Only neoplasm associated with tobacco and EtOH. Aspirate straw colored fluid. Cysts with shaggy irregular lining. Pathognomonic features – epithelial cells forming papillary projections into cystic spaces in a backround of lymphoid stroma.
Oncocytoma
rare. 50s. Benign salivary neoplasms. Mostly in parotid gland. Lots of mitochondria. Special staining to make diagnosis.
Mucoepidermoid carcinoma
most common parotid malignancy, then the palate. Not associated with drinking and smoking. Uniform age distribution. Most common gland malignancy in pediatrics. White women.
the following should raise suspicion of a High Grade Tumor.
pain, fixation to surrounding tissues, skin or facial paralysis.
Grade of mucoepidermoid carcinoma determined by ratio of mucoid to epidermoid cell composition.
Low grade – more mucoid cells. High grade – more epidermoid cells.
mucoepidermoid carcinoma stages
I and II – tx by excission alone. III and IV – additional therapy and more complex approach.
adenoid cystic carcinoma
second most common. Perineural invasion. Metastatic to lung. Cribriform. Swiss-cheese pattern. Poor prognosis.
Acinic cell carcinoma
excellent survival for low grade. 2nd most common parotid malignancy in peds.
Diagnosing a parotid tumor
facial nerve involved. Trismus. Hx of skin cancer. CT or MRI. Fine needle aspirate.
Superficial parotidectomy
cut from top of ear down to clavicle.
frostbite
swollen pina, weeping serous fluid. Tx – slow warming and topical antibiotics.
Neomycin allergy
contact dermatitis, weepy vesicular eruption. Tx – topical or systemic steroids (if severe)
cellulitis of auricle
inflammation, without vessicles or weaping. Topical or systemic antibiotics if severe.
auricular hematoma
wrestling injury. Tx – with incission and draining then compression.
Osteoma (cold-water swimming) or Exostosis (congenital) Ear Canal
only removed if obstructive or holding cerumen in canal.
Otitis externa – swimmer’s ear
Pain, drainage, debris. Moisture, trauma, infection. Tx – debridement, abiotics, wick.
fluoroquinolone
antibiotics for otitis externa. NO neosporin (aminoglycoside drops)– ototoxicity
Coalescent mastoiditis
bulge in post auricular area – medical emergency – cerebral involvement
Malignant (necrotizing) Otitis Externa
Immunocompromised, Diabetics, pseudomonas. IV antibiotics.
Otomycosis – fungal otitis externa
black or white mycelia – visible in the ear canal. Purulent discharge.
Chondrodermatitis nodularis helicis
benign lesions. Unresponsive to topical abiotics/steroids – may require complete composite excision.
Tympanosclerosis
Middle ear – white plaques of hyalinization or calcification. tympanic membrane – doesn’t effect hearing. Basement membrane – may affect hearing if extensive.
AOM – acute otitis media
normal upper respiratory bacteria – S. pneumoniae, H. influenza, M. catarhalis.
Neonatal AOM and chronic otitis media
Gram – bacilli (psuedomonas) and staph
ET – eustacian tube
ventilation and clearance of mucous from middle ear. Opened by tensor veli palatine muscle (assoc with soft palate muscles)
Barotrauma
rapid diving and flying with an ETD. Avoidance is Tx
cholesteatoma
perforation of ear drum where skin grows inward. Congenital – epithelial cysts in middle ear (2-5). Pars flaccida – prone to retraction or perforation, related to ETD. Infected granulation tissue
Meniere’s Disease
episodic vertigo, hearing loss, and tinnitis
Balance – 3 factors
eye, ear, proprioception
Perilymphatic fistula
rare sensoryneural hearing loss. Sensorineural hearing loss. Treat ASAP – do not let the sun set on a perilymphatic fistula.
only muscle of abduction in the vocal cords and innervation.
Posterior Cricoarytenoid muscle. Recurrent laryngeal branch of the vagus.
jackson’s watchdog of the larynx
Internal sensory branch of the superior laryngeal nerve
best treatment of vocal cord nodules
speech therapy and voice rest.
mayheida malignancy
follows leukoplakia of the cords so monitor cords.
Croup
heamophilus influenza, causes seal bark in kids, epiglotitis – leaning forward and drooling.
Middle ear transformer mechanism
hydraulic ratio creates a gain of 17:1 at oval window. Ossicular lever 1.3:1. - a total of 22 fold in gain.
smallest bone in the body
stapes
Organ of corti operation
transduction from mechanical to electric sound.
Cochlear frequency distribution
high tones at the base and Bass tones at the apex
fluid wave from …
oval window to round window
function of semicircular canals
sensation of angular acceleration
Meniere’s Disease
upsloping SNHL. Pure tone hearing in worse at low frequency.
age related hearing loss
downsloping SNHL. High frequency loss.
Noise induced SNHL
maximal hearing loss peaks at about 4000 Hz. Over time, mid-frequencies also become impaired
youngest age for hearing aid or chochlear implant
6 mo
ABR – auditory brainstem response
testing for pts unable or unwilling to cooperate.
