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Head & Neck > Lecture 10.2: Disorders of the Pharynx > Flashcards

Lecture 10.2: Disorders of the Pharynx Flashcards

1
Q

What are Adenoids?

A

They are a patch of tissue that sits at the very back of the nasal passage

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2
Q

What happens if Adenoids are Enlarged?

A
  • Nasal Obstruction
  • Eustachian Tube Obstruction
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3
Q

What happens if there is Nasal Obstruction due to Enlarged Adenoids? (4)

A
  • Mouth Breathing
  • Hyponasal Speech
  • Feeding Difficulty (esp. infants)
  • Snoring/Obstructive Sleep Apnoea
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4
Q

What happens if there is Eustachian Tube Obstruction due to Enlarged Adenoids? (2)

A
  • Recurrent acute otitis media (earache)
  • Chronic otitis media with effusion (glue ear,
    reduced hearing)
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5
Q

What is an Angiofibroma?

A
  • A benign tumour that is made up of blood vessels
    and fibrous tissue
  • Angiofibromas usually appear as small, red bumps
    on the face, especially on the nose and cheeks
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6
Q

What is Glue Ear?

A

When fluid collects in the middle ear

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7
Q

Symptoms of Glue Ear (6)

A
  • Poor concentration
  • TV volume up/Hearing down
  • Behavioural Issues
  • Recent URTIs
  • Hyponasal Speech
  • Snotty Nose
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8
Q

What does the hearing test of an individual with Glue Ear show?

A

Hearing test shows 30dB loss in both ears

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9
Q

Management of Glue Ear (3)

A
  • Self-limiting condition→“ watchful waiting”– repeat
    audiometry in 3/12.
  • Valsalva techniques to re-ventilate middle ear
    cavities
  • If no improvement , then consider grommets or
    hearing aids
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10
Q

Contents of the Oropharynx

A
  • Palatine tonsils
  • Anterior and posterior tonsillar pillars
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11
Q

What is Acute Pharyngitis?

A

Inflammation of the oropharynx

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12
Q

What is Tonsillitis?

A

Inflammation of the tonsils

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13
Q

What Factors are included as part of the Centor Clinical Presentation Score? (4)

A
  • Fever
  • Anterior Cervical Nodes
  • Exudate
  • Absent cough
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14
Q

What does a score of 3/4 on the Centor Clinical Presentation Score mean?

A

40-60% chance of bacterial Group A betahaemolyticstreptococcus

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15
Q

Local Complications of Streptococcal Sore Throat (3)

A
  • Otitis Media
  • Sinusitis
  • Chest Infection
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16
Q

Distant Complications of Streptococcal Sore Throat (4)

A
  • Rheumatic Fever
  • Glomerulonephritis
  • Meningitis
  • Toxic Shock Syndrome
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17
Q

Red Flags for Sore Throat (5)

A
  • Difficulty Breathing
  • Difficulty Swallowing Saliva/Drooling
  • Difficulty Opening Mouth (Trismus)
  • Severe Pain (Especially Unilateral)
  • Persistent High Fever
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18
Q

Causes of Tonsilitis (4)

A
  • Viral
  • Beta Haemolytic Strep
  • Strep Pneumoni
  • Haemophilus Influenza
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19
Q

Treatments of Tonsilitis (2)

A
  • Phenoxymethylpenicillin
  • Macroglycoside e.g., erythromycin
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20
Q

Complications of Tonsilitis

A
  • Abcess Formation
  • Peritonsillar (quinsy), retropharyngeal or
    parapharyngeal abscess
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21
Q

What are Indications to get a Tonsillectomy? (4)

A
  • Recurrent tonsillitis (5/year for at least 2 years)
  • Previous peritonsillar abscess (quinsy)
  • Suspected cancer (unilateral enlargement/
    ulceration)
  • Obstructive sleep apnoea syndrome
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22
Q

Risks of a Tonsillectomy? (3)

A
  • General Anaesthesia
  • Bleeding (primary (within 24 hours) or secondary)
    approx. 3-5%
  • Infection
23
Q

What to do with a post tonsillectomy BLEED when you’re on-call? (10)

A
  • Contact the ENT REG immediately – they may need
    to go back to theatre as an emergency
  • Airway first: sit the patient up and encourage them
    to spit blood into a bowl
  • Insert large-bore IV access and send blood for FBC,
    coagulation screen and group-and-save (urgent
    crossmatch if the bleeding is severe or unstable)
  • Do not delay in calling for an anaesthetist for help in
    stabilising an actively bleeding patient (this is.
    especially true in children)
  • Frequent haemodynamic observations
  • Nil by mouth: IV fluid resuscitation/IV analgesia
  • Ice pack on the back of the patient’s neck
  • Consider IV tranexamic acid
  • If not heavily bleeding: hydrogen peroxide gargles
  • Consider using 1:10000 adrenaline on a gauze with
    forceps
24
Q

How are hydrogen peroxide gargles done?

A
  • This is made up from a 3% solution diluted in three
    parts of water before being given to the patient to
    gargle
  • They should not swallow
25
Q

What are Tonsil Cysts?

A

Non-cancerous masses of cells on the tonsils, at the back of the throat

26
Q

What is Tonsil Debris/Stones?

A
  • Also called tonsilloliths, are small lumps that form in
    your tonsils
  • Form when debris, such as food, dead cells, bacteria, and
    other substances, becomes trapped on the tonsils
  • The debris hardens as calcium builds up around it,
    forming tonsil stones
27
Q

What is the main symptom of tonsil stones?

A

Bad Breath

28
Q

How to treat Tonsil Stones?

A

Using a saltwater gargle or a water pick, if they keep recurring then surgery may be suggested

29
Q

What are the types of Tonsil Cancer? (2)

A
  • The most common type of cancer in the tonsils is
    squamous cell carcinoma
  • A small number of tonsil cancers are lymphomas
30
Q

Symptoms of Tonsil Cancer (8)

A
  • Lump in the neck
  • A sore or ulcer in the back of the mouth that won’t heal
  • Blood in your saliva
  • Mouth pain
  • One tonsil that’s larger than the other
  • A sore throat that won’t go away
  • Ear pain
  • Difficulty swallowing, speaking or chewing
31
Q

What is Snoring caused by? (5)

A
  • Snoring caused by vibration of pharyngeal structures
    such as the tongue, soft palate & pharyngeal walls
  • Factors such as nasal or nasopharyngeal obstruction
  • Large tongue or tongue falling back into throat
  • Obesity
  • Excessive tiredness / alcohol
32
Q

Management of Snoring (7)

A
  • Lose Weight
  • Less Alcohol
  • Stop Smoking
  • Tennis Ball in the Pyjamas!
  • Treat Nasal Obstruction
  • Mandibular Advancement Device
  • Surgery: adenotonsillectomy/uvulopalatopharyngoplasty
33
Q

What is Obstructive Sleep Apnoea (OSA)?

A

A relatively common condition where the walls of the throat relax and narrow during sleep, interrupting normal breathing

34
Q

Consequences of OSA?

A
  • Daytime Lethargy
  • Sleepiness
  • Reduced Concentration
  • If severe can cause hypoxia and increase cardiovascular
    strain: pulmonary hypertension → right heart failure
    →cor pulmonale
35
Q

Investigations for OSA (2)

A
  • Nasendoscopic Examination of Pharynx
  • Sleep Studies
36
Q

Treatment of OSA (4)

A
  • Weight Loss
  • Surgery for Structural Causes eg Nasal Polyps
  • Adenoids/Adenotonsillectomy
  • CPAP: Continuous Positive Airways Pressure
37
Q

What is Odynophagia?

A

Pain Swallowing

38
Q

What can cause Acute Dysphagia? (5)

A
  • Tonsillitis
  • Pharyngitis
  • Aphthous Ulcers
  • Foreign Bodies
  • Ingestion of Caustic Liquids
39
Q

Malignant Causes of Chronic Dysphagia (5)

A
  • Pharyngeal Cancer
  • Oesophageal Cancer
  • Stomach Cancer
  • Extrinsic Pressure (Lung Cancer)
  • Worse with solids, Pain
40
Q

Neurological Causes of Chronic Dysphagia (5)

A
  • Stroke
  • Motor Neurone Disease
  • MS
  • Myaesthenia Gravis
  • Worse Swallowing Liquids
41
Q

Other Causes of Chronic Dysphagia (6)

A
  • Dry Mouth/Dental
  • Pharyngeal Pouch Strictures/
  • External Lesions
  • Thyroid Enlargement
  • Systemic Disease Scleroderma (rare)
  • Globus Pharyngeus
42
Q

Red Flags for Dysphagia (12)

A
  • True Dysphagia (solids more than liquids)
  • Hoarse
  • Breathing difficulties
  • Pain
  • Otalgia
  • Weight and Appetite Loss
  • Neck Nodes
  • Neurological Deficit
  • Drooling
  • Rapid Onset
  • Smoking
  • HPV
43
Q

What is Globus Pharyngeus?

A

The painless sensation of a lump in the throat and may be described as a foreign body sensation, a tightening or choking feeling

44
Q

Dysphagia Investigations (5)

A
  • FBC
  • ESR
  • Nasendoscopy
  • Upper GI endoscopy
  • Barium Swallow
45
Q

What is Killian’s Dehiscence?

A

A triangular area in the wall of the pharynx between the cricopharyngeus and thyropharyngeus which are the two parts of the inferior constrictors (also see Pharyngeal Pouch)

46
Q

What is a Pharyngeal Pouch?

A

Posterior herniation of pharyngeal mucosa

47
Q

Why may Pharyngeal Pouching occur? (3)

A
  • Weaker Area
  • Incoordination of pharyngeal phase of swallowing
  • Cricopharyngeal Spasm
48
Q

Treatment of Globus Pharyngeus? (2)

A
  • Reassurance
  • Treat Acid Reflux
49
Q

Common Sites for Foreign Body Lodging in Mouth (3)

A
  • Tonsil
  • Piriform Fossa
  • Cricopharyngeus
50
Q

History of Foreign Body Lodging in Mouth (3)

A
  • Well Localised
  • Immediate Sensation
  • Inability to Swallow Saliva/Drooling
51
Q

Food Bolus Immediate and Overnight Management (5)

A
  • Glucagon
  • Buscopan (hyoscine butylbromide)
  • Prokinetic such as erythromycin, domperidone or
    metoclopramide to empty the stomach
  • In uncomplicated cases, admit the patient overnight
    and give IV fluids and analgesia
  • Oesophagoscopy (rigid or flexible)
52
Q

How is Glucagon administered for the Immediate and Overnight Management of a Food Bolus?

A

Can be given as a slow IV bolus of 1-2 mg to relax the lower oesophageal sphincter

53
Q

How is Buscopan (Hyoscine Butylbromide) administered for the Immediate and Overnight Management of a Food Bolus?

A

Given in 20mg IV boluses, 30 minutes apart, to a maximum of five doses, to relax the lower oesophageal sphincter

54
Q

How is an Oesophagoscopy used for the Immediate and Overnight Management of a Food Bolus?

A

It is usually performed the following day to allow time for the obstruction to pass spontaneously, as long as there are no worrying features

Head & Neck (11 decks)

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