Lymph nodes, tonsils and glue ear

Question 1

What is the ring of Waldeyer and what does it consist of?

Answer 1

Ring of lymphatic nodules (tonsils) at the junction or oral and nasal cavity. Composed of:

 - Adenoid
 - Lingual x2
 - Palantine x2 (ones removed)
 - Tubal x2

Question 2

How do tonsils protect against pathogens?

Answer 2

Have M cells on them which are specialised antigen capture cells so alert underlying B and T cells when activated by a pathogen, initiating an immune response

Question 3

What is otitis media with effusion and how is it caused?

Answer 3

Glue Ear - ear infection with a fluid build up

Respiratory infection (usually viral) causes atrophy of the tonsils, with the tubal tonsils blocking the eustachian tube. This prevents ventilation, causing the goblet cells of the inner ear canal to produce mucous. This build up, causing effusion and increasing the pressure on the ear drum

Question 4

How can glue ear be treated?

Answer 4

If bacterial, antibiotics to clear infection

Use grommets - act as ventialtion tube, allowign clean air to come in, clearing mucous up (do not drain!). Pressure will decrease as this happens and they will fall out of ear with no pain

Question 5

What signs are seen in the diagnosis of glue ear?

Answer 5

Swollen tonsils
Bulging erythemateous
Bagel sign (bulging tympanic membrane)
light reflex in anterioinferior quadrant

Question 6

What is the difference between conductive and sensorineural hearing loss?

Answer 6

Coductive deafness - problem conducting soundwaves due to bones or mucous etc

Sensorineural hearing loss - due to damage to inner ear, auditory nerve or receptive centre in the brain

Question 7

List the lymph nodes of the head and neck

Answer 7

• Submental
• Sub lingual
• Parotid/Pre-auricular
• Posterior or Retro-auricular
• Occipital
• Jugulodigastric
• Deep cervical (incl juguloomohyoid)
• Superficial cervical (incl virchows)
• Supraclavicular