Nose + Throat Presentations Flashcards
Outline the aetiology and pathophysiology of adenotonsillar hypertrophy
The exact mechanisms leading to the adenotonsillar cell proliferation are still not fully understood
Possible bacterial and inflammatory aetiology has been suggested for AH
How does adenotonsillar hypertrophy present?
Short term = mouth breathing, nasal congestion, hyponasal speech, snoring, obstructive sleep apnoea (OSA), chronic sinusitis and recurrent otitis media
Long term = serious complications related to OSA including growth failure, cardiovascular morbidity and neurocognitive abnormalities such as low intelligence quotient, learning and behavioural problems, hyperactivity and poor attention span
How should adenotonsillar hypertrophy be investigated?
Diagnostic nasal endoscopy = rigid or a flexible nasopharyngoscope
CT scan of nasopharynx
X-ray lateral view of nasopharynx
Outline the management of adenotonsillar hypertrophy
Tonsillectomy
Adenoidectomy
Discuss the aetiology and pathophysiology of allergic rhinitis
Aetiology = dust mites, pollen/spores, animal skin, urine and saliva
Pathophysiology: exposure to allergen = recognised by antigen-IgE receptors on mast cells and basophils = mast cell degranulation = histamine release = acute nasal symptoms (sneezing and rhinorrhoea) and ocular symptoms (itching, redness, and watering)
Histamine release + leukotrienes, prostaglandins and kinins = increases vascular permeability = oedema formation
Atopic - associated with IgE Abs OR
Non-atopic
What are the signs and symptoms of allergic rhinitis?
Nasal = sneezing, rhinorrhoea, obstruction, pruritus
Ocular = itching, redness, and watering, eyelid oedema
Oedema
Sleep disruption sec to Sx - behavioural probs
How should suspected allergic rhinitis be investigated?
Allergen skin prick testing
IgE levels
Total blood eosinophil count
What is a DDx for allergic rhinitis?
Infective rhinitis = short hx of one week or less, with cough, fever, sore throat, lymphadenopathy
Irritant rhinitis = usually when Sx follow known physical (temperature or humidity) or chemical irritant (volatile chemicals and odours)
Structural or mechanical factors = deviated nasal septum, nasal polypls, adenoidal hypertrophy, foreign bodies
How is allergic rhinitis managed?
Sec gen non-sedating antihistamine (topical/systemic)
Topical corticosteroid nasal preparations
Nasal irrigation = saline to rinse the nasal cavity using a spray, pump, or squirt bottle, which can be bought OTC
Avoidance advice
