Pharyngeal, throat, and neck disorders Flashcards
What is the most important factor in flavor of food?
Taste receptor cell life span?
-smell or aroma of foodd is the most important factor in flavor.
Taste receptor cell lifespan in 10 days.
define each of the following:
- hypogeusia
- agusea
- dysgeusia
- allegeusia
- phantogeusia
Hypogeusia: diminished taste to 1 or more tastants
Ageusea: absent tase
dysgeusia: persistent sweet, sour, salty, bitter, or metallic taste
allegeusia: unpleasant taste of food or drink that is usually pleasant
phantogeusia: unpleasant taste produced indigenously due to gustatory hallucination
Causes of taste disorders?
-age, infections, gastric reflux, drugs, xerostomia (dry mouth)
Causes of xerostomia?
dz, radiation, infections, drugs (anticholinergics, TCA, antihistamines), toxins
Tx of…
- dysgeusia
- burning mouth
Dysgeusia: difficult to treat, treat underlying problem, clonazepam (klonopin)
burning mouth: TCAs, clonazepam
*benzo’s calm the pt down so they dont notice it as much.
Halitosis
-PE
smell their breath 5-10cm away from pts mouth and rate it 0-5, 5 being unbearably strong foul odor.
next check nasal passages and score.
evaluate tongue odor using a spoon. need to scrape the tongue.
Etiology of halitosis from each region:
- oral cavity
- nasal passages
- tonsils
Oral: 80-90% of time.
- breakdown of amino acids producing sulfur and other gases
- poor oral hygiene
- accumulation of post nasal drip
- dental abscess, gingivitis, unclean dentures.
Nasal passage:
- nasal infection
- polyps
- FB
Tonsils:
-tonsoliths from bacteria
Tx of halitosis from oral source?
- proper dental care and hygiene
- cleaning of posterior tongue
- rinsing & DEEP gargling w/ mouthwash
- brief chewing gum
- sufficient water intake.
oral candidiasis tx?
-diflucan is 1st choice otherwise liquid nystatin.
Stomatitis
-causes
causes:
- candida
- HSV
- VZV
- HIV **
- Recurrent aphthous stomatitis (RAS)
Aphthous Ulcers
-tx
- Symptomatic relief:
- -Triamcinolone acetonide in orabase gel
- -Topical analgesics (OTC) (oragel, anbesol)
Chemical cautery w/ silver nitrate or sulfuric acid
Severe: intralesional or PO cortisone.
Varicella Zoster Virus
-where are these lesion located in the mouth?
Location:
-grouped vesicles UNILATERALLY on the hard palate, can include buccal mucosa, tongue, and gingiva
HIV infection of the mouth
-defined as
defined as painful mucocutaneous ulceration. shallow, sharply demarcated ulcers can be found on the oral mucosa.
Geographic tongue
- how long does this last?
- cause?
- painful?
- sx
- tx
usually last one -2weeks
may be induced by viral episode
not painful or harmful it just looks very strange. They dont have any other sx and resolves on its own.
Xerostomia
- definition
- complications
- etiologies
- tx
def: dry mouth
Complications:
- dental caries
- gum dz
- halitosis
- salivary gland calculi
- dysphagia
Etiologies:
- autoimmune dx
- radiation
- medications (TCA, anticholinergics, antihistamines)
Tx:
-artificial saliva (OTC and Rx available)
Odynophagia
- definition
- tx
- ddx
def: trouble swallowing in the back of your throat
tx: treat the underlying cause.
ddx:
- candida involving the esophogus
- GERD
- stomatitis
Indirect Laryngoscopy
- indications
- CI
indications:
- Hoarsness greater than 2 weeks
- odynophagia
- voice change
- dysphagia
- hemoptysis
- FB sensation
CI
- uncooperative pt or one with strong gag reflex
- compromised airway (croup or epiglotitis)
*Fiber optic nasopharyngoscopy is becoming procedure of choice.
Hoarseness etiologies
acute laryngitis- URI or voice misuse
chronic laryngitis
benign vocal fold lesions
malignancy involving the larynx
neurologic dysfunction (ALS or MS)
non-organic (functional) issues
systemic conditions
Tx of:
- acute laryngitis
- chronic laryngitis
acute: less than 3wk duration, self-limited condition, voice rest and fluids.
Chronic: treat underlying etiology such as..
-toxins, gerd, chronic sinusitis, postnasal drip, chronic alcohol use, chronic vocal strain, tobacco smoke.
Muscle tension dysphonia
-what is this?
imbalance of tension in muscles involved in voice production, seen in aging with atrophy of some of the supporting structure of the vocal cords.
Polyps:
- result from what?
- etiologies
Nodules:
- characteristics
- aka
- most common in who?
Polyps:
-result from chornic vocal cord irritation
-etiologies: smoking, reflux, muscle tension dysphonia
Nodules:
-characteristics: bilaterally, symmetric
- aka screamers or singers nodes
- MC in women and children.
Primary Squamous cell Laryngeal Cancer
- arise from where?
- risk factors
- appearance
- benign/metastases?
- arise from the mucosal surface of the larynx
- Major risk factors are smoking and alcohol abuse
- early lesions appear initially as white plaques (Leukoplakic)
- metastasizes to regional lymph nodes
Describe the stages of swallowing
Oral preparatory phase: CN V, VII, XII. bolus processed by mastication
Pharyngeal phase: CN V, X, XI, XII. bolus advances into esophagus by pharyngeal peristalsis
Esophageal phase: peristaltic contractions in the esophagus propel bolus down. Relaxation of the lower esophageal sphincter allows the bolus to enter the stomach.
What are some disorders of the oral preparatory phase?
- inadequate mastication
- xerostomia
- neurologic disorders
- disruption of the oropharyngeal mucosa.
