Pharynx Flashcards
1
Q
Symptoms of adenoid hyperplasia.
A
nasal obstruction à mouth breathing
- feeding difficulties
- noisy respiration
- snoring
- adenoid facies
- adenoid habitus
- rhinolalia clausa
Adenoid Facies
- dull facial expression
- open mouth
- dilated & flattened nasolabial folds
- indrawn nasal alae
- protruded upper incisor teeth
- enlarged lymph nodes jaw angle & nuchal area
Nasal Obstruction May lead to: 1. Aural dss - Eustachian tube obstruction - Chronic tubal & middle ear catarrh - Serous effusion - Recurrent acute otitis media - Adhesion formation - Chronic otitis media - Conductive deafness
- Nose & paranasal sinuses dss
- chronic purulent rhinitis
- chronic purulent sinitis
- pansinusitis - Masticary apparatus d/o
- gothic palate
- anomalies teeth position
- gingivitis - Lower respiratory system d/o
- chronic laryngitis
- trachitis
- bronchitis - Mental & intelligence dev. Effects
- restless
- broken sleep à tiredness
- apathy
- dullness
- poor school performance
- pseudodementia - Somatic effects
- flat chest
- round shoulders
- LOA
- Poor general development
- Infection sensitivity
2
Q
Pathogenesis and risk factors of adenoid hyperplasia.
A
Hypertrophy of lymphoepithelial tissue of pharyngeal ring
Risk Factors
- Active immune system in child
- Hereditary deispotiion
- Endocrine factors
- Constitutional factors
- Diet: carbohydrates
Diagnosis
- Chronic mouth breathing
- Snoring
- Infection proneness
- Palpation of enlarged adenoid
3
Q
Diagnosis and treatment of adenoid hyperplasia.
A
Rhinoscopy
- Enlarged adenoid
Treatment Conservative - Climate change - Diet - Drugs
Operative
- Adenoidetomy
1. LA / GA
1. Use Beckman;s ring adenotome
1. Separate adenoid at tis base
1. Remove adenoid
Course & Prognosis
- Remove obstruction à resolve.
- Normal physical, psychological, intellectual heath
- Good prognosis
- Recurrence is unusual
Complications
- Bleeding
- Aspiration
Pre- surgery Precaution
- Familial coagulation & bleeding d/o
- BT, aPTT
- Thrombocyte count
4
Q
Tonsillar hyperplasia.
A
Symptoms
- Difficult swallowing & eating
- Respiratory obstruction
- symptoms adenoid hyperplasia
Diagnosis
- Local findings / Pharyngoscopy
Differential Diagnosis
- Adenoid hypertrophy (check if Ö)
- Malignancy (suspect if unilateral)
- Lymphatic sys dss (lymphatic pharyngeal ring points hyperplasia)
Treatment
- Tonsillectomy
- Tonsillectomy + adenoidectomy
5
Q
Diphtheria of the pharynx.
A
General
- 38 - 39’C
- PR
Local
- 60 % in pharynx
- 8% larynx
- Pain on swallowing
- Red + white/grey velvet membrane (tonsil - pillar - soft palate)
- Firm membrane (if peel à bleed)
- Jugulodigastric lymph nodes swollen,tender, hard
- Acetone breath
Other
- Albuminuria
Microbiology
- Diptheria bacillus
- Corynebacterium diphtheriae
- Incubation period: 3 - 5 days
Route Of Transmission
- Contact
- Droplets
- Cotnaminated oral/nasal secretion
Forms 1. Localized- tonsil,nose,larynx,wnd 2. Generalized- progressive/ toxic Diagnosis 1. Bacteriologic smear - Gram stain - Result 1 hr
- Culture
- Result 10 hr - Organism isolation
- Result 2 - 8 days - Membrane
- Firmly adherent & extend beyond tonsil
Differential Diagnosis
- Nonspecific tonsillitis
- Infecitous mononucleosis
- Vincent’s angina
- Candidiasis
- Agranulocytosis
- Leukemia
- Syphillis
Treatment For infected: 1. Antiserum i.m + Antibiotic 2. Diptheria immunization 3. Bed rest 4. Oral hygiene
For carriers
- Local & parenteral antibiotics
- Local disinfection
- Tonsillectomy + adenoidectomy
6
Q
Classification of tonsillitis.
A
- Acute
- Primary
- Catarrhal
- Lacunar
- Follicular
- Vincent’s / ulceromembranous
- Secondary
- Acute infectious dss
i. Diptheria
ii. Scarlet fever
iii. Tularemia
iiii. Abdominal typhoid - Blood vascular dss
i. Infectiosn mononucleosis
ii. Agraulocytosis
iii. Alimentary - toxical aleukia
iiii. Leukemia - Chronic
- Non specific
- Compensation stage
- Decompensation stage
- Specific
- Infectious granulomatous TB
- Syphilis
- Scleroma
7
Q
Acute tonsillitis.
A
Etiology Common - B - hemolytic Streptococcus - Staphylococci - Pneumococci - Mixed flora - H. ifluenza - E. coli
Saprophytic
- Saprophytic streptococcus viridans
- Pneumococci
- Fusiform bacteria
- Leptothrix
- Neisseria
- Lactobacteria
- Staphylococci
- Sarcina
- Fungi
Histology
- Leucocyte infiltrates in parenchyma
- Abscess in parenchyma & crypt
- Fibrinous exudates
- D in parenchyma & epithelium
Symptoms General - High temperature + chills - Headaches - Malaise - Swelling & tenderness of regional lymph nodes
Local
- Burning throat
- Coated tongue
- Oral fetor
- Pain in oropharynx
- Pain on swallowing radiate to ear
- Pain on opening mouth
- Difficulty in eating
- Thick speech
- Swelling pillars,uvula,tongue base
- Sialorrhea
Examination
i. Catarrhal tonsillitis
- deep red + swollen tonsil & posterior pharynx
- no exudates
i. Follicular tonsilitis
- Yellow spots around lymphatic follicles
i. Lacunar tonsillitis
- Yellow s spots over crypt opening
i. Ulceramembranous tonsillitis
- Membrane formation
Pecualirities
- If bacteria: local > general
- If virus: general > local
- If multifocal: generalized d/o
Lab Investigation
i. Smearl & culture
- DD diptheria
i. Urinalysis
- exclude nephritis
i. Blood count
- DD mononucleosis
- DD leukemia
8
Q
Vincent’s angina.
A
Spirochetes
- Fusiform rods
Symptoms
- Unilateral pain on swallowing
- Feeling of foreign body in throat
- No fever
Examination
- Ipsilateral swelling of jugulodigastric nodes
- Ulcer on one tonsils
- Whitish exudates can wiped off easily (x spread)
- Fetor
Diagnosis
- One tonsil infection
- Unilateral ymphadenopathy
- Results of bacterial culture
Differential Diagnosis
- Diptheria
- TB
- Infectous mononucleosis
- Agranulocytosis
- Leukemia
- Syphilis
- Tumor
Treatment
- Penicillin 3 - 6 days
9
Q
Chronic tonsillitis.
A
Etiology
- Aerobic + anaerobic
- Streptococci mostly
- B-hemolytic streptococci group A
Pathogenesis
- Poor drainage of crypts à retained cell debris à good medium for bacteria
- Abscess in crypt à through epitheal defects in tonsillar parenchyma à cryptic parenchymatous tonsillitis
- If penetrate capillaries ard crypt à toxin to general circulation
- Long term à fibrosis & atrophy
Stages
- Compensation
- the clinical features described - Decompensation
- Recurrent acute tonsillitis > 3x/year
- Peritonsillar abscess
- Tonsillogenic septicemia
- Posttonsillitis focal symptoms (dss of organs)
Symptoms General - Lower resistance, Cold tendency - Tiredness, LOA - High temperature
Local
- Recurrent attack of tonsillitis
- Halitosis
- Bad taste in mouth
- No pain in neck / swallowing
Examination
- Tonsils fixed to bed
- Fissure / scar on tonsil
- Watery pus + grayish yellow material if press crypt opening
- Red anterior faucial pillar
- Peritonsillar tenderness
- Enlarged jugulodigastric nodes
N.B!
- Tonsillar plugs (fixed yellow tonsillar debris on crypt) is N!
- Size of tonsil x criteria
Diagnosis
- History of recurrent tonsillitis
- Local findings
- General & lab findings
Treatment Medical 1. Tonsillar irrigation 2. Tonsil aspiration 3. Electrocoagulation
Surgery: Tonsillectomy
Indications
1. Chronic tonsillitis decompensation stage
2. Tonsil hypertrophy w mechanical obstruction
3. Tonsillar tumor suspicion
10
Q
Complications of tonsillitis.
A
Post Tonsilitis Complication
- Rheumatic fever
- Endo,myo,pericarditis
- Acute glomerulonephritis
- Focal nephritis
Local Complications
- Peritonsillar abscess
- Retropharyngeal abscess (adult/children)
Peritonsillar Abscess
Pathogenesis
- Inflamamtion from tonsillar parenchyma à surrounding tissue à peritonsilitis à form abscess in few days
- Further spreading is prevented by pharyngeal constrictor mm.
Symptoms
General
- Fever 39 - 40’C
- Deteroriation general condition
Local
- Severe pain at neck
- irradiate to ear
- refuse to eat
- avoid rapid head movement
- Increase difficulty of swallowing
- Trismus à difficult to open mouth
- Thick & indistinct speech
- Obstruction of laryngeal inlet
- Increase respiratory obstruction
Local Examination
- Sialorrhea
- Oral fetor
- Swelling of regional lymph nodes
- Head held over to dss side
Diagnosis
- Swelling, redness, protruded of tonsil, faucial arch,palate & uvula
- Uvula pushed to healthy side
- Tenderness tonsillar area
- Exudate on tongue/tonsils/palate
- Blood picture + ESR
- Swelling content through aspiration
Differential Diagnosis
- Peritonsillar phlegmon
- Tonsillogenic sepsis
- Angioneurotic edema
- Malignant diptheria
- Agranulocytosis
- Specific tonsillar infection
- TB
- Syphillis - Nonulceratign tumor of tonsils/ neighbouring tissue
- malignant lymphoma
- lymphoepithelial tumor
- anaplastic carcinoma
- leukemia
Treatment Conservative 1. Antibiotic: penicillin/ cephalosporing 1 week 2. Analgesics 3. Fluid diets 4. Cold foods 5. Ice pac to neck 6. Mouth washes
Surgery
1. Abscess tonsillectomy
2. Drainage of abscess
Abscess Tonsillectomy
11
Q
Acute catarrhal pharyngitis.
A
Etiology
- Primary virus infection
- Secondary bacterial infection
- Primary bacterial infection
- Streptococci
- H. influenzar
- Pneumococci
- Prodormal syndromes of:
- Scarlet fever
- Measles
- Rubella
- Physical or cheical injury
- Scalds, caustic, etc
Symptoms
- Pain on swallowing
- Pain radiate to ear
- Dryness, heat & soreness of pharynx
- Itching, scratching, burning, clearing the throat
- Coughing attack
- Fever, feeling of sick
Diagnosis
- Red + thick mucosa
- Dry + glazed palatal & pharyngeal mucosa
- Mucus: colorless à tenacious à yellow
- Deep red solitary follicles
- Swell & tenderness lymph nodes
- Tonsilitis
- Lateral bands infection
Treatment
- Parenteral antibiotics
- Hit milk and honey
- Cold or warm cervical dressings
- Pharyngeal irrigation
- Steam inhalations
- Prevent smoking
- Anesthetic
- Disinfectant lozenges
- Bed rest for fever
12
Q
Chronic pharyngitis.
A
Factors
- Constituionally weak mucosa
- Exogenous agents
- Dust, chemicals, heat
- Temperature change
- Drafty and smoky condition
- Dry / air cond atmosphere
- Nicole and alcohol abuse - Current ENT problem
- Mouth breathing
- Nasal obstruction
- Abuse of nose drops
- Chronic sinusitis
- Adenoidal hypertrophy - Endocrine disorders
- Menopause
- Hypothyroidism - General disorders
- Heart & kidney malfunction
- DM
- Pulmonary insufficiency
- Bronchial dss - Avitaminosis A
- Mucosal allergy
- Incorrect use of voice
Forms
- Simple chronic pharyngitis
- Chronic hyperplastic pharyngitis
- Chronic atrophic pharyngitis
Simple Chronic Pharyngitis Local - Globus sensation - Constant throat cleaning - Coughing - Feeling of dryness / phlegm in throat - Neck pain on swallowing - Tenacious secretion
General
- No fever
- No generalize upset
Chronic Hyperplastic Pharyngitis Local - Thick & granular mucosa of posterior pharyngeal wall - Solitary follicles - Smooth red to grayish red mucosa - Venous telangiectasis - Stringy colorless mucus
Complaints
- sensation in pharynx
- compulsive throat clearing / swallowing / gagging / vomiting
Chronic Atrophic Pharyngitis
- Glazed + dry posterior pharyngeal wall
- Dry, tough crust of secretion
- Smooth/thick, pink/red, tender, transparent mucosa
- Spitting of stringy secretion
- Feeling of choking + sleep disturbances
- Continous throat clearing à mucosa hemorrhage
- Atrophic rhinitis
- Laryngitis sicca
- Symptom resolve at seaside
- Symptom worse in hot dry air
