Throat Disease Flashcards
What is the function of the tonsils and adenoids?
trap bacteria and viruses on inhalation - expose to immune system - antibodies produced by the immune cells in the tissue - help to prime immune system and help prevent subsequent infections
What is the histology of the luminal surface of the tonsils?
stratified squamous epithelium which deeply invaginates into the tonsil causing crypts
What separates the base of the tonsils from the underling muscle?
dense collagenous hemi-capsule
What does parenchyma mean?
functional tissue of an organ
What is the histology of the parenchyma of the tonsils?
numerous lymphoid follicles dispersed just beneath the epithelium of the crypts
What is histology of the luminal surface of the adenoids?
ciliated pseudostratified columnar epithelium - mucocillary clearance
deep folds and few crypts
What is deep to the luminal surface of the adenoids?
stratified squamous layer and a transitional layer
What layer of the adenoids is responsible for antigen processing?
transitional layer
What layer of the adenoids is thickened by chronic infection?
stratified squamous layer
What is the result of the luminal surface of the adenoids being thinned by chronic infection?
stasis of secretions
increased exposure of tissue to antigenic stimuli
What causes acute tonsillitis (adenotonsilitis)?
majority viral - EBV, rhinovirus, influenza, parainfluenza, enterovirus, adenovirus
5-30% bacterial - Strep. pyogenes, H. influenza, S. aureus, Strep. pneumonia - 40% are beta-lactamase producing
What are the clinical features of viral acute tonsillitis/adenotonsilitis?
malaise sore throat temperature able to undertake near normal activity possible lymphadenopathy lasts 3-4 days
What are the clinical features of bacterial acute tonsillitis/adenotonsillitis?
systemic upset fever odynophagia halitosis unable to go to work or school lymphadenopathy lasts one week
What is the centor criteria used for?
differentiating bacterial from viral acute tonsillitis/adenotonsilitis
What are the centor criteria?
history of fever
tonsillar exudates
tender anterior cervical lymphadenopathy
absence of cough
What is the management for 0 points on the centor criteria?
no antibiotic
What is the management for 2 points in the centor criteria?
should receive an antibiotic if symptoms progress
What is the management for 3-4 points on the centor criteria?
treat empirically with an antibiotic
What is the supportive treatment for acute tonsillitis/adenotonsillits?
eat
drink
rest
analgesia
What antibiotic is given in acute tonsillitis/adenotnsilitis?
pencillin or clarithromycin/erythromycin if penicllin allergic
What antibiotics should be avoided in acute tonsillitis/adenotonsilitis and glandular fever and why?
amoxicillin and ampicillin
diagnostic generalised macular rash
What is the treatment for adenotonsillits/acute tonsillitis in hospital?
IV fluids
IV antibiotics - benzylpenicillin or clarithromycin if penicllin allergic
steroids
What criteria are required for a tonsillectomy?
recurrent sore throat is due to tonsillitis
episodes are debilitating and prevent normal functioning
at least 7 well documented, clinically treated sore throats in the preceding year OR at least 5 in the previous 2 years OR at least 3 in the preceding 3 years
What are the complications of a tonsillectomy?
primary haemorrhage - <24hrs - return to theatre - commonly due to inadequate haemostasis
secondary haemorrhage - >24hrs but commonly 5-10 days - ENT emergency - most commonly due to infection - admit for IV antibiotics
What is a peritonsillar abscess?
complication of acute tonsillitis
bacteria between muscle and tonsil produce pus
What is the classical history of a peritonsillar abscess?
unilateral throat pain and odynophagia
trismus
3-7 days of preceding acute tonsillitis
reduced neck mobility
What is halitosis?
bad breath
What is trismus?
lock jaw - reduced opening of jaws
What are the signs of a peritonsillar abscess?
medial displacement of the tonsil
uvula concavity of the palate lost
deviation of uvula to affected side
What is the treatment of a peritonsillar abscess?
aspiration
antibiotics - penicllin (clindamycin if penicllin allergic) - if not resolving in 48hrs consider metronidazole (not if on clindamycin as it provides anaerobic cover)
tonsillectomy considered in 6 weeks
What causes glandular fever/infectious mononucleosis (mono)?
EBV
What are the signs of glandular fever/infectious mononucleosis?
gross tonsillar enlargement with membranous exudate marked cervical lymphadenopathy palatal petechial haemorrhages generalised lymphadenopathy hepatosplenomegaly rash jaundice
How is glandular fever/infectious mononucleosis diagnosed?
atypical lymphocytes in peripheral blood
+ve monospot or Paul-Bunnell test
low CRP - <100
LFTs
What is the management of glandular fever/infectious mononucleosis?
symptomatic treatment
antibiotics
steroids
What are the symptoms of chronic tonsillitis?
chronic sore throat
halitosis
What are the signs of chronic tonsillitis?
presence of tonsiliths
persistent tender cervical lymphadenopathy
What are tonsilliths?
tonsil stones
What are the clinical features of obstructive adenoid hyperplasia?
obligate mouth breathing hyponasal voice snoring and other signs of sleep disturbance acute otitis media glue ear
What are the clinical features of obstructive tonsil hyperplasia?
snoring and other symptoms of sleep disturbance
muffled voice
possible dysphagia
What are the non-neoplastic causes of unilateral tonsillar enlargement?
acute infective
chronic infective (e.g. TB)
hypertrophy
congenital
What are the neoplastic causes of unilateral tonsillar enlargement?
benign papillomas
lymphoma
SCC
What is the management of true unilateral tonsillar enlargement?
biopsy to exclude malignancy
What is apparent unilateral tonsillar enlargement?
tonsil sits in more medial position
What are the causes of apparent unilateral tonsillar enlargement?
displacement medially by peritonsillar abscess or parapharyngeal space mass
What should be suspected if a sore throat and lethargy persist into the second week, especially if the person is 15-25 years old?
infectious mononucleosis
What are the characteristics of Strep. pyogenes?
gram positive cocci chains
beta-haemolysis
What are the late complications of tonsillitis caused by Strep. pyogenes?
rheumatic fever - 3 weeks post sore throat - fever, arthritis, pancarditis
glomerulonephritis - 1-3 weeks post sore throat - haematuria, albuminuria, oedema
What is pancarditis?
inflammation of the entire heart - the epicardium, myocardium and endocardium
What are the complications of glandular fever/infective mononucleosis?
anaemia thrombocytopenia splenic rupture upper airway obstruction increased risk of lymphoma especially in the immunosuppressed
What is thrombocytopenia?
abnormally low levels of platelets in the blood
What is the aetiology of laryngeal polyps/nodules?
reactive change in laryngeal mucosa secondary to vocal abuse, infection or smoking
occasionally seen in hypothyroidism
Where are laryngeal nodules located?
bilateral on middle to posterior 1/3rd of vocal cord
What is the typical patient with laryngeal nodules?
young woman
What is the gross appearance of a laryngeal polyp?
unilateral and pedunculated
What does pedunculated mean?
elongated stalk of tissue
What is a contact ulcer?
benign response to injury commonly located on the posterior vocal cord
What is the aetiology of a contact ulcer?
chronic throat clearing
voice abuse
GORD
intubation
What are the complications of tonsillitis?
otitis media
quinsy/peritonsillar abscess rheumatic fever and glomerulonephritis very rarely
