Tonsils, Adenoids and Glue Ear Flashcards
summarise the development of the tonsils
tonsillar fossa and palatine tonsils develop from dorsal wing of 1st palatine pouch and ventral wing of 2nd pouch @ 8 weeks
crypts 3-6 months
16 weeks adenoids develop as a sub epithelial infiltration of lymphocytes
what is the main function of the adenoids and tonsils
trap bacterial and viruses on inhalation
expose these to immune system
what happens to tonsil size throughout life
singificant adenotonsilar enlargement unusual under 2
after teens tonsils and adenoids decrease in size
what is waldeyers ring
ring of lymphoid aggregation in the subepthelial layer of oropharynx and nasopharynx
made up of tonsils (palatine tonsil), adenoids (pharyngeal tonsil) and lingual tonsils (on tongue)
what does the tonsil sit in
in a fossa formed by the muscular anterior and posterior tonsillar pillars (palatoglossus and palatopharyngeus)
describe the histology of the tonsils
Lymphoid tissues covered with specialised stratified squamous epithelium
deep cysts
base separated from muscles by dense collagenous hemi-capsule
lymphoid follicles in parenchyma
describe the histology of the adenoids
ciliated pseudostratified columnar
stratified squamous
deep folds
transitional
what epithelium lines the oral cavity, pharyngeal, vocal cords, oesophagus
squamous epithelium
what epithelium where air goes (nose, PNS, larynx, trachea)
columnar
what usually causes acute tonsillitis
majority viral - EBV, rhinovirus, parainfluenza, enterovirus, adenovirus
bacterial- strep pyogenes (group A beta-haemolytic strep), H influenza, S. aureus, strep pneumoniae
when should you suspect mono in a patient previously diagnosed with tonsilitis
if persists despite antibacterial treatment
what malignancies can be mistaken for acute tonsilitis
lymphoma, leukemia, carcinoma
what are the symptoms of viral tonsilitis
not a severe as bacterial:
- malaise
- sore throat
- temp
- able to work and do normal activities
- possible lymphadenopathy
- lasts 3-4 days
what are the symptoms of bacterial tonsilitis
more severe than viral:
- systemic upset
- fever
- odynophagia
- halitosis
- unable to work/school
- lymphadenopathy
- lasts 1 week
how do you differentiate between bacterial and viral tonsilitis
bacterial infection:
- history of fever
- tonsillar exudates
- tender anterior cervical adenopahty
- absence of cough
when should you give antibiotics in tonsilitis
centor
0-1 no
2/3 - yes if symptoms progress
4/5 - treat empirically with an antibiotic
what does the centor criteria assess
the risk of group A strep infection and hence the need for antibiotics
is puss on tonsils more/less likely to make it bacterial tonsillitis
more likely
what is the treatment for tonsilitis
supportive: eat and drink, rest, analgesia (paracetamol, NSAID)
antibiotic- penicillin 500 mg quid for 10 days, clarithromycin if allergic
hospital- IV fluids and antibiotics, steroids
surgery
what are the negatives of surgical management of tonsilectomy
very painful
risk of haemorrhage- 1 person dies every year
what are the possible complications of tonsillitis
peritonsilar abscess (quinsy) infective mononucleosis (when caused by EBV)
what is a peritonisilar abscess
complication of acute tonsilitis- when the bacteria between muscle and tonsil produce pus
what are the features of a peritonsilar abscess
unilateral throat pain and odynophagia
trismus
3-7 days of preceding acute tonsilitis
medial displacement of tonsil and uvula
concavity of palate lost
what is the treatment for a peritonsilar abscess (qunisy)
aspiration and antibiotics
what is infective mononucleosis (glandular fever) caused by
ebstein-barr virus
what are the signs of infective mononucleosis
gross tonsilar enlargement with membranous exudate marked cervical lymphadenopathy palatal petechial haemorrhages generalised lymphadenopathy hepatosplenomegaly
what tests to diagnose infective mononucleosis
atypical lymphocytes in peripheral blood,
paul-bunnell test or monospot,
low CPR,
can cause deranged LFTs
what is the management of infective mononucleosis
symptomatic
antibiotics if they get secondary bacterial infection
steroids if patient struggling
avoid contact sport to avoid spleen rupture
avoid alcohol
is chronic tonsillitis a thing
probs not
what are the features of obstructive hyperplasia of the adenoids
obligate mouth breathing
hyponasal voice
snoring and sleep disturbance (reason to remove them)
AOM/OME
what are the features of obstructive hyperplasia of the tonsils
snoring and sleep disturbance
muffled voice (transient as tonsils decrease in size)
?dysphagia
what are the causes of unilateral tonsilar enlargment
acute/chronic infection
hypertrophy
congenital
neoplastic
what is glue ear/ otitis media with effusion/ serous otitis media
inflammation of the middle ear accompanied by accumulation of fluid without the symptoms and signs of acute inflammation
- hearing loss
- fluid seen in TM and has impaired mobililty
what is acute otitis media
inflammation of the middle ear accompanied by the symptoms and signs of acute inflammation with/ without an accumulation of fluid
- may have hearing loss not always
(inc: fever, earache, irritability, opaque TM- may be bulging or have impaired mobility)
who gets OME
children, boys more esp if: in day care, have older siblings, smoking household (affects cililary function), history of recurrent URTI/AOM, if premature, craniofacial/genetic abnormalities, immunodeficient, bottle fed, allergy, seasonal
why do children get OME
as eustachian tube short- gets congested
what are the symptoms of OME
deafness, poor school performance and behavioural problems, speech delay, balance problems, loud TV
will NOT have otalgia
how do you diagnose OME
history, otoscope, tuning fork tests, audiometry tympanometry
what are the signs of OME
TM retraction, reduced TM mobility, altered TM colour, visible ME fluid/bubbles
CHL tuning fork tests
what will cause a tympanomtery test to produce a flat line
fluid in the middle ear
what is the hearing range in glue ear
roughly around 30dB
what is the management of glue ear
watchful waiting most resolve
review at 3 months
otoscopy, PTA, tympanometry
manage educational needs
if persistent for >3 months, symptoms of deafness and speech/language problems, CHL>25 dB or developmental behavioural problems then refer
what are the surgical management options of OME
<3 years= grommets
>3 years grommets, then adenoidectomy (considered earlier if nasal problems early), hearing aids
how long to grommets last
can fall out in few days or in 18 months
what are the complications of grommets
infection/ discharge early extrusion retention persistent perforation, swimming/bathing issues (cant swim as will get severe vertigo due to cold water)
