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2 ENT > Tonsils, Glue Ear and Adenoids > Flashcards

Tonsils, Glue Ear and Adenoids Flashcards

1
Q

what is the function of the tonsils

A

traps bacterial and viruses on inhalation

exposes bacterial to the immune system

holds antibodies produced by the immune system

helps to prime immune system and prevent subsequent infections

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2
Q

when do the tonsils an adenoids begin to decrease in bulk

A

after teenage years

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3
Q

what is waldeyer’s ring

A

ring of lymphoid aggregation (cluster) in the sub epithelial layer of the oro and nasopharynx

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4
Q

what is waldeyer’s ring comprised of

A

Palatine tonsils
Adenoids (pharyngeal tonsils)
Lingual tonsils

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5
Q

what covers the palatine tonsils

A

specialised squamous epithelium

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6
Q

what are some histological features of the tonsils

A

deep crypts
lymphoid follicles
posterior capsule

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7
Q

what lines the adenoid tonsils

A

ciliated pseudo stratified columnar

stratified squamous

deep folds - look like its been scrunched together

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8
Q

what type of epithelium lines the aeodigestive tract

A

ciliated columnar resp type mucosa
OR
squamous epithelium

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9
Q

what type of epithelium lines where food goes/high use areas/trauma areas

A

squamous epithelium

seen in the oral cavity, pharyngeal, vocal cords, oesophagus

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10
Q

what epithelium lines the areas where air go

A

columnar (resp type)

nose, PNS, larynx, trachea

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11
Q

what are some common diseases of the tonsils and adenoids

A 
acute tonsillitis 
recurrent/chronic adenoititis / tonsillitis 
malignancy 
tonsil crypt debris/tonsiliths 
ottitis media with effusion
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12
Q

what is the most common cause of acute tonsillitis

A

VIRAL

EBV, rhinovirus, influenza, paraifluenza, enterovirus, adenovirus

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13
Q

what percentage of tonsillitis is bacterial and what is it usually caused by

A

5-30%

Group A strep 
H.influenza 
S.aures 
Strep pneumonia 
29% are betalactamase producing
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14
Q

treatment for bacterial acute tonsillitis

A

treat with penicillin

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15
Q

what are some differentials for acute tonsillitis

A 
URTI viral 
Infectious mononucleosis 
Peritosillar abbess 
Candida infection 
Malignancy 
Diptheria 
Scarlet fever
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16
Q

symptoms if viral tonsillitis

A 
malaise 
sore throat 
temperature 
unable to undertake normal activity 
possible lymphadenopathy
lasts 3-4 days
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17
Q

symptoms of bacterial tonsillitis

A 
systemic upset 
fever 
odynophagia (pain on swallowing) 
halitosis 
unable to work/school 
lymphadenopathy 
lasts 1 week 
requires antibiotics to settle
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18
Q

What is the Centor criteria for tonsillitis

A

differentiates viral from bacterial

  • history of fever
  • tonsillar exudates
  • tender anterior cervical lymphadenopathy
  • absence of cough

0-1 - no antibiotic
2-3 - antibiotic if symptoms progress
4-5- treat empirically with an antibiotic

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19
Q

what is some supportive treatment for tonsillitis

A 
eat and drink 
rest 
over the counter analgesia 
-paracetamol 
-NSAID
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20
Q

what antibiotics should be used for acute tonsillitis

A

penicillin 500g for 10 days

if allergic - give clarithromycin (can make them sick)

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21
Q

acute tonsillitis treatment in hospital

A

IV fluids
IV antibiotics
Steroids

Surgery

22
Q

how many confirmed tonsillitis episodes are needed for a tonsillectomy

A

7 in 1 year
5 in the last 2 years
3 or more in the last 3 years

23
Q

on what day is post tonsillectomy pain the worst

A

day 5

24
Q

what is a peritonsillar abscess

A

complication of acute tonsillitis

bacterial between muscle and tonsil which produced puss

25
Q

what is the classical peritonsillar access (quinsy) history

A 
unilateral throat pain 
truisms (limited mouth opening)
2-7 days of preceding acute tonsillitis 
medial displacement of tonsil and uvula 
concavity of palate lost
26
Q

what is the treatment of a peritonsillar abscess

A

aspirin
antibiotics
draining

27
Q

what virus causes infectious mononucleosis

A

Epstein-barr

28
Q

signs of infective mononucleosis

A

gross tonsillar enlargement with membranous exudate

marked cervical lymphadenopathy

palatal petechial haemorrhages (small dots of bleeding from burst capillaries)

generalised lymphadenopathy

hepatosplenomegaly

29
Q

how do you diagnose infectious mononucleosis

A

atypical lymphocytes in peripheral blood

+ve mono spot or Paul-bunnel tests

low CRP (<100)

30
Q

how do you manage infective mononucleosis

A

symptomatic treatment

Antibiotics for secondary bacterial infection

steroids

avoid alcohol for 6 weeks

31
Q

what antibiotic do you NOT give for infective mononucleosis/tonsils in general

A

AMOXICILLIN OR AMPICILLIN

causes a generalised macular rash

32
Q

symptoms of chronic tonsillitis

A 
chronic sore throat 
malodorous breath 
presence of tonsilliths (tonsil stones) 
peritonsillar erythema 
persistent tender cervical. lymphadenopathy
33
Q

signs of obstructive hyperplasia of the adenoids

A

obligate mouth breathing
hypo nasal voice
snoring and other signs of sleep disturbance (sleep apnoea)
Acute otitis media/ otitis media with effusion

34
Q

signs of obstructive palatine tonsil hyperplasia

A

snoring and other symptoms of sleep disturbance

muffled voice

dysphagia

large size without symptoms means nothing

35
Q

what is the difference between apparent and true tonsillar enlargement

A

true - one bigger than other

apparent - one just sits higher than other

36
Q

causes of tonsillar enlargement

A 
acute infective 
chronic infective 
hypertrophy 
congenital 
neoplastic
37
Q

what is glue ear

A

chronic otitis media with effusion

inflammation of the middle ear accompanied by accumulation of fluid

no symptoms/signs of acute inflammation

38
Q

what is acute otitis media

A

inflammation of the middle ear accompanied by the signs and symptoms of inflammation with/without an accumulation of fluid

39
Q

differentiating sings of acute otitis media vs chronic otitis media with effusion vs acute otitis media with effusion

A

AOM - no fluid or hearing loss

COME- fluid, hearing loss

AOM with effusion - fluid but no hearing loss

40
Q

if a patient has earache, fever, irritability, no middle ear effusion, opaque TM, bulging TM, impaired TM mobility and no hearing loss what do they most likely have

A

acute otitis media

41
Q

who gets chronic otitis media with effusion

A

any child (but more common in younger)
M>F
30% of children <4 at any time

42
Q

risk factors chronic otitis media with effusion (glue ear)

A 
Recurrent URTI 
Recurrent acute otitis media 
Prematurity 
Craniofacial abnormalities/genetic abnormalities
Immunodeficiency 
Household smoking 
Day care
Allergy 
Nutrition?
Bottle feeding 
Seasonal
43
Q

what causes chronic otitis media with effusion (glue ear)

A

Eustachian tube dysfunction

small e tube in kids puts them at increased risk of blockage/infection

leads to pressure building in the ear as it cannot escape down the Eustachian tube

leads to accumulation of fluid and glue ear

44
Q

glue ear symptoms

A 
deafness
poor school performance 
behavioural symptoms 
speech delay 
balance problems?
high TV volume?

NO OTALGIA

45
Q

What investigations are done for glue ear

A

otoscope
tuning fork tests
audiometry (glue ear sits around 30 decibels)
tympanometry (fluid in the ear stops the TM being mobile leading to a flat resting)

46
Q

Signs of glue ear

A
  • Tympanic membrane retraction
  • Reduced TM mobility
  • Altered TM colour
  • Visible middle ear fluid/bubbles
  • Conductive hearing loss tuning fork tests
47
Q

treatment for glue ear

A

watchful waiting

(60% resolve at 1/12 months, 90% resolved after 3 months)

review at 3/12 months

  • otoscopy
  • pure tone audiometry
  • tympanometry

Grommet if its been 6-8 months

auto-inflation may be of some benefit

48
Q

what happens if glue ear is present for greater than 3/12 months with symptoms

A

deafness
speech problems
balance problems

49
Q

when should you refer a glue ear

A

if persistent 2-12 months, bilateral OME

chronic healing loss >25db

speech/language problems

developmental behavioural problems

50
Q

surgical management of glue ear

A

<3 yrs grommet
>3 yrs first intervention - grommet
>3 yrs second intervention - adenoidectomy

if nasal symptoms adenoids may be considered earlier

51
Q

what are complications of grommets

A 
infection/discharge 
early extrusion (come out) 
retention 
persistent perforation 
swimming/bathing issues

2 ENT (15 decks)

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