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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

24
Q

what is a peritonsillar abscess

A

complication of acute tonsillitis

bacterial between muscle and tonsil which produced puss

25
what is the classical peritonsillar access (quinsy) history
``` 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
what is the treatment of a peritonsillar abscess
aspirin antibiotics draining
27
what virus causes infectious mononucleosis
Epstein-barr
28
signs of infective mononucleosis
gross tonsillar enlargement with membranous exudate marked cervical lymphadenopathy palatal petechial haemorrhages (small dots of bleeding from burst capillaries) generalised lymphadenopathy hepatosplenomegaly
29
how do you diagnose infectious mononucleosis
atypical lymphocytes in peripheral blood +ve mono spot or Paul-bunnel tests low CRP (<100)
30
how do you manage infective mononucleosis
symptomatic treatment Antibiotics for secondary bacterial infection steroids avoid alcohol for 6 weeks
31
what antibiotic do you NOT give for infective mononucleosis/tonsils in general
AMOXICILLIN OR AMPICILLIN causes a generalised macular rash
32
symptoms of chronic tonsillitis
``` chronic sore throat malodorous breath presence of tonsilliths (tonsil stones) peritonsillar erythema persistent tender cervical. lymphadenopathy ```
33
signs of obstructive hyperplasia of the adenoids
obligate mouth breathing hypo nasal voice snoring and other signs of sleep disturbance (sleep apnoea) Acute otitis media/ otitis media with effusion
34
signs of obstructive palatine tonsil hyperplasia
snoring and other symptoms of sleep disturbance muffled voice dysphagia large size without symptoms means nothing
35
what is the difference between apparent and true tonsillar enlargement
true - one bigger than other apparent - one just sits higher than other
36
causes of tonsillar enlargement
``` acute infective chronic infective hypertrophy congenital neoplastic ```
37
what is glue ear
chronic otitis media with effusion inflammation of the middle ear accompanied by accumulation of fluid no symptoms/signs of acute inflammation
38
what is acute otitis media
inflammation of the middle ear accompanied by the signs and symptoms of inflammation with/without an accumulation of fluid
39
differentiating sings of acute otitis media vs chronic otitis media with effusion vs acute otitis media with effusion
AOM - no fluid or hearing loss COME- fluid, hearing loss AOM with effusion - fluid but no hearing loss
40
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
acute otitis media
41
who gets chronic otitis media with effusion
any child (but more common in younger) M>F 30% of children <4 at any time
42
risk factors chronic otitis media with effusion (glue ear)
``` Recurrent URTI Recurrent acute otitis media Prematurity Craniofacial abnormalities/genetic abnormalities Immunodeficiency Household smoking Day care Allergy Nutrition? Bottle feeding Seasonal ```
43
what causes chronic otitis media with effusion (glue ear)
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
glue ear symptoms
``` deafness poor school performance behavioural symptoms speech delay balance problems? high TV volume? ``` NO OTALGIA
45
What investigations are done for glue ear
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
Signs of glue ear
- Tympanic membrane retraction - Reduced TM mobility - Altered TM colour - Visible middle ear fluid/bubbles - Conductive hearing loss tuning fork tests
47
treatment for glue ear
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
what happens if glue ear is present for greater than 3/12 months with symptoms
deafness speech problems balance problems
49
when should you refer a glue ear
if persistent 2-12 months, bilateral OME chronic healing loss >25db speech/language problems developmental behavioural problems
50
surgical management of glue ear
<3 yrs grommet >3 yrs first intervention - grommet >3 yrs second intervention - adenoidectomy if nasal symptoms adenoids may be considered earlier
51
what are complications of grommets
``` infection/discharge early extrusion (come out) retention persistent perforation swimming/bathing issues ```

2 ENT (15 decks)

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