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ENT > Tonsils, Glue Ear and the Adenoids > Flashcards

Tonsils, Glue Ear and the Adenoids Flashcards

1
Q

what happens at 8 weeks development?

A

tonsillar fossa and palatine tonsils develop from the dorsal wing of the 1st pharyngeal pouch and the ventral wing of the 2nd pouch
tonsillar pillars originate from the 2nd/3rd arches

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2
Q

what happens at 6 weeks development?

A

adenoids develop as a subepithelial infiltration of lymphcytes

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3
Q

what are the 4 functions of the tonsils?

A

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 to prevent subsequent infections

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4
Q

how does the size of the tonsils change in growth?

A

smaller <2 yrs
- significant enlargement <2 y/o is rare
tonsils and adenoids decrease in bulk after early teenage years

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5
Q

what is waleyer’s ring?

A 
ring of lymphoid aggregation in the subepithelial layer of oropharynx and nasopharynx
comprised of
- tonsils (palatine tonsil)
- adenoids (pharyngeal tonsil)
- lingual tonsil
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6
Q

describe the histological features of the tonsils

A

specialized squamous
deep crypts
lymphoid follicles
posterior capsule

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7
Q

describe the histological features of the adenoids

A

ciliated pseudostratified columnar
stratified squamous
transitional
deep folds

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8
Q

general histology of upper aerodigestive tract?

A

ciliated columnar respiratory type mucosa

squamous epithelium

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9
Q

general histology of where food goes/high use/trauma?

A

squamous

oral, pharyngeal, vocal cords, oesophagus

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10
Q

general histology of where air goes?

A

columnar

nose, PNS, larynx, trachea

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11
Q

what most commonly causes acute tonsillitis?

A

most are viral (EBV, rhinovirus, influenza, enterovirus, adenovirus)
5-30% are bacterial
group A beta haemolytic strep = most important pathogen

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12
Q

are throat swabs used in tonsillitis?

A

no

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13
Q

what are the most common organisms cultures from chronic tonsillar disease?

A 
strep pyogenes
H influenza
staph aureus
strep pneumonia
beta lactamase producing
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14
Q

differential diagnoses of acute tonsilitis?

A 
viral URTI
glandular fever
peritonsillar abscess
candida infection
malignancy
diptheria
scarlet fever
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15
Q

symptoms of viral tonsillitis?

A 
malaise
sore throat, mild analgesia requirement
temperature
able to go about normal activities
possible lymphadenopathy
lasts 3-4 days
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16
Q

symptoms of bacterial tonsillitis?

A 
systemic upset
fever
odynophagia
halitosis
unable to work/school
lymphadenopathy
lasts 1 week, requires antibiotics to settle
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17
Q

centor criteria?

A 
differentiates viral from bacterial tonsillitis
fever
tonsillar exudate
tender anterior cervical lymphadenopathy
absence of cough
0-1 = no antibiotic
2-3 = should get antibiotic if symptoms progress
4-5 = treat empirically with antibiotic
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18
Q

treatment of tnsilitis?

A

supportive (rest, eat and drink, analgesia)
antibiotic (penicillin 500g for 10 days, clarithromycin if allergic)
hospital if cant eat and drink (IV fluids and antibiotic, steroids)
surgery

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19
Q

problem with clarithromycin?

A

makes you sick

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20
Q

guidelines for tonsillectomy?

A

watch and wait more appropriate for children with mild sore throats
tonsillectomy is recommended for recurrent severe sore throats
- sore throats must be due to acute tonsillitis
- episodes os sore throats are disabling and prevent normal functioning
- seven or more well documented, clinically significant, adequately treated sore throats in preceeding year
or
- five or more per year in past 2 years
or
- three or more per year in past 3 years

21
Q

features of post tonsillectomy?

A 
very painful
strong opiates required
daycase
pain worst at day 5
5% risk of haemorrhage
22
Q

what is a peritonsillar abscess?

A

complications of acute tonsillitis where bacteria between muscle and tonsil produce pus

23
Q

features of peritonsillar abscess?

A 
unilateral throat pain and odynophagia
trismus
3-7 days of preceeding acute tonsillitis
medial displacement of tonsil and uvula
concavity of palate is lost
24
Q

how is peritonsillar abscess managed?

A

aspiration/drainage

antibiotics

25
Q

what are the signs of glandular fever?

A 
gross tonsillar enlargement with membranous exudate
marked cervical lymphadenopathy
palatal petechial haemorrhages
generalised lymphadenopathy
hepatosplenomegaly
26
Q

how is glandular fever diagnosed?

A

atypical lymphocytes in peripheral blood (different to neutrophilia seen in tonsillitis)
+ve monospot or paul bunnel test
EBV IgE?
low CRP

27
Q

how is glandular fever managed?

A

symptomatic supportive treatment
do not prescribe ampicillin?/amoxicillin?
antibiotics - penicillin
steroids

28
Q

“chronic tonsillitis” included what?

A 
chronic sore throat
malodourous breath
presence of tonsilliths
peritonsillar erythema
persistent tender cervical lymphadenopathy
29
Q

features of obstructive hyperplasia due to adenoids?

A

obligate mouth breathing
hyponasal voice
snoring and other signs of sleep disturbance
AOM/OME (acute otitis media/otitis media with effusion)

30
Q

features of obstructive hyperplasia due to tonsils?

A

snoring and other symptoms of sleep disturbance
muffled voice
dysphagia

31
Q

is large tonsils always a pathological symptoms?

A

no

only when associated with other symptoms

32
Q

causes of true unilateral tonsillar enlargement?

A 
acute infection
chronic infection
hypertrophy
congenital
neoplasm
33
Q

glue ear, otitis media with effusion and serous otitis media are interchangeable terms for what?

A

inflammation of the middle ear accompanied by accumulation of fluid without symptoms and signs of acute inflammation

34
Q

what is acute otitis media?

A

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

35
Q

AOM vs OME?

A

hearing loss and fluid only in OME

earache, fever, irritability and opaque only in AOM

36
Q

who is OME more common in?

A

children(30% < 4 yrs old)
males > female
increased incidence in day care, older siblings, smoking household, recurrent URTI

37
Q

patient risk factors for OME?

A 
recurrent URTI
recurrent AOM
prematurity
craniofacial/genetic abnormalities
- eustachian tube dysfunction
immunodeficiency
38
Q

environmental risk factors for OME?

A 
household smoking
day care
allergy
nutrition
bottle feeding
seasonal
39
Q

what are the symptoms of chronic OM?

A 
hearing loss
poor school performance
bad behaviour
speech delay
balance problems
TV volume
NOT OTALGIA
40
Q

how is chronic otitis media diagnosed?

A 
history
otoscopy
tuning fork test
audiometry
tympanometry
41
Q

signs of chronic otitis media?

A 
TM retraction
reduced TM mobility
altered TM colour
visible ME fluid/bubbles
CHL tuning fork tests
42
Q

how is hearing investigated?

A 
age appropriate hearing assessment
audiometry
- distraction testing (kids)
- bone conduction
- OAE (otoacoustic emissions)
- pure tone audiometry
tympanometry
43
Q

how does tympanometry work?

A

measures vibration of tympanic membrane

TM cant vibrate much if middle ear is filled with fluid

44
Q

how is chronic otitis media managed?

A

watchful waiting
- 60% resolve in 1 month
- 90% resolve in 3 months
can insert grommet if still present at 6-8 months
review at 3 months for otoscopy, PTA and tympanometry
explain that is wont cause long term hearing problems

45
Q

how is chronic otitis media (glue ear) managed if present for more than 3 months?

A

referral

no evidence for antibiotics, decongestants, steroids or antihistamines etc

46
Q

how can glue ear be managed surgically if persistent?

A

<3 yrs = grommet
>3 yrs, first intervention = grommet
>3 yrs, second intervention = grommets and removal of adenoids
- adenoidectomy may be considered earlier if nasal symptoms present

47
Q

possible complications of glue ear?

A

short term speech, language and behavioural development problems (possibly)
no long term problems

48
Q

complications of grommets?

A 
infection/discharge
early extrusion
retention
persistent perfusion
swimming/bathing issues

ENT (21 decks)

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