Tonsils, glue ear and the adenoids Flashcards
What is the main function of the tonsils?
Trap bacteria and viruses on inhalation
Expose to the immune system
Antibodies produced by the immune cells in the tissue
Prime immune system and help to prevent subsequent infections
What is waldeyer’s ring and what is included in it?
Ring of lymphoid aggregation in the subepithelial layer of oropharynx and nasopharynx
Comprised of palatine tonsils, adenoids and lingual tonsil
Where can the palatine tonsils be found anatomically?
Fossa by the palatoglossus and palatopharyngeus arches
Lies superficial to the superior constrictor muscle
Where can the adenoids be found anatomically?
Midline of the posterior wall of the nasopharynx immediately inferior to the rostrum of the sphenoid and extending laterally to the lateral wall of nasopharynx
What type of epithelium covers the tonsils?
Stratified squamous epithelium invaginating the tonsils creating crypts
Parenchyma contains numerous lymphoid follicles dispersed beneath the epithelium of the crypts
What type of epithelium covers the adenoids?
Ciliated pseudostratified columnar epithelium
What are common disease of the tonsils and adenoids?
Acute tonsillitis Recurrent adenoiditis. tonsillitis Obstructive hyperplasia Malignancy Otitis media with effusion
What can cause acute tonsillitis?
Viral: EBV, rhinovirus, influenza, parainfluenza, enterovirus, adenovirus
Small percentage bacterial
Why is streptococcus pyogenes an important pathogen to identify in tonsilitis?
Due to risk of rheumatic fever, glomerulonephritis and quinsy
What are the most common bacteria to cause tonsillitis?
Streptococcus pyogenes
Haemophilus influenzae
Staph aureus
Strep pneumoniae
What is the differential with acute tonsilitis?
URTI viral infection Infectious mononucleosis Peritonsillar abscess Candida infection Malignancy: lymphoma, leukaemia, carcinoma Diphtheria Scarlet fever
How will a viral tonsillitis present?
Malaise Sore throat Temperature Able to undertake near normal activity Possible lymphadenopathy Lasts 3-4 days
How will a bacterial tonsillitis present?
Systemic upset Fever Odynophagia Halitosis Unable to work Lymphadenopathy Lasts around 1 week
What is the centor criteria?
History of fever Tonsillar exudates Tender anterior cervical adenopathy Absence of cough 1 point added if under 15 I point subtracted if over 44
How is tonsillitis treated?
Eat and drink
Rest
OTC analgesic - esp NSAIDs
Antibiotics: penicillin 500mg qid 10 days
What are the indications for a tonsillectomy?
7 or more within 1 year
5 ore mor in 2 years
3 or more in 3 year s
What is involved in a tonsillectomy?
VERY sore after - often strong opiates required
Worst day is 5
Risk of haemorrhage is 5% - one patient dies every year from a tonsillectomy
What is a peritonsilar abscess?
Complication of acute tonsillitis
Bacteria between muscle and tonsil produce pus
What is the classical history of a quinsy?
Unilateral throat pain and odynophagia Trismus 3-7days of preceding acute tonsillitis Medial displacement of tonsil and uvula Concavity of palate lost
How is quinsy treated?
Aspiration
Antibiotics
What causes glandular fever?
Ebstien-barr virus
What are the signs of glandular fever?
Gross tonsillar enlargement with membranous exudate Marked cervical lymphadenopathy Palatal petechial haemorrhages Generalised lymphadenopathy Hepatosplenomegaly
How is glandular fever diagnosed?
Atypical lymphocytes in peripheral blood film
IgM EBV
+ve monospot or paul bunnell test
Low CRP
How is glandular fever managed?
Symptomatic
Antibiotics if secondary bacterial tonsillar infection
Steroids
How will obstructive hyperplasia of the adenoids present?
Obligate mouth breathing
Hyponasal voice
Snoring and other signs of sleep disturbance
AOM/OME
How will obstructive hyperplasia of the tonsils present?
Snoring and other symptoms of sleep disturbance
Muffled voice
Dysphagia
What can cause a non-neoplastic unilateral tonsillar enlargement?
Acute infection
Chronic infective
Hypertrophy
Congenital
What can cause neoplastic unilateral tonsillar enlargement?
Papillomas
HPV related conditions such as squamous cell, lymphoma - non-hodgkins B cell
What is glue ear?
Inflammation of the middle ear accompanied by accumulation of fluid without the symptoms and signs of acute inflammation
What is acute otitis media?
Inflammation of the middle ear accompanied by the symptoms and signs of acute inflammation without the accumulation of fluid
Who is OME likely to affect?
Age - children under 8
Males more than females
30% children <4 years at any time
Increased incidence in children with day care, older siblings, smoking household, recurrent URTI
What are symptoms of OME?
Deafness Poor school performance Behavioural problems Speech delay Balance problems TV volume NOT OTALGIA
What are signs of OME?
TM retraction Reduced TM mobility Altered TM colour Visible ME fluid/bubbles CHL tuning fork: 512 Hz Conductive hearing loss
What is the treatment of glue ear?
Watchful waiting
Review: otoscopy, PTA, tympanometry
Grommet
Hearing aid
When is a referral for a glue ear indicated?
Persistent: over 3 months
CHL more than 25 dB
Speech or language problems
Developmental behavioural problems
What are complications of grommets?
Infection/ discharge Early extrusion Retention Persistent perforation Swimming/ bathing issues
