Week 4: ear, nose, throat pathology I and II Flashcards
1
Q
Chrondrodermatitis Nodularis Helicis (CNH)
A
- inflammatory condition of the skin and cartilage caused by minor trauma, sun damage, prolonged and excessive pressure, e.g. headphone use
- “cauliflower ear”
- damage to supporting elastic cartilage result in tissue necrosis and fibrosis
- painful flesh colored or red nodule on prominent projects of ear
- middle aged men with sun exposure
- chronic inflammation, necrosis of cartilage, fibrosis and deformity of auricle
2
Q
Otitis Externa
A
- commonly caused by Aspergillus
- pain and thick discharge
- predisposed: excessive water exposure or retention of foreign body, chronic cold water exposure can lead to exostoses
- Swimmer’s ear: bacterial infection, localized infection of external ear canal caused by trapping of moisture, wax, and debris resulting in obstruction, swelling, and severe pain. Alkaline pH lays environment for organisms such as pseudomonas, staph, and fungal.
3
Q
Acute otitis media
A
- bacterial or viral
- common bacterial agents in order of frequency: S. pneumo, H. influenzae, M. catarrhalis, Strep progenies, Staph epidermidis
- viral induced inflammation may lead to secondary bacterial infection: purulent exudate in middle ear space, leads to red, bulging TM that may rupture
- glue ear: recurring or persistant otitis media can cause mucosal and goblet cell hyperplasia and increased serious secretions.
4
Q
Chronic Otitis Media
A
- incomplete healing of recurrent and/or prolonged episodes of acute otitis media
- agents: P. aeruginosa, S. Aureas, fungi
- ay lead to perforation of TM, with extension of infection into ossicles and labyrinth
- complications: mastoiditis, abscess formation, temporal cerebritis, lateral sinus thrombosis
- cholestomas: retraction pockets in TM, cystic lesions filled with squamous debris and surrounded by chronic inflammation
- tympanosclerosis: hyalinzation, fibrosis
5
Q
Labyrinthitis
A
- acute inflammation caused by infections or noninfectious (drugs, chemicals)
- nausea, vomiting, vertigo, hearing loss
- bacterial is rarer, more serious, usually extension of suppurative otitis media and involves perilymph of scala tympani. Causes suppurative necrosis and common results in permanent deafness
6
Q
Malignant tumors of the ear
A
- Squamous Cell
- metastasis more frequent
- keratin pearls and intracellular bridges - basal cell carcinoma
- most common
- pearly white nodule, pearly white raised border of epithelium surrounding a rodent ulceration, covered with crusty material
- deeper than squamous cell
7
Q
Irritation fibroma of oral cavity
A
- location: bite line of mouth, gingivodental junction
- gross: exophytic firm nodule, <2cm
- micro: fibrous tissue with some inflammation and overlying squamous epithelium
- due to chronic irritation
- asymptomatic, Rx surgical excision
8
Q
Pyogenic granuloma
A
- misnomer, not pyogenic or granulomatous
- seen in gingiva of young adults, esp. pregnant women
- gross: vascular pendunculated lesion with ulceration, can grow rapidly
- histology: vascular with similarities to granulation tissue
- can regress, fibrose, or become an ossifying fibroma
9
Q
Peripheral ossifying fibroma
A
- common reactive gingival growth of uncertain etiology
- red, ulcerated nodular appearance
- young females
- may arise secondary to maturation of persistent pyogenic granulomas
10
Q
aphthous ulcer
A
- canker sore, up to 40% of US population
- painful, shallow, red, ulceration which can become bacterially infected
- usually resolves in 1-2 weeks
11
Q
Herpes simplex virus
A
- HSV-1 most common in oral cavity
- primary infection in 2-4 yo, often asymptomatic
- 10-20% of first infection can show acute herpetic gingivostomatitis with multiple vesicles in oral cavity
- vesicles resolve spontaneously in 3-4 weeks
- virus is dormant in nerves and trigenimal ganglia
- reactivation usually associated with allergies, UV light, infections, immunosuppression, heat or cold exposure
- Histo: Wright’s stain-using Tzanck test on vesicle fluid taken by unroofing vesicle. Eosinophilic intranuclear inclusions and used giant cells
12
Q
Candidasis
A
- Candida albicans is normal flora in 50% of population
- infection depends on immune status, strain of candida, other organisms in oral flora
- Thrush: superficial white membrane of organisms and fibroinflammatory exudate. CAN be scraped off
- DM, AIDS, transplants, broad spectrum antibiotics
13
Q
Hairy Leukoplakia
A
- EBV
- 80% have HIV infection. or immunosuppression
- white, confluent, hyperkeratotic thickened patches having feathery, corrugated, fluffy pattern. Lateral borders of tone
- histo: hyperparakeratosis and acanthuses with occasional koilocytosis (fried egg appearance)
- CAN’T scrape off
14
Q
Leukoplakia
A
- definition: white patch or plaque which cannot be scraped off without any specific diagnosis
- 5-25% premalignant
- associated with tobacco use
- variable appearance, solitary or multiple white patches
- histo: hyperkeratosis ranging from orderly squamous mucosal epithelium to markedly dysplastic epithelium
15
Q
Erythroplakia
A
- red, velvety plaque in oral cavity, occasionally depressed compared to surrounding mucosa, and with possible erosions
- arises on tongue or buccal mucosa, or floor of mouth
- histo: more atypical than leukoplakia
- higher risk of malignancy
- associated with tobacco use
