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Fundamentals of Medicine: EENT > Salivary Gland and Laryngeal Disordes > Flashcards

Salivary Gland and Laryngeal Disordes Flashcards

1
Q

What is Sialadenitis?

A

salivary gland inflammation

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2
Q

How does Sialadenitis occur?

A

decreased salivary flow or obstruction leads to stasis of fluid, which causes infection
can be viral (mumps, paramyxovirus) - often bilateral and dramatic
can be bacterial (staph aureus) - parotid and submandibular are most common

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3
Q

What causes Sialadenitis?

A 
Sjogen Syndrome
Dehydration (diuretics, anticholinergic medications) 
Chronic Illness
Smoking
Chronic Periodontal Disease
Sialolthiasis
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4
Q

What are common symptoms of Bacterial Sialadenitis?

A

acute painful swelling of the gland
facial swelling
erythema
warmth
tenderness upon palpation
tenderness and erythema of the duct opening
pus
patient will not want you to touch it (very painful)
patient may report that it smells or tastes bad

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5
Q

In what groups is Bacterial Sialadenitis more common, and in what group is Viral Sialadenitis more common?

A

bacterial is more common in adults
viral is more common in children; viral is less likely to have the purulent discharge, warmth and redness of bacterial sialadenitis

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6
Q

How is Sialadenitis treated?

A 
intravenous antibiotics (nafcillin)
hydration
warm compreses
sialagogues (lemon drops)
massage of gland
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7
Q

What is Sialolithiasis?

A

Saliva stone process

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8
Q

How does Sialolithiasis occur?

A

decreased salivary flow leads to stasis, leading to stone development
similar pathophysiology of sialadenitis, but different outcomes

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9
Q

What causes Sialolithiasis?

A 
Sjorgren Syndrome
Dehydration (diuretics, anticholinergic medications)
chronic illness
smoking
chronic peridontal disease
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10
Q

Which salivary duct is affected more often by Sialolithiasis?

A

Wharton’s duct (submandibular) more often (80-90%) than Stensen’s duct (parotid)

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11
Q

What are symptoms of Sialolithiasis?

A

acute painful swelling of the gland (can increase with meals)
often waxes and wanes
no pus but may be palpabel or sometimes visible stone on exam

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12
Q

How is Sialolithiasis diagnosed?

A

diagnosed upon palpation of the stone

if stone cannot be palpated, imaging may be needed (CT over x-ray over MRI)

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13
Q

How is Sialolithiasis treated?

A

increase salivary flow (hydration, warm compresses, sialogogues or lemon drops, massage of gland)
NSAIDs for pain
monitor for infectious symptoms

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14
Q

When would you refer Sialolithiasis?

A

if stone is greater than 2 mm in diameter

if there is no resolution with conservative measures after 3-5 days

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15
Q

Where do Salivary Gland Tumors most commonly occur, and are they more often benign or malignant?

A

Parotid tumors are more common and 80% are benign.

Submandibular and minor gland tumors are less common but more likely to be malignant (50-70%)

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16
Q

What are signs and symptoms of Salivary Gland Tumors?

A

painless swelling
gradual onset (months to years)
possible facial nerve involvement (increases likelihood of malignancy)
on exam feels more firm rubbery/woody

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17
Q

How are Salivary Gland Tumors diagnosed?

A

MRI

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18
Q

How are Salivary Gland Tumors treated?

A

referral to an ENT for definitive treatment

likely excision

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19
Q

Salivary gland pain indicates what?

A

Sialadenitis and Sialolithiasis are painful; salivary gland tumors are not

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20
Q

If a salivary gland illness presents with pus, warmth, and redness, it is probably

A

Sialadenitis; not Sialolthiasis

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21
Q

What is Laryngitis?

A

inflammation of the larynx

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22
Q

How does Acute Laryngitis occur?

A

due to infection of primary vocal cords (rare) or from a secondary infection (common)
most commonly due to vocal cord overuse and abuse

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23
Q

What are signs and symptoms of Acute Laryngitis?

A 
hoarse voice that can persists up to a week to 10 days after other URI
acute onset
commonly after a URI
usually no pain or mild
resolving or absent URI symptoms
malaise
fatigue
24
Q

What is GERD?

A

lower esophageal problem due to dysfunction of lower esophageal sphincter

25
Q

What is Laryngopharyngeal Reflux?

A

upper esophogeal problem due to dysfunciotn of upper esophogeal sphincter
take less gastric contents to make the effect
as much due to laryngeal spasm and vagal response as to the presence of gastric conents
worse while upright, as opposed to GERD which is worse while lying down

26
Q

How is Laryngopharyngeal relfux diagnosed?

A

should be a diagnosis of exclusion

refer to ENT for laryngoscopy to rule out cancer and other structural disorders

27
Q

How is Laryngopharyngeal reflux treated?

A

proton pump inhibitors (PPIs)
can take 1-3 months for full resolution
look for other causes if problem persists passed three months

28
Q

What is Epiglottits?

A

inflammation of the epiglottis

29
Q

What should you do if you suspect Epiglotitis?

A

refer emergently!

do not inspect; any irritation could cause closure and obstruct respiration

30
Q

How does Epiglotitis occur?

A

severe inflammation; essentially cellulitis of the epiglottis and adjacent supraglottic structures
can progress to life-threatening airway obstruction very rapidly

31
Q

What causes Epiglotitis?

A

Infections (bacterial are more common than viruses which are more common that fungal infection)

32
Q

What infectious agents are responsible for Epiglotitis in children?

A

Haemophilus influenzae type B (Hib) - has declined since immunizations
H. influenzae types, streptococci, and staphylococcus aureus

33
Q

What infectious agents are responsible for Epiglotitis in adults?

A

broad range of bacteria and viruses (not as emergent as Epiglotitis in children)

34
Q

What infectious agents are responsible for Epiglotitis in immunocompromised patients?

A

Pseudomonas aeruginosa and Candida (fungus)

35
Q

In what group is Epiglotitis most common?

A

5 cases in 100,000 children under 5 years old

median age is 1-5 years old

36
Q

What are signs and symptoms of Epiglotitis?

A

drooling
tripod formation
red, swollen epiglottis
rapid onset (within 24 hours)
respiratory distress, stridor, tachypnea, anxiety refusal to lige down
sore throat, dysphagia, drooling, anterior neck pain
muffled hot potato voice
marked reactions and labored breathing indicate impending respiratory failure
verbal patients with pain out of proportion
unimmunized patient

37
Q

How is Epiglotits treated?

A 
do not attempt to visualize
do not attempt other invasive procedures
primary objective is to manage the airway and immediately involve airway specialists
hospitalization
IV antibiotics (ceftriaxone)
IV corticosteroids (dexamethasone)
38
Q

If you are not able to maintain an airway in a patient with Epiglotitis, what should you do?

A

Attempt bag-valve mask ventilation; if you are unable to oxygenate, attempt intubation, but first be prepared to establish a surgical airway; if you are able to oxygenate, get endotracheal intubation by the most capable provider, preferably in the OR

39
Q

If you are able to maintain an airway in a patient with Epiglottitis, what should you do?

A

provide supplemental humidified oxygen and maintain the child in a position of comfort with their parent
keep patient in setting where airway can be rapidly managed

40
Q

What are Vocal Cord Polyps?

A

mass arising form the superficial lamina propia of the vocal cord
thought to form in area of resolved vocal cord hemorrhage
unilateral
typically within anterior half of cord
result of vocal cord trauma

41
Q

What are symptoms of Vocal Cord Polyps?

A

subacute hoarseness of voice
usually following vocal abuse or sever cough
mild to no dicomfort

42
Q

How are Vocal Cord Polyps diagnosed?

A

typically requires ENT for laryngoscopy

43
Q

How are Vocal Cord Polyps Treated?

A

vocal rest
occasionally corticosteroids
resection for treatment-resistant polyps

44
Q

Vocal Cord Nodules

A

typically bilateral and symmetrical
chronic vocal abuse
often resolve with vocal modification, but may need surgery
common in singers

45
Q

Polypoid Corditis

A

Reinke’s edema - gelatinous collection of lamina propia resulting from breakdown of elastin fibers leads to big, floppy, bumpy, goopy, vocal cords
caused by smoking
leads to smoker’s voice
may resolve with cessation of smoking

46
Q

How is Unilateral Vocal Cord Paralysis usually caused?

A

latrogenic (from treatment)
recurrent laryngeal nerve damage due to thyroid surgery, thyroid cancer, or other neck surgery
lower cranial nerve and/ or Vagus Nerve damage due to skull base tumor
layrngeal cancer
cricoarytenoid arthritis due to severe advanced RA
idiopathetic (must rule out masses and lesions)

47
Q

How is Bilateral Vocal Cord Paralysis caused?

A

Recurrent laryngeal nerve damage due to thyroid resection
esopharyngeal cancer
laryngeal cancer
cricoarytenoid arthritis due to severe RA

48
Q

What are symptoms of Vocal Cord Paralysis?

A

unilateral - breathy dysphonia

bilateral - inspiratory stridor

49
Q

How is Vocal Cord Paralysis diagnosed?

A

laryngoscopy

CT form base of skull to top of lungs - search for underlying cause

50
Q

How is Vocal Cord Paralysis treated?

A

depends on underlying etiology
often permanent
possible surgical management

51
Q

What is the most common type of Laryngeal Cancer?

A

Squamous cell carcinoma - an epithelial cancer arising form the mucosal surface of the larynx

52
Q

What predisposes patients to Laryngeal Cancer?

A

nearly exclusively in smokers
heavy alcohol use
men more than women
50-70 years of age

53
Q

What are signs and symptoms of Laryngeal Cancer?

A

dysphonia is the most common presenting complaint
any hoarseness lasting more than 2 weeks in a smoker should be evaluated
more advanced: hemoptysis, dysphagia, throat or ear pain
weight loss
airway compromise may occur

54
Q

How is Laryngeal cancer diagnosed?

A

diagnosis is made by having a high index of suspicion
laryngoscopy
biopsy
get head and neck CT for staging

55
Q

How is Laryngeal Cancer treated?

A

most cases are treatable, but early detection is key
goals: cure, preservation of safe and effective swallowing and voice, avoidance of permanent tracheostoma
radiation for acute
surgical cures, chemo, radiation for T3 or T4
nodal involvement more towards surgery, but still chemo

Fundamentals of Medicine: EENT (6 decks)

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