Benign ENT Disease Flashcards
(23 cards)
Problems with the oral cavity (preparation)
-Weak tongue
-Poor teeth
-Facial weakness
-Obstructing pathology
Problems with oropharyngeal (initiation)
-Velopharyngeal insufficiency
-Altered sensation
-Tumour
-Surgery
Hypopharyngeal problems (often aspiration)
-Vocal cord palsy (vocal cord medialisation in recurrent laryngeal nerve injury)
-Reduced supraglottic sensation
-Tumour
-Radiotherapy/ surgery
-Neurological
-Cricopharyngeal spasm
Problems with pharyngeal pouch/ oesophageal (dysphagia) and management
-Stricture
-Reflux
-Extrinsic compression
-Tumour
-Dysmotility
=Endoscopic stapling/ open repair
Examples of inflammatory/ infective causes of sore throat
-Tonsillitis
-Pharyngitis
-Reflux
-Smoking
-Alcohol
-Mouth breathing
Common head and neck infections
-Tonsillitis
-Quinsy/ parapharyngeal abscess
-Pharyngitis
-Supraglottitis/ epiglottitis
-Sialadenitis (trapped saliva in parotid duct)
-Role of throat swab
Overview of tonsillitis
-Presentation: fever, malaise, lymphadenopathy, pharyngitis, oedematous pustules (strep pyogenes). No stridor!
-Investigation:
-Management: analgesia, abx, hydration, surgery (tonsillectomy if 7x1 yr, 5x2 yr, 3x3 yr)
Overview of quinsy/ peritonsillar abscess
-Presentation: one sided, referred otalgia, trismus, pyrexia. uvular and soft palatal shift
-Investigation:
-Management: IV fluids, IV abx, needle aspiration of pus
Overview of parapharyngeal abscess/ deep neck space infection
-Presentation: history of URTI/ tonsillitis, throat pain, odynophagia, fever, neck swelling and tenderness, lymphadenopathy, neck stiffness, occasionally airway compromise
-Investigation: USS, CT, MRI
-Management: IV fluids and abx, airway protection, needle/ open surgical drainage.
Overview of glandular fever
-Presentation: can look like tonsillitis, lymphadenopathy, hepatosplenomegaly
-Investigation: EBV serology
-Management: IV fluids, ?abx, IV steroids, LFT, avoid contact sports
Overview of laryngitis/ Supraglottitis
-Presentation: fever, very sore throat with not much to see, odynophagia/ drooling, stridor, neck stiffness
-Investigation:
-Management: hospitalisation, IVI, IV abx and steroid, nebulised adrenaline, airway assessment
Roles of the larynx
-Airway
-Airway protection
-Increasing intra-thoracic/ intra-abdominal pressure
-Voice
Describe hoarseness and causes
-Form of dysphonia
-Usually multifactorial
-Hoarseness >3 weeks needs investigated in context
=Older= cancer
-Silent reflux
-Laryngitis
-Reinke’s oedema (inflammation of false cords)
-Lung malignancy needs to be ruled out
Complications of GORD with laryngopharyngeal reflux
-Rhinitis
-Post nasal discharge
-Pharyngitis
-Halitosis
-Hoarseness
-Globus
-DUE TO PEPSIN
Features of airway obstruction
-Stertor (noisy breathing due to obstruction above the larynx)
-Stridor (due to obstruction below or at larynx)
-Ronchi (due to narrowing of the lower respiratory airways)
Classification of neck trauma
-Sharp (superficial, penetrating)
-Blunt
-Burn/ scald
-Foreign body
Management of superficial sharp trauma
-Require careful assessment to exclude damage to important deep structures
-If there is any doubt on simple examination the wound requires formal surgical exploration
-If no deep involvement: wound can be thoroughly cleaned and closed primarily
-Multiple superficial slashes or scratches are often a feature of self inflicted inj
Management of penetrating/ deep sharp trauma
-Require emergency surgical exploration under GA with primary repair of injuries to deep structures
-Antibiotic and tetanus cover are require
Management of blunt trauma
-Consider c spine injury
-Risk of crush trauma to larynx > significant oedema
=assessment to establish likely severity of injury
=external signs bruising/swelling/crepitus
=endoscopic examination of laryngopharynx
=laryngeal oedema- intervention required
-Protect airway by laryngeal intubation with ENT ready for tracheostomy
-Following intubation CT scanning
-Planned extubating once oedema settled
Management of burns and scalds
-Dyspnoea and dysphagia
-Intubation or tracheostomy
-Steroids, antibiotics and analgesia
-Severe injury often fatal
Overview of inhaled foreign body
-Presentation: shortness of breath, stridor, hoarseness, reduced air entry, often nothing in small children initially
-Investigation and management: flexible laryngopharyngoscopy, lateral soft tissue neck x-ray, CXR
Overview of ingested foreign bodies
-Presentation: dysphagia, drooling
-Management: flexible laryngopharyngoscopy, CXR, lateral soft tissue neck x ray, emergency endoscopy and removal for sharp objects, soft food bolus= conservation with buscopan and endoscopy
Management of stridor
-Resus
-Dexamethasone IV
-IV abx (ceftriaxone and metronidazole)
-Adrenaline nebs
-Oxygen
-Assess airway using fibreoptic endoscope= are they tubable? Does it need to be secured?
