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Head & Neck > Lecture 10.2: Disorders of the Pharynx > Flashcards

Lecture 10.2: Disorders of the Pharynx Flashcards

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1
Q

What are Adenoids?

A

They are a patch of tissue that sits at the very back of the nasal passage

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2
Q

What happens if Adenoids are Enlarged?

A
  • Nasal Obstruction
  • Eustachian Tube Obstruction
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3
Q

What happens if there is Nasal Obstruction due to Enlarged Adenoids? (4)

A
  • Mouth Breathing
  • Hyponasal Speech
  • Feeding Difficulty (esp. infants)
  • Snoring/Obstructive Sleep Apnoea
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4
Q

What happens if there is Eustachian Tube Obstruction due to Enlarged Adenoids? (2)

A
  • Recurrent acute otitis media (earache)
  • Chronic otitis media with effusion (glue ear,
    reduced hearing)
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5
Q

What is an Angiofibroma?

A
  • A benign tumour that is made up of blood vessels
    and fibrous tissue
  • Angiofibromas usually appear as small, red bumps
    on the face, especially on the nose and cheeks
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6
Q

What is Glue Ear?

A

When fluid collects in the middle ear

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7
Q

Symptoms of Glue Ear (6)

A
  • Poor concentration
  • TV volume up/Hearing down
  • Behavioural Issues
  • Recent URTIs
  • Hyponasal Speech
  • Snotty Nose
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8
Q

What does the hearing test of an individual with Glue Ear show?

A

Hearing test shows 30dB loss in both ears

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9
Q

Management of Glue Ear (3)

A
  • Self-limiting condition→“ watchful waiting”– repeat
    audiometry in 3/12.
  • Valsalva techniques to re-ventilate middle ear
    cavities
  • If no improvement , then consider grommets or
    hearing aids
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10
Q

Contents of the Oropharynx

A
  • Palatine tonsils
  • Anterior and posterior tonsillar pillars
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11
Q

What is Acute Pharyngitis?

A

Inflammation of the oropharynx

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12
Q

What is Tonsillitis?

A

Inflammation of the tonsils

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13
Q

What Factors are included as part of the Centor Clinical Presentation Score? (4)

A
  • Fever
  • Anterior Cervical Nodes
  • Exudate
  • Absent cough
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14
Q

What does a score of 3/4 on the Centor Clinical Presentation Score mean?

A

40-60% chance of bacterial Group A betahaemolyticstreptococcus

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15
Q

Local Complications of Streptococcal Sore Throat (3)

A
  • Otitis Media
  • Sinusitis
  • Chest Infection
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16
Q

Distant Complications of Streptococcal Sore Throat (4)

A
  • Rheumatic Fever
  • Glomerulonephritis
  • Meningitis
  • Toxic Shock Syndrome
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17
Q

Red Flags for Sore Throat (5)

A
  • Difficulty Breathing
  • Difficulty Swallowing Saliva/Drooling
  • Difficulty Opening Mouth (Trismus)
  • Severe Pain (Especially Unilateral)
  • Persistent High Fever
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18
Q

Causes of Tonsilitis (4)

A
  • Viral
  • Beta Haemolytic Strep
  • Strep Pneumoni
  • Haemophilus Influenza
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19
Q

Treatments of Tonsilitis (2)

A
  • Phenoxymethylpenicillin
  • Macroglycoside e.g., erythromycin
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20
Q

Complications of Tonsilitis

A
  • Abcess Formation
  • Peritonsillar (quinsy), retropharyngeal or
    parapharyngeal abscess
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21
Q

What are Indications to get a Tonsillectomy? (4)

A
  • Recurrent tonsillitis (5/year for at least 2 years)
  • Previous peritonsillar abscess (quinsy)
  • Suspected cancer (unilateral enlargement/
    ulceration)
  • Obstructive sleep apnoea syndrome
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22
Q

Risks of a Tonsillectomy? (3)

Study These Flashcards
A
  • General Anaesthesia
  • Bleeding (primary (within 24 hours) or secondary)
    approx. 3-5%
  • Infection
23
Q

What to do with a post tonsillectomy BLEED when you’re on-call? (10)

Study These Flashcards
A
  • Contact the ENT REG immediately – they may need
    to go back to theatre as an emergency
  • Airway first: sit the patient up and encourage them
    to spit blood into a bowl
  • Insert large-bore IV access and send blood for FBC,
    coagulation screen and group-and-save (urgent
    crossmatch if the bleeding is severe or unstable)
  • Do not delay in calling for an anaesthetist for help in
    stabilising an actively bleeding patient (this is.
    especially true in children)
  • Frequent haemodynamic observations
  • Nil by mouth: IV fluid resuscitation/IV analgesia
  • Ice pack on the back of the patient’s neck
  • Consider IV tranexamic acid
  • If not heavily bleeding: hydrogen peroxide gargles
  • Consider using 1:10000 adrenaline on a gauze with
    forceps
24
Q

How are hydrogen peroxide gargles done?

Study These Flashcards
A
  • This is made up from a 3% solution diluted in three
    parts of water before being given to the patient to
    gargle
  • They should not swallow
25
What are Tonsil Cysts?
Non-cancerous masses of cells on the tonsils, at the back of the throat
26
What is Tonsil Debris/Stones?
* Also called tonsilloliths, are small lumps that form in your tonsils * Form when debris, such as food, dead cells, bacteria, and other substances, becomes trapped on the tonsils * The debris hardens as calcium builds up around it, forming tonsil stones
27
What is the main symptom of tonsil stones?
Bad Breath
28
How to treat Tonsil Stones?
Using a saltwater gargle or a water pick, if they keep recurring then surgery may be suggested
29
What are the types of Tonsil Cancer? (2)
* The most common type of cancer in the tonsils is squamous cell carcinoma * A small number of tonsil cancers are lymphomas
30
Symptoms of Tonsil Cancer (8)
* Lump in the neck * A sore or ulcer in the back of the mouth that won't heal * Blood in your saliva * Mouth pain * One tonsil that's larger than the other * A sore throat that won't go away * Ear pain * Difficulty swallowing, speaking or chewing
31
What is Snoring caused by? (5)
* Snoring caused by vibration of pharyngeal structures such as the tongue, soft palate & pharyngeal walls * Factors such as nasal or nasopharyngeal obstruction * Large tongue or tongue falling back into throat * Obesity * Excessive tiredness / alcohol
32
Management of Snoring (7)
* Lose Weight * Less Alcohol * Stop Smoking * Tennis Ball in the Pyjamas! * Treat Nasal Obstruction * Mandibular Advancement Device * Surgery: adenotonsillectomy/uvulopalatopharyngoplasty
33
What is Obstructive Sleep Apnoea (OSA)?
A relatively common condition where the walls of the throat relax and narrow during sleep, interrupting normal breathing
34
Consequences of OSA?
* Daytime Lethargy * Sleepiness * Reduced Concentration * If severe can cause hypoxia and increase cardiovascular strain: pulmonary hypertension → right heart failure →cor pulmonale
35
Investigations for OSA (2)
* Nasendoscopic Examination of Pharynx * Sleep Studies
36
Treatment of OSA (4)
* Weight Loss * Surgery for Structural Causes eg Nasal Polyps * Adenoids/Adenotonsillectomy * CPAP: Continuous Positive Airways Pressure
37
What is Odynophagia?
Pain Swallowing
38
What can cause Acute Dysphagia? (5)
* Tonsillitis * Pharyngitis * Aphthous Ulcers * Foreign Bodies * Ingestion of Caustic Liquids
39
Malignant Causes of Chronic Dysphagia (5)
* Pharyngeal Cancer * Oesophageal Cancer * Stomach Cancer * Extrinsic Pressure (Lung Cancer) * Worse with solids, Pain
40
Neurological Causes of Chronic Dysphagia (5)
* Stroke * Motor Neurone Disease * MS * Myaesthenia Gravis * Worse Swallowing Liquids
41
Other Causes of Chronic Dysphagia (6)
* Dry Mouth/Dental * Pharyngeal Pouch Strictures/ * External Lesions * Thyroid Enlargement * Systemic Disease Scleroderma (rare) * Globus Pharyngeus
42
Red Flags for Dysphagia (12)
* True Dysphagia (solids more than liquids) * Hoarse * Breathing difficulties * Pain * Otalgia * Weight and Appetite Loss * Neck Nodes * Neurological Deficit * Drooling * Rapid Onset * Smoking * HPV
43
What is Globus Pharyngeus?
The painless sensation of a lump in the throat and may be described as a foreign body sensation, a tightening or choking feeling
44
Dysphagia Investigations (5)
* FBC * ESR * Nasendoscopy * Upper GI endoscopy * Barium Swallow
45
What is Killian’s Dehiscence?
A triangular area in the wall of the pharynx between the cricopharyngeus and thyropharyngeus which are the two parts of the inferior constrictors (also see Pharyngeal Pouch)
46
What is a Pharyngeal Pouch?
Posterior herniation of pharyngeal mucosa
47
Why may Pharyngeal Pouching occur? (3)
* Weaker Area * Incoordination of pharyngeal phase of swallowing * Cricopharyngeal Spasm
48
Treatment of Globus Pharyngeus? (2)
* Reassurance * Treat Acid Reflux
49
Common Sites for Foreign Body Lodging in Mouth (3)
* Tonsil * Piriform Fossa * Cricopharyngeus
50
History of Foreign Body Lodging in Mouth (3)
* Well Localised * Immediate Sensation * Inability to Swallow Saliva/Drooling
51
Food Bolus Immediate and Overnight Management (5)
* Glucagon * Buscopan (hyoscine butylbromide) * Prokinetic such as erythromycin, domperidone or metoclopramide to empty the stomach * In uncomplicated cases, admit the patient overnight and give IV fluids and analgesia * Oesophagoscopy (rigid or flexible)
52
How is Glucagon administered for the Immediate and Overnight Management of a Food Bolus?
Can be given as a slow IV bolus of 1-2 mg to relax the lower oesophageal sphincter
53
How is Buscopan (Hyoscine Butylbromide) administered for the Immediate and Overnight Management of a Food Bolus?
Given in 20mg IV boluses, 30 minutes apart, to a maximum of five doses, to relax the lower oesophageal sphincter
54
How is an Oesophagoscopy used for the Immediate and Overnight Management of a Food Bolus?
It is usually performed the following day to allow time for the obstruction to pass spontaneously, as long as there are no worrying features

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