Flashcards in Pharyngeal, throat, and neck disorders Deck (30)
What is the most important factor in flavor of food?
Taste receptor cell life span?
-smell or aroma of foodd is the most important factor in flavor.
Taste receptor cell lifespan in 10 days.
define each of the following:
Hypogeusia: diminished taste to 1 or more tastants
Ageusea: absent tase
dysgeusia: persistent sweet, sour, salty, bitter, or metallic taste
allegeusia: unpleasant taste of food or drink that is usually pleasant
phantogeusia: unpleasant taste produced indigenously due to gustatory hallucination
Causes of taste disorders?
-age, infections, gastric reflux, drugs, xerostomia (dry mouth)
Causes of xerostomia?
dz, radiation, infections, drugs (anticholinergics, TCA, antihistamines), toxins
Dysgeusia: difficult to treat, treat underlying problem, clonazepam (klonopin)
burning mouth: TCAs, clonazepam
*benzo's calm the pt down so they dont notice it as much.
smell their breath 5-10cm away from pts mouth and rate it 0-5, 5 being unbearably strong foul odor.
next check nasal passages and score.
evaluate tongue odor using a spoon. need to scrape the tongue.
Etiology of halitosis from each region:
Oral: 80-90% of time.
-breakdown of amino acids producing sulfur and other gases
-poor oral hygiene
-accumulation of post nasal drip
-dental abscess, gingivitis, unclean dentures.
-tonsoliths from bacteria
Tx of halitosis from oral source?
-proper dental care and hygiene
-cleaning of posterior tongue
-rinsing & DEEP gargling w/ mouthwash
-brief chewing gum
-sufficient water intake.
oral candidiasis tx?
-diflucan is 1st choice otherwise liquid nystatin.
-Recurrent aphthous stomatitis (RAS)
--Triamcinolone acetonide in orabase gel
--Topical analgesics (OTC) (oragel, anbesol)
Chemical cautery w/ silver nitrate or sulfuric acid
Severe: intralesional or PO cortisone.
Varicella Zoster Virus
-where are these lesion located in the mouth?
-grouped vesicles UNILATERALLY on the hard palate, can include buccal mucosa, tongue, and gingiva
HIV infection of the mouth
defined as painful mucocutaneous ulceration. shallow, sharply demarcated ulcers can be found on the oral mucosa.
-how long does this last?
usually last one -2weeks
may be induced by viral episode
not painful or harmful it just looks very strange. They dont have any other sx and resolves on its own.
def: dry mouth
-salivary gland calculi
-medications (TCA, anticholinergics, antihistamines)
-artificial saliva (OTC and Rx available)
def: trouble swallowing in the back of your throat
tx: treat the underlying cause.
-candida involving the esophogus
-Hoarsness greater than 2 weeks
-uncooperative pt or one with strong gag reflex
-compromised airway (croup or epiglotitis)
*Fiber optic nasopharyngoscopy is becoming procedure of choice.
acute laryngitis- URI or voice misuse
benign vocal fold lesions
malignancy involving the larynx
neurologic dysfunction (ALS or MS)
non-organic (functional) issues
acute: less than 3wk duration, self-limited condition, voice rest and fluids.
Chronic: treat underlying etiology such as..
-toxins, gerd, chronic sinusitis, postnasal drip, chronic alcohol use, chronic vocal strain, tobacco smoke.
Muscle tension dysphonia
-what is this?
imbalance of tension in muscles involved in voice production, seen in aging with atrophy of some of the supporting structure of the vocal cords.
-result from what?
-most common in who?
-result from chornic vocal cord irritation
-etiologies: smoking, reflux, muscle tension dysphonia
-characteristics: bilaterally, symmetric
-aka screamers or singers nodes
-MC in women and children.
Primary Squamous cell Laryngeal Cancer
-arise from where?
-arise from the mucosal surface of the larynx
-Major risk factors are smoking and alcohol abuse
-early lesions appear initially as white plaques (Leukoplakic)
-metastasizes to regional lymph nodes
Describe the stages of swallowing
Oral preparatory phase: CN V, VII, XII. bolus processed by mastication
Pharyngeal phase: CN V, X, XI, XII. bolus advances into esophagus by pharyngeal peristalsis
Esophageal phase: peristaltic contractions in the esophagus propel bolus down. Relaxation of the lower esophageal sphincter allows the bolus to enter the stomach.
What are some disorders of the oral preparatory phase?
-disruption of the oropharyngeal mucosa.
Disorders of the pharyngeal phase?
-obstruction within the oropharynx
-poor compliance of the upper esophageal sphincter.
-what are some clues in the hx?
-sx occur immediately after swallowing
-point to cervical region as to wherre the food "sticks"
-c/o coughing, choking, drooling, changes in speech.
-fiberoptic endoscopic eval of swallowing
-MC bacterial cause
-response to tx?
MC: Group A Strep
-obtain throat and nasopharyngeal specimines
-rapid strep test/throat culture**
-monospot (blood test)
-PCN/amoxacillin first line
if allergic cephalosporin or macrolide
*resistant to clindamycin.
**NEVER USE sulfa, FQ, and tetracyclines b/c of high rates of RESISTANCE!!!
-Acetaminophen, NSAIDS, Aspirin in adults only
-Topical: lozenges, sprays, fluids
-within 24hrs of abx infectivity decreases by 80%, should be improved in terms of pain and fever in 48hrs..if not improving need to return to clinic.
-signs and sx
Causes: Group A Strep or possibly EVB
Signs and Sx:
-more severe sore throat than pharyngitis
-enlarged, red tonsils with exudate
Dx: same test as for pharyngitis
-reduce duration and severity of sx
-reduce risk of acute rheumatic fever, glomerularnephritis, pediatric autoimmne neuropsychiatric disorder syndrome
-reduce transmission to close contacts
-what is this?
-signs and sx
What: infection of the tonsils, complication of tonsillitis. Can present primarily or pt may be under tx for tonsillitis.
Signs and Sx:
-drooling, voice changes
-ipsilateral ear pain
-inferior and medial displacement of the tonsil and uvula
-needle aspiration diagnostic if purulent material obtained.
-I&D by ENT then start on abx (sometimes IV)
-occassionally these pts need tonsillectomy