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ENT > Tonsils, Adenoids and Glue Ear > Flashcards

Tonsils, Adenoids and Glue Ear Flashcards

1
Q

summarise the development of the tonsils

A

tonsillar fossa and palatine tonsils develop from dorsal wing of 1st palatine pouch and ventral wing of 2nd pouch @ 8 weeks
crypts 3-6 months

16 weeks adenoids develop as a sub epithelial infiltration of lymphocytes

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2
Q

what is the main function of the adenoids and tonsils

A

trap bacterial and viruses on inhalation

expose these to immune system

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3
Q

what happens to tonsil size throughout life

A

singificant adenotonsilar enlargement unusual under 2

after teens tonsils and adenoids decrease in size

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4
Q

what is waldeyers ring

A

ring of lymphoid aggregation in the subepthelial layer of oropharynx and nasopharynx

made up of tonsils (palatine tonsil), adenoids (pharyngeal tonsil) and lingual tonsils (on tongue)

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5
Q

what does the tonsil sit in

A

in a fossa formed by the muscular anterior and posterior tonsillar pillars (palatoglossus and palatopharyngeus)

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6
Q

describe the histology of the tonsils

A

Lymphoid tissues covered with specialised stratified squamous epithelium
deep cysts
base separated from muscles by dense collagenous hemi-capsule
lymphoid follicles in parenchyma

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7
Q

describe the histology of the adenoids

A

ciliated pseudostratified columnar
stratified squamous
deep folds
transitional

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8
Q

what epithelium lines the oral cavity, pharyngeal, vocal cords, oesophagus

A

squamous epithelium

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9
Q

what epithelium where air goes (nose, PNS, larynx, trachea)

A

columnar

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10
Q

what usually causes acute tonsillitis

A

majority viral - EBV, rhinovirus, parainfluenza, enterovirus, adenovirus

bacterial- strep pyogenes (group A beta-haemolytic strep), H influenza, S. aureus, strep pneumoniae

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11
Q

when should you suspect mono in a patient previously diagnosed with tonsilitis

A

if persists despite antibacterial treatment

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12
Q

what malignancies can be mistaken for acute tonsilitis

A

lymphoma, leukemia, carcinoma

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13
Q

what are the symptoms of viral tonsilitis

A

not a severe as bacterial:

  • malaise
  • sore throat
  • temp
  • able to work and do normal activities
  • possible lymphadenopathy
  • lasts 3-4 days
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14
Q

what are the symptoms of bacterial tonsilitis

A

more severe than viral:

  • systemic upset
  • fever
  • odynophagia
  • halitosis
  • unable to work/school
  • lymphadenopathy
  • lasts 1 week
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15
Q

how do you differentiate between bacterial and viral tonsilitis

A

bacterial infection:

  • history of fever
  • tonsillar exudates
  • tender anterior cervical adenopahty
  • absence of cough
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16
Q

when should you give antibiotics in tonsilitis

A

centor
0-1 no
2/3 - yes if symptoms progress
4/5 - treat empirically with an antibiotic

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17
Q

what does the centor criteria assess

A

the risk of group A strep infection and hence the need for antibiotics

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18
Q

is puss on tonsils more/less likely to make it bacterial tonsillitis

A

more likely

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19
Q

what is the treatment for tonsilitis

A

supportive: eat and drink, rest, analgesia (paracetamol, NSAID)
antibiotic- penicillin 500 mg quid for 10 days, clarithromycin if allergic
hospital- IV fluids and antibiotics, steroids
surgery

20
Q

what are the negatives of surgical management of tonsilectomy

A

very painful

risk of haemorrhage- 1 person dies every year

21
Q

what are the possible complications of tonsillitis

A 
peritonsilar abscess (quinsy) 
infective mononucleosis (when caused by EBV)
22
Q

what is a peritonisilar abscess

A

complication of acute tonsilitis- when the bacteria between muscle and tonsil produce pus

23
Q

what are the features of a peritonsilar abscess

A

unilateral throat pain and odynophagia
trismus
3-7 days of preceding acute tonsilitis

medial displacement of tonsil and uvula
concavity of palate lost

24
Q

what is the treatment for a peritonsilar abscess (qunisy)

A

aspiration and antibiotics

25
Q

what is infective mononucleosis (glandular fever) caused by

A

ebstein-barr virus

26
Q

what are the signs of infective mononucleosis

A 
gross tonsilar enlargement with membranous exudate 
marked cervical lymphadenopathy 
palatal petechial haemorrhages 
generalised lymphadenopathy 
hepatosplenomegaly
27
Q

what tests to diagnose infective mononucleosis

A

atypical lymphocytes in peripheral blood,
paul-bunnell test or monospot,
low CPR,
can cause deranged LFTs

28
Q

what is the management of infective mononucleosis

A

symptomatic
antibiotics if they get secondary bacterial infection
steroids if patient struggling
avoid contact sport to avoid spleen rupture
avoid alcohol

29
Q

is chronic tonsillitis a thing

A

probs not

30
Q

what are the features of obstructive hyperplasia of the adenoids

A

obligate mouth breathing
hyponasal voice
snoring and sleep disturbance (reason to remove them)
AOM/OME

31
Q

what are the features of obstructive hyperplasia of the tonsils

A

snoring and sleep disturbance
muffled voice (transient as tonsils decrease in size)
?dysphagia

32
Q

what are the causes of unilateral tonsilar enlargment

A

acute/chronic infection
hypertrophy
congenital
neoplastic

33
Q

what is glue ear/ otitis media with effusion/ serous otitis media

A

inflammation of the middle ear accompanied by accumulation of fluid without the symptoms and signs of acute inflammation

  • hearing loss
  • fluid seen in TM and has impaired mobililty
34
Q

what is acute otitis media

A

inflammation of the middle ear accompanied by the symptoms and signs of acute inflammation with/ without an accumulation of fluid

  • may have hearing loss not always
    (inc: fever, earache, irritability, opaque TM- may be bulging or have impaired mobility)
35
Q

who gets OME

A 
children, boys more
esp if: 
in day care, have older siblings, 
smoking household (affects cililary function), 
history of recurrent URTI/AOM, 
if premature, craniofacial/genetic abnormalities, 
immunodeficient,
bottle fed,
allergy,
seasonal
36
Q

why do children get OME

A

as eustachian tube short- gets congested

37
Q

what are the symptoms of OME

A 
deafness,
poor school performance and behavioural problems,
speech delay,
balance problems,
loud TV

will NOT have otalgia

38
Q

how do you diagnose OME

A 
history,
otoscope,
tuning fork tests,
audiometry 
tympanometry
39
Q

what are the signs of OME

A

TM retraction, reduced TM mobility, altered TM colour, visible ME fluid/bubbles
CHL tuning fork tests

40
Q

what will cause a tympanomtery test to produce a flat line

A

fluid in the middle ear

41
Q

what is the hearing range in glue ear

A

roughly around 30dB

42
Q

what is the management of glue ear

A

watchful waiting most resolve

review at 3 months
otoscopy, PTA, tympanometry

manage educational needs

if persistent for >3 months, symptoms of deafness and speech/language problems, CHL>25 dB or developmental behavioural problems then refer

43
Q

what are the surgical management options of OME

A

<3 years= grommets

>3 years grommets, then adenoidectomy (considered earlier if nasal problems early), hearing aids

44
Q

how long to grommets last

A

can fall out in few days or in 18 months

45
Q

what are the complications of grommets

A 
infection/ discharge 
early extrusion
retention 
persistent perforation,
swimming/bathing issues (cant swim as will get severe vertigo due to cold water)

ENT (27 decks)

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