URT and Salivary Disorders Flashcards
(33 cards)
Common Infections
Otitis MediaTonsilitis/Pharyngitis
Otitis Media
viral/bacterial ascending infection from nasopharynx that spreads to ear via eustachian tubeCommon in children and infantsExam: red, bulging tympanic membraneBacterial: febrile, more common to have purulent exudateStrep pneumo, H flu, MoraxellaViral: less of a fever, more common to have serous exudateRSV, Rhinovirus, CoronavirusComplications: perforation and possible loss of hearing
Tonsilitis/Pharyngitis
mucosal edema, erythemia, and reactive lymphoid hyperplasia90% are viral -> Rhinovirus, Echovirus, AdenovirusIf bacterial -> Group A Strep or Staph aureusIf Group A Strep -> can caused Acute Rheumatic Fever and/or Post-Strep Glomerulonephritis - hematuriaWhite inflammatory exudates over tonsils
Life Threatening Infections
(usually immunocompromised)Necrotizing External OtitisRhinocerebral Zyngomycosis
Necrotizing External Otitis
Usually caused by Pseudomonas Rarely by AspergillusStarts with minor trauma to auditory canal, progressing with pain, swelling and purulent dischargeLate complications: osteomyelitis of mastoid bone (possibly causing Bell’s Palsy) and meningitis, extension to temporal boneIntracranial extensions! Tx: debride dead tissue and long-term abx
Rhinocerebral Zygomycosis
Fungal infection that starts in sinonasal tract and spreads through blood vessels -> Can spread into CNSMASSIVELY destructive and very high mortality rateTypical fungi: Rhizopus, Absidia or MucorHistology: broad, non-septate hyphae with right angle branchingPt presents w/ sniffles, progresses over 1-3 d to intracranial extension, proptosis, etc.Tx: early detection and debridement, plus anti-fungal
Epistaxis
Pyogenic GranulomaJuvenile Nasopharyngeal Angiofibroma
Pyogenic Granuloma
Benign polypoid vascular proliferation of capillariesMore common in adultsCommon location is anterior nasal septumEtiology: trauma? Pregnancy?Gross appearance: smooth, lovulated, red polypoid massTx: Local excision. Recurrence is rare
Juvenile Nasopharyngeal Angiofibroma
Benign neoplasm w locally destructive growthUsually in young males (no females) Originates in lateral or upper-posterior nasopharynxUnilateralHistology: antler-like thin walled vessels with collagenous stroma w stellate fibroblastsTx: complete resectionIf recurs: hormone modulation (estrogen therapy)
Nasal Obstruction
Sinonasal inflammatory polypsSinonansal papillomasRhabdomyosarcomaOlfactory neuroblastomaSinonasal MelanomaNasopharyngeal Carcinoma
Sinonasal Inflammatory Polyps
Non-neoplastic inflammatory swellings of sinonasal mucosaCan be unilateral or bilateralMost often in adults >20 y/oSymptoms: nasal obstruction, rhinorrhea and headacheAssociated with: CF, DM, allergies, infection, aspirin intoleranceGross: edematous pink/gray masses protruding into nasal cavityHistology: intact surface epithelium with a lot of eosinophilsTx: Excision
Sinonasal Papillomas
Benign neoplasm of sinonasal mucosaRare to see malignant transformation -> but can cause damage if it impinges on local structuresAssociated with HPV 6 and 11Locally destructive, potentially fatalUsually unilateral, may be bilateralSx:nasal obstruction, epistaxis, pain3 forms: SeptalCylindrical (exophytic)Inverted (endophytic) -> much more difficult to resectTx: wide surgical incision
Rhabdomyosarcoma
t(2;13), t(1;13)malignant tumor of skeletal muscleMost common sarcoma in head/neck of kidsMost common locations: orbit > nasopharynx > ear > sinonasal cavityGross: sarcoma botryoides (“grape-like mass”)Histology: looks like skeletal muscle (striated muscle fibers)Good survival at early stage
Olfactory Neuroblastoma
Malignant small round blue cell tumorUnilateral nasal obstruction, epistaxis and visual disturbancesCenter of lesion is usually in cribiform plate -> possible damage to CN 1If stays confined, good prognosisIf extension into nasal cavity, orbit, sinuses, it can get very largeSx: epistaxis, headaches, visual disturbancesTx: radical surgery and radiationHistology: small, round blue cell w/ rosettesMarkers: NSE, Chromogranin, S100
Sinonasal Melanoma
very raremalignant & likely to metastasizePOOR prognosisHistology: black spots (pigmented melanin)Polyploid mass causing obstructionTx: surgical resection of large part of nasal plate
Nasopharyngeal Carcinoma
Associated with EBVUncommon in USA but more common in Asia (in adults) and Africa (in kids)3 patterns: Keratinizing Squamous Cell Carcinoma: least radiosensitive, worst prognosis, dividing slowlyNon-keratinizing SCCUndifferentiatied: most radiosensitive, best prognosisTx: radiation
Midline Destructive Lesions
Wegener’s GranulomatosisExtranodal NK/T cell Lymphoma
Wegener’s Granulomatosis
non-infective vasculitisTriad: Sinonasal, Lung, KidneyUlceration/necrosis of palate due to obstruction of blood vesselsMore common in males, 30-50 y/oPossible autoimmuneSymptoms of nasal involvement: sinusitis, purulent rhinorrhea, obstruction, painPathology - ulceration in the palateLabs: increased ESR, cANCA (anti-proteinase3)Histology: caseating granulomas plus necrosisTx: If limited: steroids or cyclophosphamide If systemic: high-dose steroids and cyclophosphamide and possible TNF antagonist
Extranodal NK/T cell Lymphoma
VERY rare in US, more common in AfricaHighly destructive angiocentric T Cell Lymphoma (malignant T cells attack the blood vessels)Extreme tissue loss (bone, soft tissue)Radiologic findings are same as Wegener’sHistology: tumor cells express NK markers (CD2, CD16, CD56, TIA-1, cytoplasmic CD3)Prognosis: if localized, not so bad. If systemic, rapidly lethal
Hoarseness
Laryngeal NodulesLaryngeal PolypsLaryngeal Papilloma and PapillomatosisSquamous Cell Carcinoma of the Larynx
Laryngeal Nodules
non-neoplasticDue to chronic irritation -> trauma or inflammation“Singer’s nodules” -> bilateralSingle nodule, following voice abuse, infection, alcohol, smoking, hypothyroidismMost common in middle 1/3
Laryngeal Polyps
Unilateral Caused by: voice abuse, infection, EtOH, smoking, hypothroidSimgle, on middle 1/3Benign
Laryngeal Papilloma and Papillomatosis
Benign, exophytic neoplastic growthAdult type -> single lesion that rarely recursJuvenile type -> multiple lesions with high recurrence Often associated with HPV 6 and 11, may be acquired at birthUsually regresses at pubertyRx: laser ablation, antiviral therapyMalignant transformation
Squamous Cell Carcinoma of the Larynx
> 95% are squamous cellM 50 y/oRisk Factors: smoking, EtOH, asbestosSymptoms: hoarseness, dysphagia, hemoptysisComplication: Infection/metastasisLocations: glottic, supraglottic, subglottic, transglottic (rare, but worse)
