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ENT > Tonsils, glue ear and the adenoids > Flashcards

Tonsils, glue ear and the adenoids Flashcards

1
Q

What is the main function of the tonsils?

A

Trap bacteria and viruses on inhalation
Expose to the immune system
Antibodies produced by the immune cells in the tissue
Prime immune system and help to prevent subsequent infections

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2
Q

What is waldeyer’s ring and what is included in it?

A

Ring of lymphoid aggregation in the subepithelial layer of oropharynx and nasopharynx
Comprised of palatine tonsils, adenoids and lingual tonsil

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3
Q

Where can the palatine tonsils be found anatomically?

A

Fossa by the palatoglossus and palatopharyngeus arches

Lies superficial to the superior constrictor muscle

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4
Q

Where can the adenoids be found anatomically?

A

Midline of the posterior wall of the nasopharynx immediately inferior to the rostrum of the sphenoid and extending laterally to the lateral wall of nasopharynx

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5
Q

What type of epithelium covers the tonsils?

A

Stratified squamous epithelium invaginating the tonsils creating crypts
Parenchyma contains numerous lymphoid follicles dispersed beneath the epithelium of the crypts

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6
Q

What type of epithelium covers the adenoids?

A

Ciliated pseudostratified columnar epithelium

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7
Q

What are common disease of the tonsils and adenoids?

A 
Acute tonsillitis
Recurrent adenoiditis. tonsillitis
Obstructive hyperplasia
Malignancy
Otitis media with effusion
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8
Q

What can cause acute tonsillitis?

A

Viral: EBV, rhinovirus, influenza, parainfluenza, enterovirus, adenovirus
Small percentage bacterial

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9
Q

Why is streptococcus pyogenes an important pathogen to identify in tonsilitis?

A

Due to risk of rheumatic fever, glomerulonephritis and quinsy

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10
Q

What are the most common bacteria to cause tonsillitis?

A

Streptococcus pyogenes
Haemophilus influenzae
Staph aureus
Strep pneumoniae

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11
Q

What is the differential with acute tonsilitis?

A 
URTI viral infection
Infectious mononucleosis
Peritonsillar abscess
Candida infection
Malignancy: lymphoma, leukaemia, carcinoma
Diphtheria
Scarlet fever
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12
Q

How will a viral tonsillitis present?

A 
Malaise
Sore throat
Temperature
Able to undertake near normal activity
Possible lymphadenopathy
Lasts 3-4 days
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13
Q

How will a bacterial tonsillitis present?

A 
Systemic upset
Fever
Odynophagia 
Halitosis
Unable to work
Lymphadenopathy
Lasts around 1 week
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14
Q

What is the centor criteria?

A 
History of fever
Tonsillar exudates
Tender anterior cervical adenopathy
Absence of cough
1 point added if under 15
I point subtracted if over 44
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15
Q

How is tonsillitis treated?

A

Eat and drink
Rest
OTC analgesic - esp NSAIDs
Antibiotics: penicillin 500mg qid 10 days

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16
Q

What are the indications for a tonsillectomy?

A

7 or more within 1 year
5 ore mor in 2 years
3 or more in 3 year s

17
Q

What is involved in a tonsillectomy?

A

VERY sore after - often strong opiates required
Worst day is 5
Risk of haemorrhage is 5% - one patient dies every year from a tonsillectomy

18
Q

What is a peritonsilar abscess?

A

Complication of acute tonsillitis

Bacteria between muscle and tonsil produce pus

19
Q

What is the classical history of a quinsy?

A 
Unilateral throat pain and odynophagia 
Trismus
3-7days of preceding acute tonsillitis
Medial displacement of tonsil and uvula 
Concavity of palate lost
20
Q

How is quinsy treated?

A

Aspiration

Antibiotics

21
Q

What causes glandular fever?

A

Ebstien-barr virus

22
Q

What are the signs of glandular fever?

A 
Gross tonsillar enlargement with membranous exudate
Marked cervical lymphadenopathy
Palatal petechial haemorrhages
Generalised lymphadenopathy
Hepatosplenomegaly
23
Q

How is glandular fever diagnosed?

A

Atypical lymphocytes in peripheral blood film
IgM EBV
+ve monospot or paul bunnell test
Low CRP

24
Q

How is glandular fever managed?

A

Symptomatic
Antibiotics if secondary bacterial tonsillar infection
Steroids

25
Q

How will obstructive hyperplasia of the adenoids present?

A

Obligate mouth breathing
Hyponasal voice
Snoring and other signs of sleep disturbance
AOM/OME

26
Q

How will obstructive hyperplasia of the tonsils present?

A

Snoring and other symptoms of sleep disturbance
Muffled voice
Dysphagia

27
Q

What can cause a non-neoplastic unilateral tonsillar enlargement?

A

Acute infection
Chronic infective
Hypertrophy
Congenital

28
Q

What can cause neoplastic unilateral tonsillar enlargement?

A

Papillomas

HPV related conditions such as squamous cell, lymphoma - non-hodgkins B cell

29
Q

What is glue ear?

A

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

30
Q

What is acute otitis media?

A

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

31
Q

Who is OME likely to affect?

A

Age - children under 8
Males more than females
30% children <4 years at any time
Increased incidence in children with day care, older siblings, smoking household, recurrent URTI

32
Q

What are symptoms of OME?

A 
Deafness
Poor school performance
Behavioural problems 
Speech delay 
Balance problems
TV volume 
NOT OTALGIA
33
Q

What are signs of OME?

A 
TM retraction 
Reduced TM mobility 
Altered TM colour
Visible ME fluid/bubbles
CHL tuning fork: 512 Hz
Conductive hearing loss
34
Q

What is the treatment of glue ear?

A

Watchful waiting
Review: otoscopy, PTA, tympanometry
Grommet
Hearing aid

35
Q

When is a referral for a glue ear indicated?

A

Persistent: over 3 months
CHL more than 25 dB
Speech or language problems
Developmental behavioural problems

36
Q

What are complications of grommets?

A 
Infection/ discharge 
Early extrusion 
Retention 
Persistent perforation 
Swimming/ bathing issues

ENT (20 decks)

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