throat powerpoint
TRANSCRIPT
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About Throat
Minci © 2007
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Tonsillitis
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• Acute, subacute (3 wks – 3 mths: Bacterium Actinomyces), chronic.
• Signs /Symptoms: Red, swollen tonsils White patches may appear Severe sore throat, pain at tonsil area Painful/ difficult swallowing Headache Fever and chills Enlarged and tender lymph nodes Loss of voice
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• CausesBacterial: Viral: Superinfection
• Treatment Analgesia, lozenges ± antibiotics
• ComplicationPeritonsillar abscess (quinsy)TonsillolithHypertrophy
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STRIDOR
• High pitched sound resulting from turbulent air flow in upper airway. May be inspiratory, expiratory or both.– Croup– Acute epiglotitis– Acute airway obstruction
• Larynx : Cricoid cartilage (non-compliant cartilage) & subglottis (narrow)
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Features Croup Epiglotitis
1. Organism Parainfluenza virus H. influenzae
2. Age <2 years 2 – 6 years
3. Onset Gradual Rapid
4. Previous attack Often No
5. Cough Barking (seal) No
6. Dysphagia No +++
7. STRIDOR Inspiratory Inspiratory/Expiratory
8. Pyrexia + ++
9. Position Lying down Sitting forward
10. Drooling No +++
11. Nodes +++ +
12. Behaviour Struggling Quiet, terrified
13. Voice Hoarse Muffled
14. Colour Pink Grey
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Acute airway obstruction
• Overcome by skilled intubation or needle cricothyrotomy in children : jet oxygen at 15L/min through a wide bore cannula(14G) placed in cricothyroid membrane.
• Surgical cricothyrotomy• Need tracheostomy – because jet
oxygenates rather than ventilates, so CO2 builds up.
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Hoarseness
Medical term : Dysphonia (Abnormality in voice quality)
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• Commonly voice overuse or laryngitis.
• If > 3 weeks – laryngeal carcinoma until proven otherwise.
• Causes ( refer table)
Neoplastic Vocal cord, laryngeal papilloma, squamous cell cancer of larynx.
Inflammatory GORD laryngitis, laryngitis (viral, bacterial, allergic, tubercular/ fungal)
Neurological VC paralysis, spasmodic dysphonia, essential tremor, PD, CVA,
Misc. Vocal abuse, VC atrophy, VC scarring, hypothyroidism, Reinke’s oedema, drugs.
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Singer’s Nodules• Benign, small swellings situated on
the apposing surfaces of the true cords, commonly at the junction of the anterior one-third and posterior two-thirds
• Symmetrical• Swellings are made of keratin and
result from constant banging together of the vocal cords due to vocal overuse - as in singing, teaching - or abuse - poor speed production.
• Speech therapy, surgery.
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Laryngeal carcinoma• Incidence : 1 in 100 000• Elderly, almost always smokers, may be heavy
drinkers, chews tobacco/betel. M>F• Main features :
– 60% in glottis (good prognosis), present early with hoarseness
– Dysphagia– Lump in neck, earache, persistent cough– Squamous cell carcinoma– Early detection has 90% 5 year cure rate– Mx Radiotherapy, resection.
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Head & Neck Tumours• Acoustic neuroma (vestibular
schwannoma)
• Progressive, ipsilateral tinnitus ± SN deafness, giddiness.
• May have increased ICP signs, facial numbness, CN V, VI, VII may be affected.
• Test : MRI
• Rx : Surgery
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DYSPHAGIA
difficulty in swallowing food or liquid, the cause of which may be
local or systemic
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Odynophagia –painful swallowingGlobus – sensation of lump in the throatPhagophobia – psychogenic dysphagia
Functional dysphagia
• Common in – Elderly – Stroke patients– Head and neck ca– Progressive neuro
disease : PD, MS or ALS.
Dysphagia
Mechanical block Motility disorders
Others-Oesophagitis
(infection, reflux)- Globus hystericus
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Mechanical Block
• Malignant Stricture– Cancer (Oesophageal, gastric, pharyngeal)
• Benign stricture– Oesophageal web or ring– Peptic stricture
• Extrinsic pressure– Lung ca– Mediastinal LN– Retrosternal goitre– AA– LA enlargement
• Pharyngeal pouch
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Motility disorders
• Achalasia• Myasthenia gravis• Diffuse oesophageal
spasm• Palsy (bulbar/
pseudobulbar)• PD• Stroke
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• Key questions :– Difficulty swallowing solids & liquids from the start?– Difficult to make swallowing movement?– Odynophagia?– Intermittent, constant or worse?– Neck bulge or gurgle on drinking?
• Examination :– Cachexic/ anaemia– Mouth– Feel for supraclavicular nodes– Look for Sx of systemic disease
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• Investigation : – FBC, U&Es– CXR (mediastinal fluid level, absent gastric
bubble)– Barium swallow– Upper GI endoscopy and biopsy– ENT opinion if suspected pharyngeal cause
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Facial Palsy
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Causes
Intracranial :-Brainstem tumours
-Strokes-Polio
-Multiple sclerosis-CBP angle lesions (acoustic neuroma,
Meningitis)
Intratemporal:-OM
-Ramsay-Hunt-- cholesteatoma
Infratemporal:-Parotid tumours
-Trauma
Others: -Lyme disease
-GB-Sarcoid-Herpes
-Diabetes-Bell’s palsy
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Examination & Tests• Check:
– Face : paralysis, weakness– Mouth : loss of lacrimation, taste and reduced
saliva production– Ears : exclude OM, zoster, cholesteatoma – Parotid
• Consider temporal bone radiography & EMG
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Ramsay Hunt syndrome
• Also known as herpes zoster oticus
• Severe otalgia (elderly), preceding CNVII palsy.
• Zoster vesicles appear around ear, deep meatus.
• May have vertigo and sensorineural deafness
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Bell’s palsy• Viral polyneuropathy with demyelination : affect V, X, C2
nerves• Abrupt onset, associated with pain• Mouth sags, dribble, taste impaired and watery 9dry)
eyes.• Cannot wrinkle forehead, blow forcefully, whistle, or pout
cheeks.• Treatment :
– Protect eye– Prednisolone + oral acyclovir– Surgical exploration
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Lumps in the neck
• Refer to ENT– Neck lump clinic : FNA for cytology– CT/ MRI– USS shows lump consistency– Culture specimen for TB
• Diagnosis :– How long present?– Which tissue layer is the lump? Intradermal?– Location?
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LUMPS
MIDLINE:- cysts
SUBMANDIBULAR:-Lymphadenopathy
- Salivary stone-Tumour
-Sialadenitis
ANTERIOR:-Cysts
-Tumour (parotid)
POSTERIOR: -Nodes
-Cervical ribs
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Salivary Glands
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• History & examination :– Dry mouth/eyes– Lumps– Swelling related to food– Pain– Look for external swellings, secretions– Bimanual palpation for stones, test VII nerves,
regional nodes– *mumps, acute parotitis, stones, Sjogren’s
tumours*
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Dry Mouth (xerostomia)• Signs
– Dry, atrophic, fissured oral mucosa– Discomfort, difficulty eating, speaking,
wearing dentures– No saliva pooling in floor of mouth– Difficulty expressing saliva from major ducts
• Complications– Dental caries– Candida infection
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• Causes :– Drugs : tricyclics, antipsychotics, -blockers, diuretics, hypnotics– Mouth breathing– Dehydration– Head & neck radiotherapy– Sjogren’s syndrome, SLE, scleroderma,– Sarcoidosis– HIV/AIDS– Obstruction– Graft-versus-host disease
• Management:– Increase oral fluid intake; frequent sips– Good dental hygiene: avoid acidic drinks/food– Try saliva substitute– Chewing sugar-free gum or sweets– Pilocarpine rarely satisfactory– Irradiation xerostomia