Infections And Diseases Of The Larynx And Nasopharynx Important Notes
- Arteries Supplying Tonsils
- Anterior tonsillar
- Posterior tonsillar
- Ascending pharyngeal
- Superior tonsillar
- Inferior tonsillar
- Acute Tonsillitis
- It is generalised inflammation of the tonsils
- Causative Organisms
- Viral
- Bacterial
- Acute Tonsillitis Types
- Acute catarrhal tonsillitis
- Acute follicular tonsillitis
- Acute parenchymatous tonsillitis
- Acute membranous tonsillitis
- Acute Tonsillitis Clinical features
- Sore throat
- Difficulty or painful swallowing
- Earache
- Enlai’ged and congested tonsils
- Cervical lymphadenopathy
- Quinsy
- Collection of pus in peritonsillar space is called quinsy
- Causative Organisms
- Streptococcus pyogenes
- Staphylococcus aureus
- Anaerobes
- Quinsy Clinical Features
- Severe pain in throat
- High temperature
- Dysphagia
- Dribbling of saliva
- Trismus
- Torticollis
- Bulging of tonsillar, peritonsillar, and palatal region
- Cervical lymph nodes are tender and enlarged
- Ryle’s Tube
- Ryle’s Tube is one meter long tube made up of red rubber or plastic
- Ryle’s Tube has got markings at different levels
- Obstructive Lesions Of Oesophagus
- Oesophageal stricture
- Oesophageal cancer
- Lower oesophageal ring
- Dysphagia
- Scleroderma
- Achalasia
Infections And Diseases Of The Larynx And Nasopharynx Long Essays
Question 1. Describe signs, symptoms, and treatment of carcinoma of larynx
Answer:
Carcinoma Of Larynx: Carcinoma Of Larynx is a malignancy involving true vocal cords and anterior and posterior commissures
Carcinoma Of Larynx Clinical Features:
- Carcinoma Of Larynx Types
- Supraglottic
- Throat pain
- Dysphagia
- Referred ear pain
- Lump in the neck
- Hoarseness of voice
- Weight loss
- Respiratory obstruction
- Persistent cough
- Haemoptysis
- Halitosis
- Supraglottic
Read And Learn More: General Surgery Question and Answers
-
- Glottic
- Hoarseness of voice
- Stridor
- Subglottic
- Stridor
- Hoarseness of voice
- Glottic
Carcinoma Of Larynx Investigations:
- Chest X-ray- to rule out lung disease
- Lateral veiw of the neck- to detect extension of tumor
- CT scan- to detect
- Extension of tumour
- Cartilage invasion
- Nodal metastasis
- Direct laryngoscopy
- For staging of tumour
- Microlaryngoscopy
- Biopsy- to confirm diagnosis
Carcinoma Of Larynx Treatment:
- Radiotherapy
- Indicated in early lesions when the vocal cords are not involved
- Surgery
- Done to
- Preserve voice
- Prevent permanent tracheostoma
- Allow adequate resection of tumour
- Total laryngectomy
- Structures removed are
- Entire larynx
- Hyoid bone
- Pre-glottic space
- Strap muscles
- Tracheal rings
- Structures removed are
- Done to
- Combined Therapy
Question 2. Discuss the differential diagnosis of obstructive lesions in the oesophagus
Answer:
Various differential diagnoses of obstructive lesions in the oesophagus are as follows:
- Oesophageal Structure
- It is a complication of acid reflux
- Oesophagus Causes
- GERD
- Zollinger- Ellison syndrome
- Trauma from nasogastric tube placement
- Chronic acid exposure
- Oesophagus Features
- Progressive dysphagia
- Oesophageal Cancer
- Oesophageal Cancer Clinical features
- Progressive dysphagia
- Insidious in onset
- Retrosternal discomfort
- Indigestion
- Weight loss
- Mild anaemia
- Hoarseness of voice
- Oesophageal Cancer Treatment
- Radiotherapy
- Surgery
- Resection
- Intubation
- Laser photocoagulation
- Diathermy
- Oesophageal Cancer Clinical features
- Lower oesophageal Ring
- Schatzki’s ring
- Lower oesophageal Ring is an oesophageal web in its lowermost part
- Lower oesophageal Ring contains only mucosa and submucosa
- Covered by squamous epithelium- above and columnar epithelium- below
- Appears at the Squamocolumnar junction
- Lower oesophageal Ring is asymptomatic
- Dysphagia lusoria
- Dysphagia lusoria is caused by compression of the esophagus from any congenital vascular abnormality
- The abnormality may be in
- Aberrant right subclavian artery
- Double aortic arch
- Right aortic arch with left ligament- martyrium
- Scleroderma
- Scleroderma is a collagen vascular disease of unknown etiology
- Scleroderma Features
- Induration of skin
- Fibrous replacement of the smooth muscle of internal organs
- Dysphagia
- Severe heartburn
- Scleroderma Treatment
- Treat gastro-oesophageal reflux disorder
- Use of H2 inhibitors like cimetidine or ranitidine
- Achalasia
- In it peristalsis is absent
- Lower oesophageal sphincter fails to relax during swallowing
- Achalasia Features
- Dysphagia
- Regurgitation
- Weight loss
- Achalasia Treatment
- Use of calcium channel antagonist
- Mechanical dilatation
- Oesophago cardiomyotomy
Question 3. Mention the indications for tracheostomy. Describe the steps of the operation
Answer:
Tracheostomy: Tracheostomy is a procedure of making an opening in anterior wall of trachea and converting it into a stoma on skin surface
Tracheostomy Indications:
- To bypass obstructions
- Infections
- Trauma to larynx
- Tumour
- Foreign body
- Laryngeal edema
- Congenital anomaly
- Supraglottic or glottic pathologic condition
- Retained secretions
- Comatose patient
- Respiratory muscle paralysis
- Painful cough
- Aspiration of pharyngeal secretions
- Respiratory insufficiency
- Emphysema
- Chronic bronchitis
- Facial fractures
- To provide a long-term route for mechanical ventilation
- Prophylactic
- Severe sleep apnoea
Tracheostomy Steps:
- Position the unconscious patient in a supine position with the neck extended
- Vertical skin incision is given n Veins are ligated n Muscles are separated
- Subcutaneous fat is removed with electrocautery to aid in exposure
- Thyroid gland is retracted upwards n Trachea is exposed
- 4% xylocaine is infiltrated into the trachea
- Suction secretions and blood out of the lumen
- n Place appropriate size tracheostomy tube with an inflated cuff
- Secure it to the skin with 4-0 permanent sutures
- Attach a tracheostomy collar
- Place a sponge soaked in iodine between the skin and the flange for 24 hours
Question 4. Discuss the types, postoperative management, and complication of tracheostomy.
Answer:
Tracheostomy Types:
- Emergency
- Elective
- Permanent
Tracheostomy Postoperative Management:
- The site should be kept clean and dry to minimize infection
- Monitor
- Bleeding
- Breathing difficulty
- Displacement of tube
- Subcutaneous emphysema
- Irrigate with normal saline regularly
- Suctioning done regularly in every Vi hour
- Use of humified oxygen
- Use of mucolytic agents
- Deflate cuff every hour for 5 minutes
Tracheostomy Complications:
- Immediate complications
- Bleeding
- Apnoea
- Pneumothorax
- Injury to adjacent structures- recurrent laryngeal nerve, vessels, and oesophagus
- Postobstructive pulmonary edema
- Endotracheal tube ignition
- Early complication
- Bleeding- due to increased blood pressure
- Plugging of mucus
- Tracheitis
- Cellulitis
- Displacement of tube
- Subcutaneous emphysema
- Intermediate complications
- Secondary infection
- Blockage of tube
- Late complications
- Tracheal stenosis
- Scar
- Tracheomalacia
- Tracheoesophageal fistula
- Tracheocutaneous fistula
- Granulation
Infections And Diseases Of The Larynx And Nasopharynx Short Essays
Question 1. Retropharyngeal abscess
(or)
Chronic retropharyngeal abscess
Answer:
Retropharyngeal Abscess: The collection of pus in retropharyngeal space is called a retropharyngeal abscess
Retropharyngeal Abscess Types:
Question 2. Peritonsillar abscess
(or)
Quinsy
Answer:
Peritonsillar Abscess
The collection of pus in peritonsillar space is called quinsy
Peritonsillar Abscess Etiology:
- Acute tonsilitis
- De novo
- Causative organisms
- Streptococcus pyrogens
- Staphylococcus aureus
- Anaerobic organisms
Peritonsillar Abscess Clinical Features:
- High-grade fever with chills
- Malaise
- Headache
- Neck pain
- Throat pain
- Dysphagia
- Change in voice
- Oralgia
- Odynophagia
- Nausea
- Constipation
- Trismus
- Halitosis
- Ipsilateral earache
Peritonsillar Abscess Treatment:
- Conservative
- 4 fluids
- Systemic antibiotics
- Analgesics
- Antipyretics
- Surgical treatment
- Needle aspiration- to drain the abscess
- Incision and drainage for larger abscess
- Tonsillectomy
Peritonsillar Abscess Complications:
- Parapharyngeal abscess
- Laryngeal oedema
- Septicaemia
- Endocarditis
- Lung abscess
- Nephritis
- Brain abscess
- Jugular vein thrombosis
Question 3. Acute tonsilitis
Answer:
Acute Tonsilitis
Acute Tonsilitis is inflammation of the tonsil
Acute Tonsilitis Types:
- Acute catarrhal tonsillitis
- Seen in viral infections
- Acute follicular tonsilitis
- Crypts are filled with purulent material
- Acute parenchymal tonsilitis
- Tonsils are inflamed and enlarged
- Acute membranous tonsilitis
- Exudates from crypts form a membrane over the surface
Acute Tonsilitis Etiology:
- Hemolytic streptococci
- Staphylococci
- Pneumococci
Acute Tonsilitis Clinical Features:
- Sore throat
- Dysphagia
- Fever
- Earache
- Headache
- Abdominal pain
- Body ache
- Malaise
- Fetid breath
- Coated tongue
Acute tonsilitis Treatment
- Bed rest
- Increased fluid intake
- Analgesics
- Antibiotics
Infections And Diseases Of The Larynx And Nasopharynx Short Answers
Question 1. Quinsy
(or)
Peritonsillar abscess
Answer:
Quinsy
The collection of pus in peritonsillar space is called quinsy
Peritonsillar Abscess Etiology:
- Acute tonsilitis
- De novo
- Causative organisms
- Streptococcus pyrogens
- Staphylococcus aureus
- Anaerobic organisms
Peritonsillar Abscess Clinical Features:
- High-grade fever with chills
- Malaise
- Headache
- Neck pain
- Throat pain
- Dysphagia
- Change in voice
- Oralgia
- Odynophagia
- Nausea
- Constipation
- Trismus
- Halitosis
- Ipsilateral earache
Question 2. Tracheitis
Answer:
Tracheitis
Tracheitis is the inflammation of the trachea
Tracheitis Causative Organism:
- Staphylococcus aureus
- Clinical Features:
- Fever
- Stridor
- Tachypnoea
- Respiratory distress
- High WBC count
- Cough
Tracheitis Treatment:
Systemic antibiotics
Question 3. Pharyngitis
Answer:
Pharyngitis
Pharyngitis is an infection of the pharynx
Pharyngitis Etiology:
- Infections
- Allergy
- Trauma
- Toxins
- Neoplasia
Pharyngitis Clinical Features:
- Pharyngitis can be acute or chronic
- Enlarged tonsils
- Difficulty in swallowing and breathing
- Cough
- Fever
Question 4. Arterial supply to tonsils
Answer:
Arterial Supply To Tonsils
Question 5. Collar stud abscess
Answer:
Arterial Supply To Tonsils
- Arterial Supply To Tonsils is an acute suppurative infection of a digit presenting as a stud-like blister
- Arterial Supply To Tonsils results when a cold abscess which is deep to deep fascia ruptures through the deep fascia and forms another swelling in the subcutaneous plane which is fluctuant
Collar Stud abscess Treatment:
- Simple incision does not resolve the case
- Nondependent aspiration avoids the formation of sinus
- Systemic antibiotics are preferred
Question 6. Pharyngocele
Answer:
Pharyngocele
- Pharyngocele refers to the lateral pharyngeal wall herniation
Pharyngocele Clinical features
- Dysphagia
- Lateral cervical mass
- Valsalva maneuver
- It is diagnosed by pharyngoesophageal swallow
Question 7. Endotracheal intubation
Answer:
Endotracheal Intubation
- Endotracheal intubation secures the airway by placing a tube into the trachea either via nose, mouth, or tracheostomy
- This tube has an inflatable cuff
- Once the tube is placed into the trachea, the cuff is inflated
- This prevents the aspiration of debris
- This tube is connected to an anesthetic machine to allow the delivery of oxygen, nitrous oxide, and inhalation anesthesia
- A throat pack is used as a supplement to the cuff to prevent aspiration of blood, saliva, and debris
Question 8. Nasogastric intubation
Answer:
Nasogastric Intubation
- Nasogastric intubation refers to the insertion of a nasogastric tube through the nose into the stomach
Nasogastric intubation Uses:
- In acute gastric dilatation
- To aspirate gastric contents in intestinal obstruction
- To diagnose GI bleeding
- To provide enteral feeding in comatose patients
Question 9. Acute glottic edema
Answer:
Acute Glottic Edema
- Acute glottic emdema a rare condition when not associated with an infectious disease or other clinical symptoms
- Acute Glottic Edema is one of the complication of prolonged orotracheal intubation
Acute Glottic Edema Clinical Features:
- Hoarseness of voice
- Cough
- Short expiration
- Swelling in the throat
Acute Glottic Edema Treatment:
- Application of ice externally
- Holding small pieces of ice in the back part of mouth and frequently swallowing a small piece
- Alternate hot and cold application
Question 10. Ryle’s tube
Answer:
Ryle’s Tube
- Ryle’s Tube is also called nasogastric tube
- At the end of this tube there are lead shots
- After introducing within the stomach its position is confirmed by pushing 5-10 ml of air and auscultating in the epigastrium
- Ryle’s Tube is a long tube having 3 marks
- When the tube is passed upto 1st mark it enters stomach
- Usually it is passed upto 2nd mark
Ryle’s Tube Uses:
- In acute gastric dilatation
- To aspirate gastric contents in intestinal obstruction
- To diagnose GI bleeding
- To provide enteral feeding in comatose patients
Question 11. Signs and symptoms of acute pharyngitis
Answer:
Signs And Symptoms Of Acute Pharyngitis
- Acute pharyngitis is related to sore throat
- Symptoms Are:
- Sore throat
- Running nose
- Sneezing
- Cough
- Headache
- Body aches
- Muscle pain
- Fever
- Malaise
- Fatigue
- Nausea
- Loss of appetite
Question 12. Causes of acute tonsillitis
Answer:
Causes Of Acute Tonsillitis
- Bacteria causing acute tonsillitis are
- Haemolytic streptococci
- Staphylococci
- Pneumococci
Question 13. Singer’s nodule
Answer:
Singer’s Nodule
- Singer’s Nodule is vocal cord nodule
- Results from repetitive overuse or misuse of the voice
- This causes irritation of vocal cords
- They are hard, rough, callous-like growth
- They can small as pinhead size or large as pea
- Site: midpoint of vocal folds
- Occasionally associated with abnormal blood vessels
- Women between 20-50 years of age are more prone to develop
Singer’s Nodule Clinical features
- Hoarseness of voice
- Shooting pain in ears
- Coughing
- Tiredness
Singer’s Nodule Treatment: Vocal rest
Infections And Diseases Of The Larynx And Nasopharynx Viva Voce
- Tonsils drains into jugulodigastric lymph nodes
- High tracheostomy can cause tracheal stenosis
- Mid-tracheostomy is ideal
- Low tracheostomy impinges the suprasternal notch
- Tracheostomy is ideal for intermittent positive pressure ventilation