Infections And Diseases Of The Larynx And Nasopharynx Question And Answers

Infections And Diseases Of The Larynx And Nasopharynx Important Notes

1. Arteries supplying tonsils
   • Anterior tonsillar
   • Posterior tonsillar
   • Ascending pharyngeal
   • Superior tonsillar
   • Inferior tonsillar
2. 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
3. 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
4. Ryle’s tube
   • It is one meter long tube made up of red rubber or plastic
   • It has got markings at different levels
5. 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: It 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

Read And Learn More: General Surgery Question and Answers

• • Glottic
    • Hoarseness of voice
    • Stridor
  • Subglottic
    • Stridor
    • Hoarseness of voice

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
• Combined therapy

Question 2. Discuss the differential diagnosis of obstructive lesions in the oesophagus
Answer:

Various differential diagnosis of obstructive lesions in the oesophagus are as follows:

• Oesophageal stricture
  • It is 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
• Lower oesophageal ring
  • Schatzki’s ring
  • It is an oesophageal web in its lowermost part
  • It contains only mucosa and submucosa
  • Covered by squamous epithelium- above and columnar epithelium- below
  • Appears at the Squamocolumnar junction
  • It is asymptomatic
• Dysphagia lusoria
  • It is caused by compression of the oesophagus 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
  • It 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: It 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

It 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

Collection of pus in peritonsillar space is called quinsy

Peritonsillar abscess Etiology:

• Acute tonsilitis
• De novo
• Causative organisms
  • Streptococcus pyogens
  • 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

It is the inflammation of 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

It is an infection of the pharynx

Pharyngitis Etiology:

• Infections
• Allergy
• Trauma
• Toxins
• Neoplasia

Pharyngitis Clinical Features:

• It 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

• It is an acute suppurative infection of a digit presenting as a stud-like blister
• It 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 formation of sinus
• Systemic antibiotics are preferreds

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 anaesthetic 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 insertion of 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 glotticedemaia a rare condition when not associated with an infectious disease or other clinical symptoms
• It 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

• It 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
• It 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

• It 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

1. Tonsils drains into jugulodigastric lymph nodes
2. High tracheostomy can cause tracheal stenosis
3. Mid-tracheostomy is ideal
4. Low tracheostomy impinges the suprasternal notch
5. Tracheostomy is ideal for intermittent positive pressure ventilation