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ENT Introduction

Material for exam 1 (Larynx and Pharynx)

3 divisions of pharynx Nasopharynx Oropharynx Laryngopharynx
Definition of larynx "voicebox"
Larynx functions Airway Voice production
Nasopharynx Upper pharynx Extends from choanae to inferior soft palate
Oropharynx Middle pharynx Directly behind oral cavity Visible pharynx Extends from inferior soft palate to lingual surface of epiglottis
Laryngopharynx Hypopharynx Lower pharynx Located behind larynx and below aperture of larynx
Nerves associated with (facial) aspects of ENT Trigeminal (V) Facial (VII) Auditory (VIII) Glossopharyngeal (IX) Vagus (X)
Salivary glands Parotid Submandibular Sublingual
Duct of parotid gland Stensen Located across from 2nd molar
Duct of submandibular Wharton Located near base of tongue Primary involvement in sialolithiasis
Examples of oral and throat disorders Parotitis Sialadenitis Nerve complications (Bell's, Trigeminal neuralgia) Pharyngitis/Laryngitis Epiglottitis Peritonsillar abscess Tonsillitis Tongue diseases Dental Cancers
Parotitis Inflammation of the parotid gland
Causes of parotitis Viruses Bacterial: Staph. aureus Mumps (children) Sjogren syndrome (adult females)
Complications of parotitis Deafness Orchitis Encephalitis Pancreatitis (self-resolution)
Labs to test for parotitis IgM serum test CBC: mild leukopenia BMP: elevated BUN/SCr
Parotitis dx Clinically May check labs
Sialadenitis Inflammation of parotid or submandibular gland (Mumps is one form)
Primary gland involved in sialolithiasis Submandibular gland Wharton's ducts
Causes of sialadenitis Bacterial infection: Staph. aureus Ductal obstruction (ex, stones in submandibular) Autoimmune diseases
Primary symptom of sialadenitis Pain with eating Pain with salivation
Sialadenitis dx CBC (if fever, should be checking WBC count) CT scan Ultrasound
Sialadenitis tx IV abx: nafcillin I/D Lemon drops
Appearance of stones in Stensen ducts radiopaque
Suppurative sialadenitis Glands cease to work (may be due to severe dehydration) Medical Emergency! Critical care IV abx Hydration
Sialolithiasis stone composition K Mg Ca (Similar to kidney stones)
Sjogren syndrome Autoimmune disease Systemic Affects females, particularly older
Symptoms and complications of Sjogren syndrome Xerostomia: "cotton mouth" Dry eyes Keratoconjunctivitis Dysphagia Hard to speak for long periods Changes in taste Oral complications (increase in dental caries, infections, and acidity; dentures problems) (Can present w/other autoimmune diseases)
Sjogren syndrome dx Labs: elevated rheumatoid factor/ANA
Sjogren syndrome tx Eye drops (Restasis) Hydration Refer to rheumatologist
Bell's palsy Facial paresis (paralysis) Usually idiopathic
Nerve affected by Bell's palsy Facial nerve (CN VII)
Symptoms and complications of Bell's Unilateral symptoms Eyebrow sagging Inability to close affected eye Mouth is drawn to unaffected side Affects sense of taste
Onset of symptoms w/Bell's Can present quickly
Differential dx of Bell's Stroke Autoimmune diseases Tumors Ramsay Hunt
Bell's tx Benign Resolves spontaneously No tx needed Steroids may be given
Who does Bell's affect? Usually women Pregnant Diabetic
Prognosis of Bell's Good Usually resolves spontaneously
Bell's dx and assessment Have patient: Raise eyebrows Wrinkle forehead (Stroke patients will be able to do both actions)
Ramsay Hunt (RH) Complication of herpes zoster Sudden onset
Nerves affected by RH CN V: Trigeminal CN VIII: Auditory CN IX: Glossopharyngeal CN X: Vagus
Symptoms of RH Tinnitus Otalgia Loss of taste Vesicles in ear
Prognosis of RH Total recovery not as good as Bell's
RH tx Acyclovir (antiviral)
Trigeminal neuralgia Sudden episodes of lacinating facial pain "Tic deulereux"
Who is affected by trigeminal neuralgia? Middle age Older patients
Differential dx for trigeminal neuralgia In younger individuals: think MS (Check FH for MS, also living in/from midwest)
Epiglottitis Medical Emergency! Inflammation of epiglottis
Who is seen with epiglottitis? Mostly children May be some adults
Symptoms and complications of epiglottitis Potential for airway obstruction! Respiratory distress Drooling Stridor "Tripod posture" Anxiety Sudden sore throat
Vaccine for epiglottiitis Hib 2, 4, 6, and 12 months old
Causes of epiglottitis Hib (children) Bacterial or viral (adults)
How should an exam for epiglottitis be performed? With the patient in an upright position
Tests for epiglottitiis Lateral radiograph of neck "Thumb sign"
Epiglottitis tx 3rd gen cephalosporins Ceftriaxone Vancomycin/Clindamycin
Laryngitis Hoarseness
Causes of laryngitis URI Usually viral M. catarrhalis H. flu Cancer (smokers) GERD
What is important to remember with laryngitis? Patient's hx
Symptoms of laryngitis May be flu-like symptoms Hoarse voice
Laryngitis tx Usually supportive Rest Avoid rigorous or excessive use of voice
Peritonsillar abscess Infection of tonsils Most common deep neck infx of children (and ~smokers)
Causes of peritonsillar abscess Staph. Strep. (pyogenes) MRSA
Symptoms of peritonsillar abscess Severe sore throat "Hot potato voice" Trismus Odynophagia Deviation of soft palate White spots
Peritonsillar abscess tx Penicillin Penicillin-based abx
Indications for tonsillectomy Airway obstruction (sleep apnea, daytime fatigue, loud snoring, etc.) Recurrent/chronic Strep. pyogenes tonsillitis Recurrent peritonsillar abscess
Is tonsillectomy an inpatient or outpatient surgery? Outpatient, if followed up w/in 6 hours of surgery
Who should perform a needle aspiration? The physician
Created by: Carrie D.