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ENT Introduction
Material for exam 1 (Larynx and Pharynx)
| Question | Answer |
|---|---|
| 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.
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