耳鼻咽喉科学课件

Pharyngology (EENT Hospital of Fudan University) Anatomy of pharynx lNasopharynx lOropharynx lLaryngopharynx Nasopharynx ltop and posterior: adenoid llateral: Eustachian tube lanterior lbottom Oropharynx lfaux ltonsil Tonsil Laryngopharynx lvallecula epiglottica lpyriform sinus lpostericoid space Laryngopharynx Retropharyngeal and parapharyngeal space Waldeyers ring Pharyngitis lAcute lChronic lAtrophic lPathogen lPathology lSymptoms lSigns lDiagnosis & differentiated diagnosis lComplications lTherapy Pathogen(acute pharyngitis) lVirus: Coxsackie lBacteria A -hemolytic streptococci lPhysical and chemical stimulation Inflammation & Congestion & Swelling & Fever & Sore throat & Dysfunction lTreatment : Antibiotics Pathogen(chrnoic pharyngitis) lRegional recurrent acute pharyngitis chronic upper respiratory tract infection physical & chemical stimulation occupational lGeneral chronic diseases Symptoms: lSense as if there are foreign bodies in throat l Itching throat lSense of dryness in throat lCough lChronic simple pharyngitis chronic mucosal congestion lChronic hypertrophic pharyngitis chronic mucosal congestion + hyperplasia of lymphoid tissues Treatment: lRemove of pathogeny lChinese medicine Pathogen(atrophic pharyngitis) qAtrophic rhinitis Adenotonsillar disease lMajor divisions are: Infection/inflammation Obstructive Neoplasm Acute Tonsilitis lSymptoms: general+regional lSigns: lComplications: peritonsillar abscess rheumatism lTherapy: antibiotics Acute Tonsilitis lPathogen: -hemolytic streptococci anaerobe mixed infection lPathology: catarrhal purulent (follicular+lacunar) Acute Tonsillitis lSigns and symptoms: Fever Sore throat Tender cervical lymphadenopathy Dysphagia Erythematous tonsils with exudates Recurrent Acute Tonsillitis lSame signs and symptoms as acute lOccurring in 4-7 separate episodes per year l5 episodes per year for 2 years l3 episodes per year for 3 years Chronic tonsilitis ?Pathogen: recurrent acute tonsilitis ?Diagnosis: case history Chronic Tonsillitis lChronic sore throat lMalodorous breath lPresence of tonsilliths lPeritonsillar erythema lPersistent tender cervical lymphadenopathy lLasting at least 3 months Chronic tonsilitis ?Pathologic mechanism that the infected tonsil becomes a focus Allergy Chronic tonsilitis ?How to identify whether or not the infected tonsil is a focus? case history examination diagnostic test blocking test Acute adenoiditis lSymptoms include: Purulent rhinorrhea Nasal obstruction Fever Associated Otitis Media Recurrent Acute Adenoiditis l4 or more episodes of acute adenoiditis in a 6 month period lSimilar presentation as recurrent acute rhinosinusitis lIn older children nasal endoscopy can help Chronic adenoiditis lSymptoms include: Persistent rhinorrhea Postnasal drip Malodorous breath Associated otitis media 3 months Think of reflux Adenoidal hypertrophy lSymptoms: ear(secretory otitis media) nose(nasal obstruction, snoring) lower respiratory tract “adenoidal face” & chronic toxic lExaminations: X ray / CT lTherapy: adenoidectomy Obstructive Adenoid Hyperplasia lSigns and Symptoms Obligate mouth breathing Hyponasal voice Snoring and other signs of sleep disturbance Obstructive Tonsillar Hyperplasia lSnoring and other symptoms of sleep disturbance lMuffled voice lDysphagia Obstructive Sleep Apnea lAdenotonsillar hypertrophy lSleep disturbance lRising indication for adenotonsillectomy lPE: Dark circles under eyes Breathing with mouth open Small amount of clear rhinorrhea Tonsils are almost touching in the midline Indications of Tonsillectomy lchronic / abscess lhypertrophy lfocus lkeratosis / diphtheria ltumor Tonsillectomy lCurrent clinical indicators of AAO-HNS: 3 or more infections per year despite adequate medical therapy Hypertrophy causing dental malocclusion or adversely affecting orofacial growth documented by orthodontist Hypertrophy causing upper airway obstruction, severe dysphagia, sleep disorder, cardiopulmonary complications Peritonsillar abscess unresponsive to medical management and drainage documented by surgeon, unless surgery performed during acute stage Persistent foul taste or breath due to chronic tonsillitis not responsive to medical therapy Chronic or recurrent tonsillitis associated with streptococcal carrier state and not responding to beta-lactamase resistant antibiotics Unilateral tonsil hypertrophy presumed neoplastic Contraindications of Tonsillectomy lacute attack lblood disorder lgeneral disorder linfectious disease lmenstruation/pregnancy limmune deficiency Adenoidectomy lCurrent clinical indicators from AAO-HNS: 4 or more episodes of recurrent purulent rhinorrhea in prior 12 months in a child 3 months or second set of tubes Dental malocclusion or orofacial growth disturbance documented by orthodontist Cardiopulmonary complications including cor pulmonale, pulmonary hypertension, right ventricular hypertrophy associated with upper airway obstruction Otitis media with effusion over age 4 Peritonsillar abscess lacute tonsillitis peritonsillar cellulitis abscess l-hemolytic streptococci ltypes: anterior-superior posterior-superior Peritonsillar abscess lAbscess formation outside tonsillar capsule lSigns and symptoms: Fever(3-5d) Sore throat muffled voice Dysphagia/odynophagia Drooling Trismus Unilateral swelling of soft palate/pharynx with uvula deviation lThought to be extension of tonsillitis to involve surrounding tissue with abscess formation lRecently described to be an infection of small salivary glands in the supratonsillar fossa called Webers glands lWould explain superior pole involvement and the usual absence of tonsillar erythema/exudates Therapy for Peritonsillar abscess lpuncture and incision (diagnosis & therapy) lantibiotics ltonsillectomy Retropharyngeal abscess lacute purulent lymphadenitis trauma / foreign body secondary lchronic tuberculosiscold abscess Diagnosis of retropharyngeal abscess lcase history lsymptoms and signs lx ray / CT Retropharyngeal & parapharyngeal space Therapy for retropharyngeal abscess lacute: antibiotic incision and drainage (position) lchronic: puncture incision (path ? ) anti-tuberculosis Congenital tonsillar masses lTeratoma lHemangioma lLymphangioma lCystic hygroma Malignant Neoplasms lMost common is lymphoma lNon-Hodgkins lymphoma lRapid unilateral tonsillar enlargement associated with cervical lymphadenopathy and systemic symptoms Angiofibroma of nasopharynx lmale ljuvenile (1025) lbleeding lnasopharygeal langiofibroma Angiofibroma of nasophary