Chronic Rhinosinusitis and GABHS Quiz

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the primary requirement for the diagnosis of chronic rhinosinusitis?

Presence of nasal obstruction

Patient history of allergies

Objective evidence of mucosal inflammation (correct)

Symptoms lasting more than 6 weeks

Which of the following is a common clinical feature of chronic rhinosinusitis in adults?

Painless nasal polyps

Facial pain and/or pressure (correct)

Chronic cough

Recurrent ear infections

Which factor is NOT listed as a risk factor or associated condition for chronic rhinosinusitis?

Obesity (correct)

Immunodeficiency

Dental infections

Smoking

What percentage of the general population is affected by chronic rhinosinusitis?

5-12% Signup and view all the answers

At what mean age is chronic rhinosinusitis typically diagnosed?

39 Signup and view all the answers

Which scenario would warrant reserving a throat culture to confirm a negative rapid antigen detection test (RADT)?

Close contact with immunocompromised individuals Signup and view all the answers

What is the first-line oral antibiotic for treating GABHS pharyngitis in patients without PCN allergy?

Cefuroxime Signup and view all the answers

Which of the following is NOT a complication of GABHS pharyngitis?

Chronic lung disease Signup and view all the answers

In which condition would you typically see elevated levels of ESR and CRP?

Acute rheumatic fever Signup and view all the answers

What is a common serious complication associated with GABHS that affects the kidneys?

Hematuria Signup and view all the answers

What is the recommended action if a rapid antigen detection test (RADT) for GAS pharyngitis is positive?

Treat with antibiotics Signup and view all the answers

Which of the following factors increases the likelihood of GAS pharyngitis in a patient?

Absence of cough Signup and view all the answers

When should a throat culture be obtained if the RADT for GAS pharyngitis is negative?

In patients who are high risk for GABHS Signup and view all the answers

What is the recommended approach for patients under 14 years old with suspected GAS pharyngitis if there are less than 3 clinical criteria present?

No testing or treatment is necessary Signup and view all the answers

What is the interpretation if more than 3 criteria for GAS pharyngitis are present?

High risk for GABHS with the need for empiric antibiotics Signup and view all the answers

Which of the following conditions can result from foreign bodies in the nose?

Chronic rhinosinusitis Signup and view all the answers

What is a primary clinical manifestation of nasal polyps?

Chronic nasal obstruction Signup and view all the answers

Which disorder is primarily associated with inflammation of salivary glands?

Sialadenitis Signup and view all the answers

Which of the following conditions is characterized by ulcers in the oral cavity?

Aphthous stomatitis Signup and view all the answers

Which type of cancer is specifically mentioned as part of the clinical manifestations to identify and describe?

Oral squamous cell carcinoma Signup and view all the answers

What is a common cause of epistaxis?

Nasal trauma Signup and view all the answers

Which disorder involves the presence of leukoplakia?

Oropharyngeal cancer Signup and view all the answers

Which of the following is NOT a component of the clinical manifestations discussed?

Hypertension Signup and view all the answers

What is the minimum duration for symptoms to diagnose chronic rhinosinusitis?

12 weeks Signup and view all the answers

Which of the following is NOT one of the cardinal symptoms for chronic rhinosinusitis in adults?

Cough Signup and view all the answers

Which of these clinical features is NOT suggestive of GABHS pharyngitis?

Chronic cough Signup and view all the answers

What is the recommended treatment approach for chronic rhinosinusitis?

Supportive care with fluids and rest Signup and view all the answers

What must be documented to diagnose chronic rhinosinusitis?

Nasal endoscopy findings or CT evidence Signup and view all the answers

Which symptom would indicate a need for immediate evaluation in the case of chronic rhinosinusitis?

Double vision Signup and view all the answers

Which age group has the highest incidence of GABHS pharyngitis?

Children ages 5-15 Signup and view all the answers

What is a significant supportive feature of GABHS pharyngitis?

Palatal petechiae Signup and view all the answers

What should be done when the need for testing for GABHS pharyngitis is unclear?

Use Centor criteria for evaluation Signup and view all the answers

Which of the following is a subtype of chronic rhinosinusitis?

Allergic fungal rhinosinusitis Signup and view all the answers

Study Notes

ENT 3

ENT 3 is a course taught by Professor Boucher at South College.
The course covers topics related to the nose, sinuses, nasopharynx, oropharynx, oral cavity, and salivary glands.
Topics include chronic rhinosinusitis (CRS), invasive fungal rhinosinusitis, foreign bodies, trauma, nasal polyps, inverted papillomas, oropharyngeal disorders, and oral cancer.

Instructional Objectives

Students will learn about the epidemiology, etiology, clinical manifestations, diagnosis, and management of epistaxis, nasal polyps, rhinitis, rhinosinusitis, and nasal trauma.
Students will learn about the diagnosis and management of nasal foreign bodies.
Students will learn about the evaluation, diagnosis, and management of common benign and malignant neoplasms of the nasopharyngeal and paranasal sinuses.
Students will learn about the clinical manifestations, diagnosis, and treatment of diseases of the teeth/gums, including necrotizing ulcerative gingivitis.
Students will learn about the clinical manifestations, diagnosis, and treatment of infectious/inflammatory oropharyngeal disorders, including aphthous stomatitis/ulcers, candidiasis, deep neck infection, epiglottitis, herpes simplex/labialis, laryngitis, peritonsillar abscess, and pharyngitis.
Students will learn about the clinical manifestations, diagnosis, and treatment of salivary disorders, including sialadenitis and parotitis.
Students will learn about the clinical manifestations, diagnosis, and treatment of oropharyngeal trauma and other oropharyngeal disorders, including leukoplakia.
Students will learn about the clinical manifestations, diagnosis, and treatment of oral squamous cell carcinoma (SCC).
Students will learn about the etiology, clinical manifestations, diagnosis, and management of foreign bodies of the larynx and pharynx.

Chronic Rhinosinusitis (CRS)

CRS is an inflammatory condition affecting the paranasal sinuses and nasal passages for 12 weeks or longer.
It affects 5-12% of the general population, with an average age at diagnosis of 39.
Onset can be abrupt or slow and insidious (months to years).
Diagnosis requires objective evidence of mucosal inflammation.

Risk Factors/Associated Conditions (CRS)

Allergic rhinitis
Asthma
Aspirin-exacerbated respiratory disease (AERD)
Depression
Smoking
Irritants & pollutants
Immunodeficiency
Defects in mucociliary clearance (e.g., cystic fibrosis)
Viral infections
Systemic illnesses
Dental infections
Anatomic abnormalities
Indoor dampness & mold exposure

Clinical Features (CRS)

Four cardinal signs/symptoms in adults: anterior/posterior nasal mucopurulent drainage (opaque white or light yellow), nasal obstruction/blockage/congestion (bilateral), facial pain, pressure, and/or fullness (headache), reduction or loss of sense of smell.
In children, the fourth cardinal symptom is cough instead of a loss of smell.

Danger Signs/Complications (CRS)

High fever
Double vision (or reduced vision)
Proptosis
Dramatic periorbital edema
Ophthalmoplegia
Other focal neurologic signs
Severe headache
Meningeal signs
Significant or recurrent epistaxis

Evaluation (CRS)

Clinical history (4 cardinal symptoms, duration, risk factors, previous treatments, imaging, and surgeries)
Objective documentation of mucosal disease using anterior rhinoscopy, nasal endoscopy, and/or CT scans (with or without contrast).
Allergy evaluation (optional testing; mainly perennial allergens)
Considerations for immunologic defects and infectious complications (e.g., recurrent episodes of acute purulent sinusitis, history of pulmonary infections, recurrent otitis media, labs, and/or imaging for systemic diseases).

Diagnosis (CRS)

Based on presence of suggestive symptoms and objective evidence of mucosal inflammation.
Must have at least 2 of the 4 cardinal signs/symptoms.
Symptoms must last for > 12 weeks.
Must have at least one finding from a nasal endoscopy or CT scan—purulent (not clear) mucus or edema in the middle meatus or ethmoid regions, polyps in the nasal cavity or the middle meatus, radiographic imaging demonstrating mucosal thickening or partial or complete opacification of the paranasal sinuses.

Subtypes (CRS)

CRS with nasal polyposis (20-33%)
Allergic fungal rhinosinusitis (AFRS) (<5%)
CRS without nasal polyposis (60-65%)
Diagnosis is aided by CT findings and tissue biopsy.
Treatment strategies vary depending on the subtype.

Treatment (CRS)

Primary care level management, but ENT & allergy specialists are often involved, particularly for refractory cases.
Intranasal saline irrigation/sprays
Intranasal corticosteroids (i.e., fluticasone, budesonide)
Oral corticosteroids (for severe/refractory mucosal edema).
Antibiotics (for acute exacerbations only, not routinely).
Antileukotriene agents (adjunct for allergic rhinitis, nasal polyps)
Endoscopic sinus surgery
Biologic agents

Invasive Fungal Rhinosinusitis

A rare aggressive fungal infection of the sinuses.
Time course: days to weeks.
Most cases occur in patients with immunosuppression (e.g., diabetes, HIV, or organ transplant).

Symptoms (Invasive Fungal Rhinosinusitis)

Symptoms of acute disease (similar to acute bacterial rhinosinusitis ABRS)
Fever
Facial pain (facial numbness with cranial nerve involvement)
Nasal congestion
Possible visual and mental status changes (diplopia)

Diagnosis (Invasive Fungal Rhinosinusitis)

CT and/or MRI imaging
Tissue biopsy to confirm the diagnosis

Treatment (Invasive Fungal Rhinosinusitis)

Immediate medical and surgical intervention
Hospital admission
ENT consultation
IV antifungal therapy (voriconazole or amphotericin B)
Wide surgical debridement

Nasal Foreign Bodies

Common in children and developmentally disabled patients.
Inorganic materials (beads, pebbles)
Organic materials (beans, peas)
Button batteries and magnets require immediate attention.

Signs (Nasal Foreign Bodies)

Unilateral foul-smelling discharge
Nasal obstruction

Management (Nasal Foreign Bodies)

Patients should try blowing their nose, or insufflation
Pretreat with nasal decongestants and topical anesthetics
Conscious sedation (if needed; protect airway)
Use tools like Katz extractor, Foley catheter, or forceps.

Referral Criteria (Nasal Foreign Bodies)

Foreign body refractory to removal attempts
Chronic foreign body with localized reaction
Young or developmentally delayed patients requiring conscious sedation
Significant trauma on attempted removal
Sharp, penetrating, or hooked foreign body

Nasal Trauma

Nasal fracture is the most commonly fractured bone in the body.
Symptoms: epistaxis, pain, soft tissue hematomas (e.g., periorbital hematoma).
Evaluation: full HEENT, intranasal exam, r/o septal hematoma/crepitus/palpable bony segments, step-off of infraorbital rim/zygomatic complex fracture, x-rays of facial, spine, pulmonary, & intracranial injuries as indicated by mechanism of injury (MOI).
Treatment of nasal fracture: goal is maintaining long-term nasal airway patency and cosmesis, urgent ENT referral if septal hematomas; bilateral I&D + fluid cultures; nasal packing (3-5 days); antibiotics (e.g., cephalexin, clindamycin) (3-5days); closed reduction of fracture under local or general anesthesia.

Malignant Nasopharyngeal & Paranasal Sinus Neoplasms

Squamous cell carcinoma (SCC)—most common neoplasm.
Adenocarcinoma, mucosal melanomas, sarcomas, and non-Hodgkin lymphomas are less frequent.
Early symptoms are similar to rhinosinusitis.
Common symptoms include unilateral nasal obstruction, discharge, otitis media, pain, and recurrent hemorrhage.
Most cases are advanced on presentation.
Treatment involves chemotherapy and radiation therapy.
Prognosis of advanced tumors is poor.

Benign Nasopharyngeal Neoplasms: Nasal Polyps

Pale, edematous, and mucosa-covered masses.
Common association with allergic rhinitis; possible chronic nasal obstruction and dysosmia.
Topical intranasal steroids improve quality of life (1 to 3 months for small polyps).
Short-course oral steroids may be considered.
Surgery for massive polyps or failed medical therapy.

Benign Nasopharyngeal Neoplasms: Inverted Papillomas

Usually arise on the lateral nasal wall.
Caused by HPV.
Unilateral nasal obstruction and occasional hemorrhage.
Malignant potential (Squamous Cell Carcinoma SCC) occurs in roughly 10% of cases.
Complete excision is strongly recommended.

Diseases of the Teeth and Gums

Included in oropharyngeal disorders
Common conditions are addressed (i.e. necrotizing ulcerative gingivitis).

Infectious/Inflammatory Oropharyngeal Disorders - Aphthous Stomatitis (Canker Sores)

Common (5-21%).
Etiology unknown, possibly related to HHV-6.
Affects buccal and labial mucosa (not palate or gingiva).
Symptoms include recurring, painful, solitary, or multiple ulcers, typically with a white-yellow pseudomembrane surrounded by an erythematous halo (7-14days).

Aphthous Stomatitis (Canker Sores) - Differential Diagnosis (DDx)

Erythema multiforme or drug allergies
Acute herpes simplex
Pemphigus
Pemphigoid
Bullous lichen planus
Behçet disease
IBD
SCC

Aphthous Stomatitis (Canker Sores) - Treatment

Good oral hygiene and avoidance of exacerbating factors.
Pain control and medications such as viscous lidocaine (2%) or benzocaine (10%).
Short course of corticosteroids (e.g. prednisone) and topical corticosteroids (e.g., fluocinonide).
Medicated mouthwash.

Oral Candidiasis ("Thrush")

Infection of oral mucosa typically caused by Candida albicans.
Risk factors include immunocompetency, denture use, xerostomia, antibiotic/steroid use, diabetes mellitus, anemia, HIV/AIDS, hematological malignancies, and head/neck radiation therapy.
Immunocompromised patients may have associated esophagitis or laryngeal candidiasis.
Signs/symptoms may be asymptomatic/cottony feeling in the mouth, loss of taste, painful eating and swallowing.
Examination may reveal pseudomembranous, white plaques on buccal mucosa, palate, tongue, oropharynx that are easily scraped off; atrophic (denture stomatitis): older adults with dentures; erythema beneath upper dentures without plaques—erythematous macular lesions; Angular cheilitis: erythematous fissures bilaterally at the angles of the mouth.

Oral Candidiasis ("Thrush") - Diagnosis

Clinical-based.
Testing: scraping lesions for Gram stain and/or KOH prep to identify potentially-budding yeast cells/pseudohyphae and true hyphae.

Oral Candidiasis ("Thrush") - Treatment

Antifungals (e.g., fluconazole, ketoconazole, clotrimazole troches, nystatin mouth rinses).
Duration of treatment may be longer in HIV/AIDS patients.

Deep Neck Infections - Ludwig's Angina

Cellulitis of the submandibular space (often from infection in the mandibular dentition).
Commonly-encountered neck space infection.
Tongue displacement upward and backward, sometimes occluding the airway (emergency).
Pus may be palpable in the floor of the mouth.
Diagnosis—clinical examination and CT scan with contrast
Treatment—hospital admission, intravenous (IV) antibiotics (ceftriaxone and metronidazole), drainage of any abscess (needle aspiration, or incision and drainage (I&D)), and consultation with a dentist or ENT.

Deep Neck Infections - Deep Neck Abscess

Typically caused by odontogenic infections.
Also, other potential causes include suppurative lymphadenitis, direct spread of pharyngeal infection, penetrating trauma, pharyngoesophageal foreign body, cervical osteomyelitis, or IV drug injection into the internal jugular vein.
Rapidly developing severe sore throat, odynophagia, and edema + fever—may spread to mediastinum or cause sepsis.
Diagnosed with clinical examination and a CT with contrast
Treatment—Secure airway, IV antibiotics, I&D, potential need for intubation or tracheotomy.

Epiglottitis

Inflammation of the epiglottis and supraglottic structures.
Commonly due to viral or bacterial infections (and rare instances of caustic ingestion, thermal injury, or trauma).
Most likely bacterial cause is H. influenzae type B.
Symptoms often present rapidly, with severe sore throat and odynophagia, not proportionate to minimal oropharyngeal findings.
Seen more often in patients with diabetes and individuals who have not received routine vaccinations.
Symptoms include severe sore throat, dysphagia, muffled/hoarse voice, stridor, dyspnea/drooling; frequently a tripod position to maximize airway patency.

Epiglottitis—Examination and Imaging

Indirect laryngoscopy (not usually required in children) to reveal edematous and erythematous epiglottis—though not always needed for diagnosis.
Children may demonstrate a tripod position, to maximize airway patency
Imaging (x-ray) safer than direct visualization: consider x-ray to look for enlarged epiglottis
X-Ray may show enlarged epiglottis ("thumbprint sign")
CT scans are also available.
Imaging not to delay airway management.

Epiglottitis - Treatment

Airway management and evaluation (emergency).
Keep patient calm; avoid agitating the patient (especially in children).
Avoid unnecessary sedation and inhalers; avoid racemic epinephrine unless absolutely necessary.
Intravenous (IV) antibiotics (e.g., ceftriaxone or amoxicillin/clavulanate).
IV dexamethasone.
Analgesics and antipyretics.
Supportive care with supplemental humidified oxygen.

Herpes Labialis

"Fever blister" or "cold sore"; reactivation of HSV-1.
Oral vesicles along the vermilion border.
Common (15-45% of US population).
Triggers include immunodeficiency, stress, exposure to sunlight, fever, and dental procedures.

Herpes Labialis—Signs and Symptoms

Prodrome (pain; burning, tingling, pruritis)
Eruption of clustered vesicles (lasting 7–14 days).

Herpes Labialis—Treatment

Local anesthetics (e.g., topical lidocaine).
Oral antivirals (e.g., acyclovir, famciclovir, valacyclovir).
Topical antivirals are less effective than oral antivirals.

Herpes Labialis—Treatment Strategies

No Treatment (mild symptoms; no prodrome).
Episodic therapy (mild–moderate symptoms; with prodrome).
Chronic suppressive therapy (severe disease; frequent recurrences, especially without prodrome).
Recurrences that are bothersome or associated with serious complications (e.g., erythema multiforme).

Acute Laryngitis

A common cause of hoarseness, often following a URI (viral or bacterial).
Symptoms include hoarseness, potential sore throat, congestion.
Treatment is supportive (rest voice, PO hydration, and humidified air); antibiotics are not routinely necessary.
Complications: vocal fold hemorrhage, polyps, and cysts.

Peritonsillar Abscess

Common deep infection (polymicrobial) of the head and neck.
Typically forms in the soft palate above the superior pole of the tonsil.
Mostly in young adults (20-40).
More common during the fall/winter and spring (November-December/April-May).
Risk factors include periodontal disease and smoking.

Peritonsillar Abscess—Signs and Symptoms

Ill-appearing patient, fever, malaise, significantly severe sore throat, foul breath, dysphagia, or otalgia.
Trismus (difficulty opening the jaw), odynophagia (painful swallowing), drooling.
Muffled voice ("hot potato" voice).
Tense swelling and erythema of anterior pillar and soft palate.
Displacement of the tonsil inferiorly and medially, with contralateral deviation of the uvula.
Tender cervical lymphadenopathy.

Peritonsillar Abscess - Diagnosis

Needle aspiration.
Intraoral or submandibular ultrasonography (US).
Computed tomography (CT) or magnetic resonance imaging (MRI) if needed.

Peritonsillar Abscess - Treatment

Small abscesses (<1 cm) may be observed with antibiotics.
Abscesses larger than 1 cm require drainage (e.g. needle aspiration, incision, and drainage (I&D) and sometimes removal of tonsils).
Intravenous (IV) antibiotics, such as piperacillin-tazobactam (or alternative IV medications such as metronidazole + ceftriaxone, or clindamycin), and supportive care (hydration and analgesia).
Airway management may be required.

Pharyngitis

Very common, most often caused by viruses (and less likely by bacteria).
Peak season is late winter to early spring.
Most common causes include viral upper respiratory infections (URIs), postnasal drip (rhinitis), gastroesophageal reflux disease (GERD), persistent cough, thyroiditis, allergies, foreign body, and smoking.
Symptoms often include scratchy throat, sore throat, difficulty swallowing.
SARS-CoV-2 testing may be considered.

Viral Pharyngitis - Signs and Symptoms

Coryza (runny nose)
Conjunctivitis (red eyes)
Malaise (general discomfort in body)
Hoarseness
Low-grade fever
Sore throat
Congestion

Viral Pharyngitis - Treatment

Conservative treatment (i.e. supportive care): Systemic PO analgesics (acetaminophen, NSAIDs, aspirin); topical medications (lozenges, sprays, beverages, food items); breathing humidified air, and avoid tobacco smoke.

Infectious Mononucleosis (IM)

Pharyngitis with significant fatigue.
Cause: Epstein-Barr virus (EBV).
Most common in 15–30-year-old patients.
Symptoms include pharyngeal injection with exudates (shaggy, white-purple); posterior cervical and auricular lymphadenopathy; palatal petechiae; and hepatosplenomegaly.

Infectious Mononucleosis (IM) - Diagnosis

Heterophile antibody test (e.g., Monospot).
EBV-specific antibodies.
CBC: Lymphocytosis (>4500/μL).
Peripheral smear: atypical lymphocytosis (>50%).

Infectious Mononucleosis (IM) - Treatment

Supportive care (e.g., fluids, rest, acetaminophen or NSAIDs).
Avoid contact sports for at least 3-4 weeks.
NO antibiotics.

Group A Beta-hemolytic Streptococcal (GABHS) Pharyngitis

Highest incidence in children (ages 5–15).
Acute-onset sore throat (often with fever), pharyngeal edema, patchy tonsillar exudates, and prominent/tender anterior cervical lymphadenopathy.
Palatal petechiae, scarlatiniform rash, and strawberry tongue may appear.

GABHS Pharyngitis - Importance of Accurate Diagnosis

Prevent suppurative complications (e.g., peritonsillar abscess)
Prevent acute rheumatic fever (ARF).
Reduce duration and severity of symptoms.
Prevent transmission.

GABHS Pharyngitis - Clinical Features in Adults

Sudden onset of sore throat
Fever
Pharyngotonsillar or uvular edema
Patchy tonsillar exudates
Anterior cervical lymphadenopathy (tender)
Scarlet-like (scarlatiniform) skin rash and/or strawberry tongue
History of GABHS exposure.

GABHS Pharyngitis - Diagnostic Criteria (Centor Criteria)

Pharyngotonsillar exudates
Tender anterior cervical lymphadenopathy
Fever
Absence of cough
Patient's age (higher likelihood between 3 and 14 years)

GABHS Pharyngitis - Diagnosis (Continued)

Diagnostic criteria aid in determining when a test is necessary
Negative Rapid Antigen Detection Test (RADT) warrants throat culture in select circumstances.
Specific patients for whom throat culture is still potentially necessary are those with high risk of complications (e.g. ARF) or children, patients with immunocompromise, or contact with those exhibiting high risk, persons living within high GAS prevalence, and situations exhibiting ongoing/current epidemic.

GABHS Pharyngitis - Treatment

Analgesics (e.g., NSAIDs, acetaminophen).
PO antibiotics (e.g., penicillin VK, cefuroxime, cefpodoxime; amoxicillin x 10 days) for 10 days
Alternative antibiotics (i.e erythromycin, azithromycin) for those with PCN allergy.

GABHS Pharyngitis – Complications

Acute Rheumatic Fever (ARF)
Rare (approximately 1 case per 100,000)
Joint swelling
Pain
Nodules
Erythema Marginatum
Myocarditis
Chorea
Poststreptococcal Glomerulonephritis (PSGN).
Intrinsic renal failure
Hematuria
Edema.

GABHS Pharyngitis – Other Complications

Peritonsillar abscess (<1%)
Scarlet fever
Punctuate, erythematous, blanchable, sandpaper-like exanthem.
Accentuated in body folds and creases (Pastia's lines).
Strawberry tongue.

Other Bacterial Pharyngitis—Gonococcal Pharyngitis

Primarily in sexually active patients.
Symptoms include fever, dysuria, and greenish exudates.
Ceftriaxone (250mg IM) plus azithromycin (1 gm PO single dose)

Other Bacterial Pharyngitis—Diphtheria

Sore throat, low-grade fever,
Adherent grayish membrane
Tender cervical lymphadenopathy.
Antitoxin, plus erythromycin (500 mg IV QID) or penicillin G (50,000 units/kg IV Q12H).

Salivary Disorders

Sialadenitis: general acute swelling of the parotid or submandibular glands; often seen with dehydration and chronic illness, Sjogren's syndrome or chronic periodontitis; commonly due to bacterial infection (S. aureus); painful swelling around the meals/swallowing.
Physical Examination (Sialadenitis): Tenderness and erythema of the duct opening; Pus often massageable from the duct.
Treatment (Sialadenitis): Hydration, warm compresses; sialagogues (e.g., lemon drops); massage the gland; intravenous (IV) antibiotics (PO for less severe cases).

Suppurative Parotitis

Acute infection of parotid gland (viruses and bacteria; typically S. aureus & mixed aerobic/anaerobic bacteria).
Common presentations in conditions which cause debilitation, dehydration, or poor oral hygiene.
Particularly prevalent among elderly postoperative patients; consider mumps in children and young adults.
Testicular evaluation should be considered, i.e., epididymo-orchitis is also possible.

Suppurative Parotitis - Signs and Symptoms

Firm, erythematous swelling
Pain and tenderness.
Possible trismus (trouble opening the mouth) and dysphagia (trouble swallowing).
Systemic symptoms like fever and chills.
Potential for purulence to discharge from Stenson's duct.

Suppurative Parotitis - Diagnosis

Initial diagnosis is often based on a combination of history, physical exam and imaging modalities like Ultrasound, CT scan or MRI;
Elevated serum amylase may be present in cases which lack evidence of pancreatitis
Gram stain and culture from the discharged fluids may also lead to a more confirmed diagnosis.

Suppurative Parotitis - Treatment

Inpatient hydration.
Intravenous antibiotics (e.g., vancomycin, cefepime, ceftriaxone).
If unsuccessful by IV antibiotics for 48 hours, consider surgical I&D (incision and drainage) of the affected area.

Oropharyngeal Disorders - Others

Precancerous lesions of the oral cavity— Leukoplakia: white adherent plaque; premalignant lesion.
Risk factors include tobacco use, dentures, and lichen planus.
2–6% have dysplasia or early squamous cell carcinoma (SCC).
Diagnosis—biopsy.
Treatment—watchful waiting with biopsy, potential excision.

Oropharyngeal Disorders - Others - Oral Hairy Leukoplakia

White, corrugated painless plaques on the lateral aspect of the tongue.
Associated with HIV infection, organ transplant, malignancy, or steroid use, and EBV infections.
Not considered premalignant.
Antivirals may present temporary resolution.

Oropharyngeal Disorders - Oral Cancer

Squamous Cell Carcinoma (SCC): most common type of oral cancer.
Risk factors include age, tobacco use, and alcohol use.
Physical Examination: raised/firm/white lesions with ulcers at their base; can lead to nodularity and ulceration; often painful especially on the lateral tongue or areas with direct palpation.
Diagnosis—biopsy.
Treatment—surgery and/or radiation.

Upper Airway Foreign Body

More prevalent in young children.
One study showed 1068 foreign body aspirations:
3% in the larynx
13% in the trachea
52% in the right main bronchus
6% in the right lower lobe bronchus
18% in the left main bronchus
5% in the left lower lobe bronchus

Upper Airway Foreign Body—Signs and Symptoms

Choking or coughing
Subsequent wheezing, coughing, or stridor.
Often, 1/3 of parents do not remember an incident prior to the event which the foreign body was found, more than a week beforehand

Upper Airway Foreign Body—Treatment

Airway management (including back blows and chest thrusts based on age of patient).
Airway procedures, depending on location/size/type of foreign body.

Esophageal Foreign Body

Primarily caused by food bolus impaction
Most cases pass spontaneously.
Peak incidence is between 6 months and 6 years of age.
Small batteries can cause necrosis and perforation.

Esophageal Foreign Body—Treatment

Flexible endoscope (to relax the esophagus)
Glucagon 1.0 mg IV.

Emergent Airway Management- Cricouthyroidotomy/Tracheostomy

Cricouthyroidotomy: relatively quick and easy, stab through cricothyroid membrane to allow access to the trachea, can be used with small round endotracheal tube to aid in airway, anaesthetic not essential.
Formal Tracheostomy: not an emergency procedure; requires full anaesthetic for proper incision/intubation; can be a more permanent procedure for patients, ideally suited for intubation.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

Test your knowledge on chronic rhinosinusitis and GABHS pharyngitis with this informative quiz. Explore key features, risk factors, and treatment options associated with these common conditions. Ideal for medical students and healthcare professionals looking to reinforce their understanding.