Chronic Rhinosinusitis Quiz

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Questions and Answers

What is the minimum duration for a condition to be classified as chronic rhinosinusitis?

4 weeks

6 months

12 weeks (correct)

1 week

Which of the following is NOT considered a risk factor for chronic rhinosinusitis?

Dental infections

Allergic rhinitis

Frequent exercise (correct)

Immunodeficiency

Which cardinal sign of chronic rhinosinusitis involves nasal drainage?

Mucopurulent drainage (correct)

Sinus swelling

Facial pain

Nasal obstruction

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

What action should be taken if a rapid antigen detection test (RADT) for GABHS pharyngitis is positive?

Treat with antibiotics. Signup and view all the answers

Which patient demographic is more likely to exhibit symptoms of GABHS pharyngitis?

Children aged 3-14 years Signup and view all the answers

When should a throat culture be obtained after a negative RADT?

If there are ongoing concerns about GABHS despite the RADT result. Signup and view all the answers

What is the recommended approach for patients with less than 3 criteria present for GABHS pharyngitis?

Do not benefit from testing, supportive measures are advised. Signup and view all the answers

What is the likelihood of GABHS pharyngitis if more than 3 criteria are present?

Intermediate likelihood of GABHS. Signup and view all the answers

What is a situation where a throat culture should be reserved for confirmation of a negative RADT?

The patient is a child or high-risk for severe infection. Signup and view all the answers

Which of the following is considered first-line treatment for GABHS pharyngitis?

Penicillin VK or similar oral antibiotics for 10 days. Signup and view all the answers

What serious complication can arise from GABHS pharyngitis?

Acute rheumatic fever. Signup and view all the answers

Which symptom is NOT a characteristic of poststreptococcal glomerulonephritis?

Joint swelling. Signup and view all the answers

In which scenario might benzathine PCN be indicated for GABHS treatment?

The patient has a compliance problem with oral medications. Signup and view all the answers

Which disorder is characterized by inflammation and infection of the sinuses?

Rhinosinusitis Signup and view all the answers

What is a common clinical manifestation of nasal polyps?

Nasal congestion Signup and view all the answers

Which condition is an example of a benign neoplasm in the nasopharyngeal region?

Inverted Papilloma Signup and view all the answers

What is a significant clinical feature of necrotizing ulcerative gingivitis?

Halitosis Signup and view all the answers

Which condition is primarily associated with infectious inflammation of the oropharynx?

Epiglottitis Signup and view all the answers

Which of the following is a common treatment approach for rhinitis?

Nasal corticosteroids Signup and view all the answers

What is a typical symptom of foreign bodies in the nose?

Persistent sneezing Signup and view all the answers

Which oral condition often presents in the form of painful, recurrent sores?

Aphthous Stomatitis Signup and view all the answers

What is one of the cardinal symptoms of chronic rhinosinusitis for children?

Cough Signup and view all the answers

Which symptom is NOT considered a danger sign or complication for chronic rhinosinusitis?

Mild sinus pressure Signup and view all the answers

How many of the 4 cardinal signs and symptoms must be present to diagnose chronic rhinosinusitis?

Two Signup and view all the answers

What is a key objective finding for diagnosing chronic rhinosinusitis?

Polyp in the nasal cavity Signup and view all the answers

Which treatment is NOT recommended for chronic rhinosinusitis?

Antibiotics Signup and view all the answers

What age group has the highest incidence of Group A beta-hemolytic streptococcus (GABHS) pharyngitis?

Children ages 5-15 Signup and view all the answers

What is one of the supportive features of GABHS pharyngitis?

Palatal petechiae Signup and view all the answers

According to Centor criteria, what is considered a low risk for GABHS?

0-1 symptoms present Signup and view all the answers

Which of the following is NOT a significant symptom of GABHS pharyngitis?

Mild headache Signup and view all the answers

What can help prevent the complications of GABHS pharyngitis?

Accurate diagnosis Signup and view all the answers

Study Notes

ENT 3

ENT 3 course offered by Professor Boucher at South College
Course focuses on diseases of the nose, sinuses, nasopharynx, oropharynx, and oral cavity.

Topics

Nose and sinus disorders: chronic rhinosinusitis, invasive fungal rhinosinusitis, foreign bodies, trauma
Nasopharyngeal and paranasal sinus neoplasms: polyps, inverted papillomas
Oropharyngeal disorders
Oral cancer

Instructional Objectives

Describe epidemiology, etiology, clinical manifestations, diagnosis, and management of epistaxis, nasal polyps, rhinitis, rhinosinusitis, and nasal trauma. Learning objective numbers 1-5, 7
Identify and describe etiology, clinical manifestations, diagnosis, and management of foreign bodies in the nose. Learning objective numbers 1-5, 7
Demonstrate evaluation, diagnosis, and management of benign and malignant neoplasms of the nasopharyngeal and paranasal sinuses. Learning objective numbers 1-5, 7
Identify and describe clinical manifestations, diagnosis, and treatment of diseases of the teeth and gums, including necrotizing ulcerative gingivitis. Learning objective numbers 1-5, 7
Identify and describe 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. Learning objective numbers 1-5, 7
Identify and describe clinical manifestations, diagnosis, and treatment of salivary disorders, including sialadenitis and parotitis. Learning objective numbers 1-5, 7
Identify and describe clinical manifestations, diagnosis, and treatment of oropharyngeal trauma. Learning objective numbers 1-5, 7
Identify and describe clinical manifestations, diagnosis, and treatment of other oropharyngeal disorders, including leukoplakia. Learning objective numbers 1-5, 7
Identify and describe clinical manifestations, diagnosis, and treatment of oral squamous cell carcinoma (SCC). Learning objective numbers 1-5, 7
Identify and describe etiology, clinical manifestations, diagnosis, and management of foreign bodies of the larynx and pharynx. Learning objective numbers 1-5, 7

Chronic Rhinosinusitis (CRS)

Inflammatory condition of the paranasal sinuses and nasal passages lasting 12 weeks or more
Affects 5-12% of the general population (children and adults); mean age at diagnosis is 39
Onset is either abrupt or insidious (months to years)
Diagnosis requires objective evidence of mucosal inflammation

Chronic Rhinosinusitis (CRS) Risk Factors/Associated Conditions

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

Chronic Rhinosinusitis (CRS) Clinical Features

(Adults):
- Anterior and/or posterior nasal mucopurulent drainage (opaque white or light yellow)
- Nasal obstruction/blockage/congestion (bilateral)
- Facial pain, pressure, or fullness (headache)
- Reduction or loss of sense of smell
(Children):
- Same as adults except the 4th symptom is cough instead of loss of smell

Chronic Rhinosinusitis (CRS) Danger Signs & Complications

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

Chronic Rhinosinusitis (CRS) Evaluation

Clinical history (4 cardinal symptoms, duration, risk factors, previous treatments, and imaging)
Objective documentation of mucosal disease using anterior rhinoscopy, nasal endoscopy, and/or CT scans (showing purulent mucus, edema, polyps, thickening, or opacification of the paranasal sinuses)
Allergy evaluation (optional testing; mainly perennial allergens)
Consideration of immunologic defects or infectious complications (patients with recurrent episodes of acute purulent sinusitis, history of pulmonary infections, or recurrent otitis media)

Chronic Rhinosinusitis (CRS) Diagnosis

Based on presence of suggestive symptoms and objective evidence of mucosal inflammation.
Must have at least two of the four cardinal signs and symptoms.
Symptoms must be present for more than 12 weeks.
Must have one or more findings on nasal endoscopy or CT showing purulent (not clear) mucus or edema in the middle meatus or ethmoid regions; polyps in the nasal cavity or middle meatus.
Radiographic imaging must demonstrate mucosal thickening or partial or complete opacification of the paranasal sinuses.

Chronic Rhinosinusitis (CRS) Subtypes

Three distinct clinical syndromes/subtypes: CRS with nasal polyposis (20-33%); allergic fungal rhinosinusitis (AFRS) (<5%); CRS without nasal polyposis (60-65%)
Subtypes are differentiated by CT findings and/or tissue biopsy

Chronic Rhinosinusitis (CRS) Treatment

Primary care management, but ENT and allergy specialists often required (especially for refractory CRS and AFRS)
Intranasal saline (irrigation and/or sprays)
Intranasal corticosteroids (i.e., fluticasone, budesonide)
Oral corticosteroids (severe/refractory mucosal edema, to reduce polyp size, minimize inflammation of AFRS; typically 10-15 days)
Antibiotics (only to manage acute exacerbations, not long-term)
Antileukotriene agents (adjunct in patients with allergic rhinitis or nasal polyps)
Endoscopic sinus surgery (for medical polypectomy or insufficient results)
Biological agents

Invasive Fungal Rhinosinusitis

Rare, aggressive fungal infection of the sinuses
Time course: days to weeks
Most cases occur in immunosuppressed individuals (e.g., diabetes mellitus, HIV, organ transplant recipients)
Chronic or acute (profound immunosuppression)
Causes: Aspergillus and Mucor species

Invasive Fungal Rhinosinusitis (Symptoms)

Symptoms of acute illness (similar to acute bacterial rhinosinusitis [ABRS]): fever, facial pain (facial numbness with cranial nerve involvement), nasal congestion, possible visual or mental status changes (diplopia).

Invasive Fungal Rhinosinusitis (Diagnosis & Treatment)

Diagnosis: CT and/or MRI, but confirmed with tissue biopsy
Treatment: medical and surgical emergency
Hospital admission and ENT referral
IV antifungal therapy (voriconazole or amphotericin B)
Prompt/wide surgical debridement

Nasal Foreign Bodies

Common in children and developmentally disabled
Inorganic materials (beads, pebbles, etc.)
Organic materials (beans, peas)
More difficult to remove as they swell with time
Button batteries and magnets require immediate attention due to risk of septal perforation
Symptoms: unilateral foul-smelling discharge, nasal obstruction
Management: patient can blow nose or trial of insufflation; pretreat with nasal decongestant and topical anesthetic; conscious sedation if needed; use of a Katz extractor, Foley catheter, or forceps

Nasal Foreign Bodies (Referral Criteria)

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 Foreign Bodies (Instruments)

Jobson-Horne probe, hook, and alligator forceps

Nasal Trauma

Nasal fracture: nasal pyramid is the most frequently fractured bone in the body
Symptoms: epistaxis, pain, soft tissue hematomas (periorbital hematoma/black eye)
Evaluation: Full HEENT exam (intranasal exam to rule out septal hematoma); crepitus; palpable and mobile bony segments; step-off of the infraorbital rim (zygomatic complex fracture) ; x-rays for facial, spinal, pulmonary, and intracranial injuries (based on mechanism of injury [MOI])

Nasal Trauma (Treatment)

Goal: maintenance of long-term nasal airway patency and cosmesis
Septal hematoma: urgent referral to ENT; bilateral internal drainage (I&D) + fluid cultures; nasal packing (3-5 days) to prevent re-formation of hematoma
Anti-staphylococcal antibiotics (e.g., cephalexin, clindamycin) (3-5 days or the duration of packing) to reduce the risk of toxic shock syndrome
Closed reduction of fracture (local or general anesthesia)

Malignant Nasopharyngeal & Paranasal Sinus Neoplasms

Squamous cell carcinoma (SCC): most common neoplasm found in sinuses and nasopharynx
Adenocarcinoma, mucosal melanomas, sarcomas, and non-Hodgkin lymphomas—less common
Early symptoms similar to rhinosinusitis
Common symptoms: unilateral nasal obstruction and discharge, otitis media
Cancer-related symptoms: pain and recurrent hemorrhage
Most cases are advanced at presentation and treated with chemoradiation therapy.
Poor prognosis for advanced tumors

Benign Nasopharyngeal Neoplasms (Nasal Polyps)

Pale, edematous, mucosal-covered masses
Common association with allergic rhinitis
Possible chronic nasal obstruction and dysosmia
Topical intranasal steroids improve quality of life (for small polyps), (1-3 months)
Consider short course oral steroids
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) seen in ~10% of cases.
Complete excision is strongly recommended.

Oropharyngeal Disorders

Diseases of the teeth and gums
Infectious and inflammatory disorders
Salivary disorders
Other disorders

Neutrophilic Ulcerative Gingivitis (Vincent's Angina or Trench Mouth)

Often from infection with spirochetes and fusiform bacilli
Young adults under stress (e.g., medical/dental students)
Underlying systemic diseases possible
Painful, acute gingival inflammation and necrosis.
Possible bleeding, halitosis, fever, and cervical lymphadenopathy
Treatment: warm 1/2 strength peroxide rinses, metronidazole 500 mg PO q8h for 7 days (or until lesions have healed), dental gingival curettage

Infectious/Inflammatory Oropharyngeal Disorders

Aphthous stomatitis (canker sores)
Recurring, painful, solitary or multiple ulcers typically covered by a white-to-yellow pseudomembrane and surrounded by an erythematous halo (7-14 days)
Differential diagnosis (DDx): erythema multiforme or drug allergies, herpes simplex, pemphigus, pemphigoid, bullous lichen planus, Behçet disease, inflammatory bowel disease (IBD), and squamous cell carcinoma (SCC).
Treatment: good oral hygiene, avoidance of exacerbating factors/foods, pain control (viscous lidocaine 2% or benzocaine 10%), 1 week tapering course prednisone (40-60 mg), topical corticosteroids (e.g., fluocinonide gel), medicated mouthwash
Oral candidiasis (thrush)
Infection of oral mucosa usually caused by Candida albicans
Risk factors: immunocompetent patients (dentures, xerostomia, antibiotic/steroid use, diabetes mellitus, anemia), immunocompromised patients (HIV/AIDS, hematologic malignancies, transplant recipients, chemotherapy, steroids, head, and neck radiation therapy [RT])

Deep Neck Infections

Cellulitis of the submandibular space (often due to infection of mandibular dentition); most commonly encountered neck space infection
Edema and erythema of the upper neck and floor of the mouth
Tongue may be displaced upward and backward; may occlude airway
May have pus in floor of the mouth
Diagnosis: clinical, augmented by CT with contrast
Treatment: hospital admission, IV ceftrriaxone + metronidazole, Cx/Sens., dental consult/ENT consult, + drainage
Deep neck abscess
Usually caused by odontogenic infections, pharyngeal infection, suppurative lymphadenitis, direct spread, penetrating trauma, pharyngoesophageal FB, cervical osteomyelitis, IV drug injection into internal jugular vein
Marked neck pain and edema, + fever
Untreated or inadequately treated may spread to mediastinum or cause sepsis
Diagnosis: clinical, augmented with CT with contrast
Treatment: secure airway, IV antibiotics, I&D, may require intubation or tracheotomy

Epiglottitis

Inflammation of the epiglottis and supraglottic structures
Usually due to viral or bacterial infection, (also caustic ingestion, thermal injury, or trauma)
Most common bacterial cause is Haemophilus influenzae type B (Hib)
Usual presentation: rapidly developing severe sore throat or odynophagia out of proportion to minimum oropharyngeal findings on exam
More common in diabetics and those who have not received routine vaccinations

Epiglottitis (Examination and Imaging)

Exam: Indirect laryngoscopy (not in children) revealing edematous and erythematous epiglottis; children may be in tripod position to increase airway patency
Imaging: X-ray, or CT scan—imaging should not delay airway management X-ray: Enlarged epiglottis (thumbprint sign)

Epiglottitis (Treatment)

Airway management and evaluation; keep patient calm; avoid agitating patient (especially children); avoid sedation (unless needed for intubation), inhalers, or racemic epinephrine; hospitalization for IV antibiotics (e.g., ceftriaxone or amoxicillin/clavulanate); IV dexamethasone; analgesic/antipyretic; supplemental humidified oxygen

Herpes Labialis

"Cold sores" or "fever blisters"
Reactivation of HSV-1 oral vesicles along the vermilion border.
Common (15-45% of US population)
Triggers: immunodeficiency, stress, exposure to sunlight, fever, trauma, dental procedures
Symptoms & signs: prodrome (pain, burning, tingling, pruritus); eruption of clustered vesicles (7-14 days)
Treatment: local anesthetics (e.g., topical lidocaine); oral antivirals (e.g., acyclovir, famciclovir, valacyclovir); topical antiviral (acyclovir) less effective than oral antivirals.

Herpes Labialis (Treatment Strategy)

No treatment (mild symptoms, no prodrome)
Episodic therapy (mild-moderate symptoms with prodrome)
Chronic suppressive therapy (severe disease, frequent recurrences, especially if no prodrome, recurrences bothersome, recurrences associated with serious systemic complications [e.g., erythema multiforme])

Acute Laryngitis

Common cause of hoarseness; often follows a URI (viral or bacterial)
Signs and symptoms: hoarseness; +/- sore throat, congestion
Treatment: supportive (voice rest, PO hydration, humidified air)
Antibiotics usually not necessary
Complications: vocal fold hemorrhage, polyps, cysts

Peritonsillar Abscess

Most common deep infection (polymicrobial) of the head and neck.
Usually forms in the soft palate, just above the superior pole of the tonsil, in the location of Weber's glands.
Occurs mostly in young adults (20-40)
More commonly in November-December and April-May
Risk factors include periodontal disease and smoking

Peritonsillar Abscess (Signs & Symptoms)

Ill-appearing, fever, malaise; severe sore throat, foul breath, dysphagia, or otalgia.
Trismus, odynophagia, drooling
Muffled voice (“hot potato voice”)
Tense swelling and erythema of anterior tonsillar pillar and soft palate
Tonsil is usually displaced inferiorly and medially with contralateral deviation of the uvula
Tender cervical lymphadenopathy

Peritonsillar Abscess (Diagnosis & Treatment)

Diagnosis: needle aspiration; intraoral or submandibular ultrasound; CT/MRI (an adjunct)
Small abscess (<1 cm): observation and antibiotics
Drainage of abscess larger than 1 cm: needle aspiration, I&D, and/or tonsillectomy, antibiotics (e.g., piperacillin-tazobactam IV; alternatives include IV metronidazole + ceftriaxone or clindamycin)
Hydration and analgesia and airway management

Peritonsillar Abscess (Complications)

Airway obstruction
Aspiration pneumonia
Death secondary to hemorrhage
Extension of infection into the deep neck or mediastinum
Poststreptococcal sequelae (if caused by Group A beta-hemolytic streptococcus [GABHS])

Pharyngitis

Very common; peak seasons are late winter and early spring
Causes: mostly viral and bacterial; others include GERD, postnasal drip (rhinitis), persistent cough, thyroiditis, allergies, foreign body, and smoking
Symptoms: scratchy feeling, sore throat.
Consider SARS-CoV-2 testing in patients with acute pharyngitis

Viral Pharyngitis

Most common cause of pharyngitis
Signs and symptoms: Coryza, conjunctivitis, malaise, hoarseness, low-grade fever
Treatment: conservative - Systemic PO analgesics (e.g., acetaminophen, NSAIDs, ASA); topicals (e.g., lozenges, sprays, beverages, foods); breathing humidified air; avoid tobacco smoke

Infectious Mononucleosis

Pharyngitis with significant fatigue
Cause: Epstein-Barr virus (EBV)
Most common in ages 15-30

Infectious Mononucleosis (Examination)

Pharyngeal injection with exudates (shaggy, white-purple)
Posterior cervical and auricular lymphadenopathy
Palatal petechiae
Hepatosplenomegaly

Infectious Mononucleosis (Diagnosis & Treatment)

Diagnosis: Heterophile antibody test (e.g., Monospot) or EBV-specific antibody test to confirm; CBC: lymphocytosis (absolute count >4,500/µL); peripheral smear: differential count >50% (or atypical lymphocytosis)
Treatment: Supportive (fluids, rest, acetaminophen or NSAIDs, no contact sports for min 3-4 weeks); No antibiotics

Group A Beta-Hemolytic Streptococcal Pharyngitis (GABHS)

Group A beta-hemolytic streptococcus (GABHS)
Highest incidence in children (ages 5-15)
Signs & symptoms
Acute-onset sore throat; fever; pharyngeal edema; patchy tonsillar exudates; prominent, tender anterior cervical lymphadenopathy
Supportive features: palatal petechiae, scarlatiniform rash, and strawberry tongue

GABHS Pharyngitis (Diagnosis)

For most patients with suspected GAS pharyngitis: test with a sensitive rapid antigen detection test (RADT); follow-up throat culture not always needed; positive RADT - treat with antibiotics; negative RADT - additional testing not usually needed; reserve throat cultures to confirm negative RADT results in selected patients (children, high-risk infection or complications [e.g., history of ARF or immunocompromised], high-risk people such as caregivers for infants, immunocompromised individuals, living in areas with high GAS prevalence [e.g., college dorms], in areas with ARF outbreaks, and high clinical suspicion of GAS but is negative RADT [e.g., > 3 Centor criteria])

GABHS Pharyngitis (Treatment)

Analgesic (e.g., NSAIDs, acetaminophen)
PO antibiotic preferred 1st line (e.g., penicillin VK, cefuroxime, cefpodoxime) x 10 days
Can also use amoxicillin 500 mg BID x 10 days
PO antibiotic for PCN allergy (e.g., erythromycin, azithromycin)
Antibiotic for compliance problems or inability to take PO meds (e.g., benzathine PCN or procaine PCN as a single IM injection)

GABHS Pharyngitis (Complications)

Acute rheumatic fever (ARF)
Rare (1 case per 100,000)
Joint swelling/pain, subcutaneous nodules, erythema marginatum, myocarditis, chorea
Poststreptococcal glomerulonephritis
Intrinsic renal failure
Hematuria, edema
Peritonsillar abscess
Rare (<1%)
Toxic appearance
Scarlet fever
Punctate, erythematous, blanchable, and sandpaper-like exanthem, accentuated in body folds and creases (Pastia's lines).
Strawberry tongue

Other Bacterial Pharyngitis

Gonococcal pharyngitis - Sexually active patients, Fever, dysuria, greenish exudate, Ceftriaxone 250 mg IM + Azithromycin 1 gm PO x 1 dose
Diphtheria - Sore throat, low-grade fever, Adherent grayish membrane, Antitoxin + Antibiotic, Tender cervical adenopathy, Erythromycin 500 mg IV QID or PCN G 50,000 units/kg IV q12h

Salivary Disorders

Sialadenitis

General: acute swelling of the parotid or submandibular gland; can also occur with dehydration and chronic illness (e.g., Sjögren's syndrome; chronic periodontitis); often bacterial (e.g., S. aureus)
Signs and symptoms: increased pain and swelling with meals

Sialadenitis (Physical Examination & Treatment)

Physical Examination: Tenderness and erythema of the duct opening, pus often massaged from the duct.
Treatment: Hydration, warm compresses, sialagogues (e.g., lemon drops), massage the gland; IV antibiotics (PO for less severe cases)

Suppurative Parotitis

Acute infection of the parotid gland (viruses and bacteria)
Typically S. aureus and mixed oral aerobes and anaerobes
Most common in debilitation, dehydration, and poor oral hygiene, particularly among elderly postoperative patients
Consider mumps in children and young adults; sarcoidosis
Evaluate testicles (epididymo-orchitis)

Suppurative Parotitis (Signs & Symptoms)

Firm, erythematous swelling
Pain and tenderness
Possible trismus and dysphagia
Systemic: fever and chills
Exam: possible purulence from Stenson's duct

Suppurative Parotitis (Diagnosis & Treatment)

Diagnosis: US (preferred initially), CT, MRI; elevated serum amylase in the absence of pancreatitis; Gram stain & culture discharge
Treatment: inpatient hydration and IV antibiotics (admission); surgical I&D if no response in 48 hours

Oropharyngeal Disorders (Other)

Precancer: Leukoplakia
White adherent patch or plaque
Premalignant lesion
Risk factors include tobacco, dentures, lichen planus.
Dysplasia or early SCC (2-6%)
Diagnosis: biopsy
Treatment: watchful waiting + exision
Oral hairy leukoplakia
White, corrugated, painless plaques usually on lateral tongue
Plaques cannot be scraped off
Prevalent in HIV, organ transplant, malignancy, steroids (systemic or inhaled)
Associated with EBV
Not considered premalignant
Treatment usually not indicated
Antivirals may provide temporary resolution

Oral Cancer

Squamous cell carcinoma (SCC)
Risk Factors: increasing age, tobacco use, alcohol use
Physical Examination: Raised, firm, white lesions with ulcers at the base, can lead to nodularity or ulceration; usually involves the lateral surface of the tongue; quite painful with gentle palpation.
Diagnosis: biopsy
Treatment: surgery/radiation

Upper Airway Foreign Bodies

More common in young children
One study of 1068 foreign body aspirations:
3% in larynx
13% in trachea
52% in right main bronchus
6% in right lower lobe bronchus
18% in left main bronchus
5% in left lower lobe bronchus
Signs & symptoms: sudden episode of choking or coughing; subsequent wheezing, coughing, or stridor; 1/3 of parents were unaware of the aspiration or remembered an event that occurred more than a week prior

Upper Airway Foreign Bodies (Airway Management)

Airway management: 5 x back blows; 5 x chest thrusts (alternate)

Esophageal Foreign Bodies

Usually due to food bolus impaction
Most will pass spontaneously (80%)
Peak incidence between 6 months and 6 years
Small batteries (necrosis/perforation)
Complete obstruction: drooling, inability to handle secretions
Treatment: flexible endoscope; glucagon 1.0 mg IV (relaxes the esophagus)

Emergent Airway Management

Cricothyroidotomy: quick, relatively easy stab through cricothyroid membrane; insert any small round airway (e.g., biro casing); anaesthetic not essential; life-saving
Formal tracheostomy: not usually an emergency; needs full anaesthetic; ideal for temporary or permanent intubation; hole cut in 2nd & 3rd tracheal rings; usually after dividing thyroid isthmus; inferior thyroid veins can be troublesome

References

Current Medical Diagnosis & Treatment 2025, Papadakis
Handbook of Otolaryngology: Head and Neck Surgery, 2nd Ed. Goldenberg
UpToDate online

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Test your knowledge on chronic rhinosinusitis with this quiz that covers key facts, risk factors, and diagnostic details. Understand the duration, signs, and prevalence of this common condition. Perfect for healthcare students and professionals looking to refresh their knowledge.