Otolaryngology Quiz: Deep Neck Infections

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the most common cause of deep neck abscesses?

Odontogenic infections (correct)

Cervical osteomyelitis

Pharyngoesophageal foreign body

Suppurative lymphadenitis

Which of the following is NOT a clinical finding associated with deep neck infections?

Marked acute neck pain and swelling

Fever is always present (correct)

Tongue may be displaced upward and backward

Edema and erythema of the upper neck under the chin and often of the floor of the mouth

What is the most common type of deep neck abscess?

Retropharyngeal abscess

Submandibular abscess

Peritonsillar abscess

Ludwig angina (correct)

What is Lemierre syndrome?

A rare complication of deep neck infections involving thrombophlebitis of the internal jugular vein (A) Signup and view all the answers

Which of the following is NOT a treatment option for deep neck infections?

Antiviral medication (A) Signup and view all the answers

What is the most common cause of vocal fold paralysis?

Idiopathic (C) Signup and view all the answers

What is the primary indication for a tracheotomy?

Prolonged mechanical ventilation (B) Signup and view all the answers

What is the correct order of airway management procedures in an acute emergency with airway obstruction above the trachea?

Endotracheal intubation, cricothyrotomy, tracheostomy (A) Signup and view all the answers

Which of the following is NOT a common symptom of breathy dysphonia?

Airway compromise (B) Signup and view all the answers

Which of the following groups are at a higher risk of foreign body aspiration?

Both B and C (C) Signup and view all the answers

What is the recommended treatment for severe peritonsillar abscess?

Parenteral amoxicillin (1g) (B) Signup and view all the answers

What is a possible sign of a peritonsillar abscess on a CT scan?

A hypodense core with a ring-enhancing lesion (B) Signup and view all the answers

Which of the following is NOT a recommended treatment option for less severe peritonsillar infection?

Parenteral amoxicillin (1g) (B) Signup and view all the answers

What is the definition of a peritonsillar phlegmon?

An inflammation of the soft tissue surrounding the tonsil (C) Signup and view all the answers

In adults, recurring or atypical peritonsillar infections may be indicative of what?

Malignancy (D) Signup and view all the answers

Which of the following statements best describes vocal fold polyps?

Unilateral masses on the superficial lamina propria of the vocal fold, often related to vocal trauma. (C) Signup and view all the answers

What is a common treatment for recalcitrant lesions of the vocal folds?

Surgical removal. (C) Signup and view all the answers

Which of the following conditions is NOT a traumatic lesion of the vocal folds?

Polypoid corditis. (B) Signup and view all the answers

What is Reinke edema?

A buildup of fluid in the vocal folds, leading to a swelling of the gelatinous matrix. (A) Signup and view all the answers

What are contact ulcers and granulomas?

Lesions that form on the arytenoid cartilages as a result of vocal trauma. (A) Signup and view all the answers

Study Notes

Otolaryngology Disorders

Course: PAMA 5619 - Clinical Medicine I
Semester: II, Spring
Instructor: Tong Pineda, MD

Genesis 2:7 NLT

Then the Lord God formed the man from the dust.
He breathed the breath of life into the man's nostrils.
The man became a living person

Current Medical Diagnosis & Treatment 2025 by Maxine A. Papadakis, Stephen J. McPhee, Michael W. Rabow, Kenneth R. McQuaid

Harrison's Principles of Internal Medicine, 21e by Joseph Loscalzo, Anthony Fauci, Dennis Kasper, Stephen Hauser, Dan Longo, J. Larry Jameson
Textbooks for this module

Head, Ears, Nose, Oral, Throat Module Objectives

Identify common head and face injuries.
Recognize and differentiate between conductive and sensorineural hearing loss (B2.02c)
Recognize and differentiate between peripheral and central vertigo (B2.02c)
Compare and contrast pharyngitis and tonsillitis, describing clinical presentation
Describe the Centor criteria and its use in GABHS pharyngitis.
Identify risk factors for oral cancer development.
Identify common conditions affecting teeth and gums.
Distinguish between anterior/posterior epistaxis, and identify appropriate management.

Leukoplakia, Erythroplakia, Lichen Planus, & Oropharyngeal Cancer

Leukoplakia: A whitish plaque-like lesion (cannot be removed by rubbing).
Erythroplakia: similar to leukoplakia but has a definite erythematous component; warrants biopsy
Lichen Planus: chronic inflammatory, autoimmune disease. Presents as lacy leukoplakia or erosive. Definite diagnosis through biopsy
Oropharyngeal cancer: generally presents later than oral cavity cancer. Lesions often buried in lymphoid tissue of palatine/lingual tonsils. Unilateral odynophagia, weight loss, ipsilateral cervical lymphadenopathy can be symptoms; correlates with tobacco, alcohol, HPV. Empiric treatment includes chemotherapy and radiation.

Squamous Cell Carcinoma

Difficult to distinguish from other oral lesions.
Painful, raised, firm, ulcerative lesions on palpation.
Small tumors (< 3 mm) have lower probability of metastasis. Higher cure rates if resected early (< 2cm diameter)
Radiation or chemotherapy (lymph node extension), and possibly external beam radiation with surgical reconstruction, is used for treatment.

Oral Candidiasis (Thrush)

Fluctuating mouth discomfort.
Creamy white, curd-like patches on erythematous mucosa.
Easy to rub-off – unlike leukoplakia or lichen planus.
Risk Factors: Dentures, debilitated state (poor oral hygiene), diabetes mellitus, anemia, chemotherapy, local radiation, corticosteroid use (oral or systemic), broad-spectrum antibiotics, angular cheilitis (nutritional deficency).
Diagnosis: Clinical; wet prep with potassium hydroxide for spores and nonseptate mycelia.
Treatment: Usually Fluconazole (100mg orally x 7 days)

Glossitis, Glossodynia, & Burning Mouth Syndrome

Glossitis: inflammation of the tongue, with loss of filiform papillae. Red, smooth surface, not painful
Glossodynia: burning/pain of the tongue, may or may not be associated with glossitis.
Burning mouth syndrome: when there are no specific clinical findings
Possible causes: nutritional deficiencies (niacin, riboflavin, iron, Vitamin E), drug reactions, dehydration, irritants/foods, autoimmune reactions

Necrotizing Ulcerative Gingivitis

Painful, acute gingival inflammation and necrosis.
Commonly associated with bleeding, halitosis, fever, and cervical lymphadenopathy.
Often caused by spirochetes and fusiform bacilli infection.
More common in young adults under stress
Treatment: warm half-strength peroxide rinses, oral penicillin (250mg TID) x 10 days, dental gingival curettage
Underlying systemic diseases can predispose this condition.

Apthous Ulcer

Very common, easily recognized ulcers.
Single or multiple painful, small, round ulcerations with yellow-grey, fibrinoid centers surrounded by red halos.
Usually around mucosa; not attached to gingiva.
Minor: < 1 cm diameter; heals 10-14 days.
Major: > 1 cm diameter; disabling pain
Treatment: challenging, no single systemic treatment proves effective. Important to avoid local irritants.
Treatment Options include; topical corticosteroids (triamcinolone acetonide, 0.1%, or fluocinonide ointment, 0.05%) with an adhesive base, 1-week tapering course of prednisone (40-60 mg/day) may be successful.
Recurrent cases: cimetidine maintenance therapy or thalidomide for HIV patents.
Incisional biopsy in large, persistent, or unclear cases

Herpes Stomatitis

Typically common, mild, short-lived.
Initial: burning followed by typical, small vesicles that rupture and form scabs.
Common sites: attached gingiva, mucocutaneous lip junction, tongue, buccal mucosa, and soft palate.
Treatment: Acyclovir (200-800 mg orally 5x/day x 7-10 days), valacyclovir (1000 mg orally twice daily for 7-10 days).
Intervention generally not necessary in healthy adults.

Pharyngitis & Tonsillitis

Centor criteria: helpful for evaluating possible streptococcal infection. High probability of infection when 4 criteria met; presence, exudate or swollen tonsils, anterior cervical adenopathy, absence of cough, temp over 38 degrees celsius.
Possible subsequent infections with group A beta-hemolytic streptococcal (GABHS) infection.
Treatment: usually antibiotics if GABHS is suspected, especially in those with 2-3+ Centor criteria.

Peritonsillar Abscess & Cellulitis

Infection surrounding the tonsillar capsule.
Presents as severe sore throat, odynophagia, trismus, medial deviation of soft palate, peritonsillar fold, unusual voice ("hot potato" voice).
Diagnosed via aspiration (19-21 gauge needle medial to molar; less than 1 cm deep).
Treatment: Parenteral amoxicillin (1g), amoxicillin-sulbactam (3g), or clindamycin (600-900 mg).
Consider less severe cases; amoxicillin (500 mg TID orally), amoxicillin-clavulanate (875 mg BID), or clindamycin (300 mg QID) x 7-10 days; then surgically evaluate.

Deep Neck Infections

Commonly originate from odontogenic infections.
Other causes: suppurative lymphadenitis, direct spread/extension of pharyngeal infection, penetrating trauma, foreign body, pharyngoesophageal, cervical osteomyelitis, intravenous injection of internal jugular vein, substance abuse.
Ludwig angina: most common. Cellulitis of sublingual and submaxillary spaces. Rapid airway compromise is a serious emergency, surgical airway may be required if that occurs
Possible clinical signs: Marked acute neck pain & swelling, Fever (may be absent), edema/erythema of upper neck, under the chin to floor of the mouth, Displaced upward/backward tongue, coalescence of pus in the floor of the mouth, potentially spreading to mediastinum or systemic sepsis
Treatment includes: secure airway (intubation/tracheotomy), IV antibiotics (Penicillin + metronidazole, ampicillin-sulbactam, clindamycin), external drainage via bilateral submental incisions.

Snoring

Upper aerodigestive tract blockage during sleep.
Narrowing due to changes in position, muscle tone, and soft tissue hypertrophy/laxity
Could be simple snoring – or associated with obstructive sleep apnea (OSA) with life-threatening consequences
Possible symptoms include Excessive daytime sleepiness, daytime headaches, weight gain
Treatment: Diet modification/exercise, weight loss, avoidance of alcohol/hypnotics, positional adjustments (e.g., sleep with an elevated head area or using pillows), CPAP, or oral appliance therapies, surgical treatment in rare or resistant cases.

Acute Inflammatory Salivary Gland Disorders

Sialadenitis: common in the parotid or submandibular glands.
Presents with acute swelling, increased pain/swelling with meals, tenderness/erythema of duct opening.
Pus can be massaged from the duct.
Potentially linked with dehydration, chronic conditions (SJögren syndrome) or periodontal disease.
Treatment: Intravenous nafcillin (1gm IV Q4-6h), then switch to oral antibiotics if tolerated (10 days), hydration, warm compresses, lemon drops, massage, supportive care; and if indicated, incision/drainage (I&D).
Sialolithiasis: calculus formation (stone) is more common in Wharton duct (submandibular glands) than Stensen duct (parotid glands). Presents with postprandial pain/swelling, possibly history of recurrent sialadenitis.

Chronic Inflammatory & Infiltrative Disorders of the Salivary Glands

Common conditions: Sjögren syndrome, sarcoidosis, metabolic disorders, alcohol use disorder, diabetes mellitus, vitamin deficiencies, medications - thioureas, iodine, phenothiazines

Salivary Gland Tumors

Generally, smaller tumors in a salivary gland are more likely benign.
Parotid gland tumors are more common than submandibular gland tumors (greater risk of malignancy).
50-60% of primary submandibular tumors are benign.
Tumors of the minor salivary glands are most likely malignant, usually adenoid cystic carcinoma.
Treatment: surgical removal if indicated.

Hoarseness & Stridor

Hoarseness: abnormal vocal fold vibration (e.g., unilateral vocal fold paralysis, vocal fold mass)
Stridor: high-pitched sound due to the narrowing of the airway (above or below the vocal folds)
Causes: laryngeal disease, trauma, tumors, laryngopharyngeal reflux, or foreign body
Evaluate all persistent hoarseness that persists beyond 2 weeks.

Common Laryngeal Disorders: Laryngopharyngeal Reflux

Symptoms: hoarseness, throat irritation, heartburn, foreign body sensation, chronic cough.
GERD (gastroesophageal reflux disease) can cause laryngeal symptoms when other causes have been excluded.
Diagnosis: Laryngoscopy; and confirm with medications like omeprazole

Epiglottitis

Severe, rapidly developing, sore throat, usually due to viral or bacterial infection.
Odynophagia is out of proportion to minimal oropharyngeal findings.
Common in diabetic patients.
Diagnosis: Laryngoscopy – swollen, erythematous epiglottitis.
Treatment: IV antibiotics (e.g., ceftizoxime, cefuroxime), dexamethasone, and airway management (intubation).

Masses of the Larynx: Traumatic Lesions of the Vocal Folds

Vocal fold nodules: smooth, paired lesions at the vocal fold junction. Often from vocal abuse (e.g., singers' nodules in adults, screamers' nodules in children). Vocal fold nodules generally resolve easily with voice therapy. Unsuccessful treatments can require surgical removal.
Vocal fold polyps: Usually on one side of vocal folds; caused by vocal injury/trauma or bleeding of vocal folds. Surgical removal may be required if symptoms do not lessen.
Vocal fold cysts: also called traumatic lesions of the vocal folds; often true cysts with epithelial lining or pseudocysts forming from mucus secreting glands on the inferior part of the vocal fold. Variable hoarseness degree. Often resolve with conservative measures (voice rest & corticosteroids). Surgical removal in cases of severe hoarseness or other complications.
Polypoid corditis: Loss of elastin fibers and loosening of the intracellular junctions in the vocal fold lamina propria, often leading to Reinke edema. Common causes include chemical irritants, smoking, heavy vocal use or hypothyroidism. Conservative measures such as voice rest will reduce symptoms. In severe cases, surgical removal may be needed.
Contact ulcers/granulomas: lesions which frequently form on the vocal processes of the arytenoid cartilages (commonly post-intubation). Often resolve quickly with conservative approach, however, if chronic, multimodal treatment such as fluticasone (440mcg BID) and omeprazole (Oral 40mg BID). Voice therapy is often useful and surgical removal may be indicated in severe cases.
Laryngeal Leukoplakia: Leukoplakia in the vocal folds commonly associated with smoking/hoarseness. Direct laryngoscopy and biopsy are typical management approaches; and if more severe dysplasia or squamous cell carcinoma is suspected, removal may be necessary.
Squamous Cell Carcinoma (SCC): The most common type of laryngeal malignancy, almost always correlated with tobacco use. Clinical presentation often includes: change in voice, throat/ear pain, hemoptysis, dysphagia, weight loss; and/or airway compromise). Diagnosis through CT/MRI to determine tumor extent; then biopsy, esophagoscopy, bronchoscopy to aid staging. Treatment usually includes multimodal approach; cure, voice conservation, swallowing, avoid permanent tracheostomy. Sometimes, early stages respond to radiotherapy (80-95% cure rate) and more advanced cases require total laryngectomy.

Vocal Fold Paralysis

Vocal fold paralysis is the impairment or loss of function of one or both of the vocal folds.
Common cause of vocal paralysis: recurrent laryngeal nerve damage (either injury/lesion of the recurrent laryngeal nerve, or thyroid surgery/other neck surgeries, or mediastinal/apical lung involvement.
Idiopathic causes are also possible scenarios.
Bilateral vocal fold paralysis frequently results in inspiratory stridor.
Unilateral paralysis: Symptoms can vary, occasional temporary paralysis resolving within a year.

Cricothyrotomy & Tracheostomy

Cricothyrotomy and tracheostomy are airway management procedures used in emergencies where the upper airway is obstructed (e.g., trauma, mass, severe bleeding).
Tracheostomy involves creating an opening into the trachea for insertion of a tube; cricothyrotomy involves making a small incision in the cricothyroid membrane for direct airway access.
Tracheostomy is more involved and time-consuming, but cricothyrotomy can be performed more rapidly in emergencies.

Foreign Bodies in the Trachea & Bronchi

Foreign bodies: usually occur in children (aspiration). Less frequent in adults, especially those who wear dentures.
Heimlich maneuver is important first-line treatment.
If the Heimlich maneuver is ineffective, cricothyrotomy may be necessary in the acute setting.
X-ray (CXR)
Bronchoscopy is also used to remove foreign bodies.

Foreign Bodies in the Esophagus

Typically not emergent, but button battery ingestion IS an emergency.
Treatment depends on the foreign body.
Methods include: laryngoscopy or plain films, CT scan, barium swallow, esophagoscopy or rigid laryngoscopy

Diseases Presenting as Neck Masses

Differential diagnosis: Consider location in the neck, patient age, associated disease processes, rapid growth/tenderness (often inflammatory), firm/painless/slowly enlarging masses are frequently neoplastic (cancer).
Common in young adults, mostly benign; lymph nodes are frequently linked with conditions like HIV lymphoma.
Patients > 40: cancer (either primary or metastatic) most likely.
Diagnosis: Fine-needle aspiration (FNA) biopsy.

Congenital Lesions Presenting as Neck Masses

Branchial cleft cysts: soft cystic mass near the anterior border of the sternocleidomastoid muscle; often swell or become infected. Excision to prevent recurrent infection/carcinoma.
First branchial cleft cysts (most common site): prominent in high neck, sometimes below the ear. Fistula present in external auditory canal
Second branchial cysts are common; and possible for communication with tonsillar fossa
Third branchial cleft: may communicate with piriform sinus.

Thyroglossal Duct Cysts

Midline neck masses, frequently below the hyoid bone.
Common in young adults (mostly before age 20).
Surgical excision to prevent recurrent infection and malignancy.

Infectious & Inflammatory Neck Masses

Reactive cervical lymphadenopathy (common in HIV patients): normal lymph nodes (< 1 cm), usually tender, and associated with infections of the pharynx, salivary glands, scalp. Treatment related to the underlying disease. I&D may be indicated, as well as evaluation (FNA) of larger nodes (>1.5 cm) with necrotic center or those not correlated to known infection
Tuberculosis (TB) and nontuberculous mycobacterial infections can present with granulomatous neck masses (single/matted nodes). Diagnostic approach often involves FNA biopsy. Treatments depend on the culture results.

Lyme Disease

Caused by the spirochete Borrelia burgdorferi transmitted by the Ixodes genus ticks.
Symptoms often include facial paralysis, hearing loss, dysesthesias, dysgeusia, headache, pain, and cervical lymphadenopathy.

Cancer Metastases & Lymphomas

Metastatic cancer (80% are firm, persisting, enlarging masses in older adults). Originates from upper aerodigestive tract (nasopharynx, tonsils, tongue base, or larynx, etc.)
Complete head & neck exam, imaging (FNA, CT, MRI, PET scan)
Lymphomas account for approx. 10% of lymphomas in the head and neck region.
Diagnosis: multiple, rubbery nodes. FNA or open biopsy.

Studying That Suits You

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

Description

Test your knowledge on deep neck infections and associated conditions. This quiz covers topics such as causes of abscesses, clinical findings, and airway management procedures. Perfect for students and healthcare professionals specializing in otolaryngology.