Pediatric Otolaryngology Quiz

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Questions and Answers

What are the common symptoms associated with obstructive sleep apnea (OSA) in children?

Common symptoms include excessive loud snoring, frequent awakenings during the night, and hypersomnolence.

How can chronic mouth breathing affect craniofacial growth patterns in children?

Chronic mouth breathing can lead to adenoid facies, characterized by changes such as a pinched nose and elongated face.

What diagnostic assessments are essential for evaluating a patient with suspected adenoiditis?

Essential assessments include a thorough history, physical examination, and lateral postnasal space soft tissue x-ray.

What potential complications should be monitored following adenotonsillectomy?

Potential complications include hemorrhage, airway obstruction, and post-op pulmonary edema. Signup and view all the answers

What are the characteristic physical features associated with adenoid facies?

Characteristic features include an open mouth, loss of nasolabial groove, and a high arched palate. Signup and view all the answers

What is Waldeyer’s Ring and what role does it play in the immune system?

Waldeyer’s Ring is a ring of lymphoid tissue that guards the entrances to the digestive and respiratory tracts, playing a crucial role in the early recognition of pathogens and initiating an immune response. Signup and view all the answers

Describe the anatomical location and features of the palatine tonsils.

The palatine tonsils are lymphoid tissue masses located on either side of the oropharynx, characterized by a mucous membrane covering their medial surface, adorned with 8-30 depressions called crypts. Signup and view all the answers

What structures are in contact with the lateral surface of the palatine tonsils?

The lateral (deep) surface of the palatine tonsils is bounded by fibrous tissue (capsule) and is in proximity to the superior constrictor muscle, buccopharyngeal fascia, glossopharyngeal nerve, and several arteries. Signup and view all the answers

What are the primary arteries supplying the palatine tonsils, distinguishing between the inferior and superior poles?

The inferior pole is primarily supplied by the tonsillar branch of the facial artery, ascending palatine artery, and dorsal lingual artery, while the superior pole receives blood from the ascending pharyngeal and descending palatine arteries. Signup and view all the answers

Explain the venous drainage of the palatine tonsils.

The venous drainage of the palatine tonsils occurs through the peritonsillar plexus, draining into the lingual and pharyngeal veins, ultimately leading to the internal jugular vein (IJV). Signup and view all the answers

What arteries primarily provide blood supply to the adenoids?

The ascending pharyngeal artery, ascending palatine artery, ascending branch of maxillary artery, artery of pterygoid canal, and branches from the tonsillar branch of the facial artery. Signup and view all the answers

List two common organisms that cause acute tonsillitis.

Strep pneumoniae and H. influenzae. Signup and view all the answers

Identify two non-suppurative complications of acute tonsillitis.

Scarlet fever and acute rheumatic fever. Signup and view all the answers

What are the primary medical treatments for acute tonsillitis?

Broad spectrum antibiotics and anti-inflammatory medications. Signup and view all the answers

Name a clinical feature that distinguishes Quinsy from other throat infections.

Presence of severe trismus and unilateral bulging of the affected side. Signup and view all the answers

What is the main cause of chronic adenotonsillar hypertrophy?

Increased immunologic activity and chronic infection. Signup and view all the answers

What grading system is used to classify the size of tonsils?

Grading I to IV, where Gr I indicates tonsils hidden behind the anterior pillar and Gr IV indicates kissing tonsils. Signup and view all the answers

Identify two predisposing factors for acute tonsillitis.

Upper respiratory tract infections and exposure to contagious infections. Signup and view all the answers

Discuss a surgical indication for performing a tonsillectomy.

Chronic/recurrent acute tonsillitis is an absolute indication for tonsillectomy. Signup and view all the answers

What are the clinical features of Quinsy?

Toxic appearance, febrile state, severe odynophagia, and dribbling saliva. Signup and view all the answers

What role does the pharyngeal plexus play concerning the adenoids?

The pharyngeal plexus provides the nerve supply to the adenoids. Signup and view all the answers

Explain the potential complication of chronic adenotonsillar hypertrophy.

It can cause upper-airway obstruction in children. Signup and view all the answers

What is a common indication for medical management of Quinsy?

Broad spectrum antibiotics are indicated to treat the underlying infection. Signup and view all the answers

What types of antibiotics are typically recommended for treating tonsillitis-related infections?

Broad spectrum antibiotics are typically recommended. Signup and view all the answers

Study Notes

Adenoids and Tonsils

Adenoids are lymphoid tissue at the junction of the roof and posterior nasopharyngeal wall, related inferolaterally to the eustachian tube.
The tonsils (palatine, tubal, and lingual) comprise a ring of lymphoid tissue guarding the entrance to the digestive and respiratory tracts.
They play a crucial role in early recognition of pathogenic microorganisms and initiating an immune response.
The palatine tonsils are a pair of lymphoid tissue masses on either side of the oropharynx.
The tonsils are situated in the tonsillar fossa, with anterior and posterior pillars.
The medial surface is covered by mucous membrane with 8-30 crypts (depressions).
The largest crypt (crypta magna) separates the upper and lower poles of the tonsil.
A fibrous capsule (part of pharyngobasilar fascia) separates the tonsil from the superior constrictor of the pharynx.
The lateral (deep) surface is bordered by a fibrous tissue (capsule) that separates it from its bed, which includes the superior constrictor muscle, buccopharyngeal fascia, glossopharyngeal nerve, facial, lingual, and internal carotid arteries, and IJV.
The inferior pole receives blood supply from the tonsillar branch of the facial artery, ascending palatine artery, and dorsal lingual artery.
The superior pole receives blood supply from the ascending pharyngeal and descending palatine arteries.
Venous drainage is through the peritonsillar plexus to the lingual and pharyngeal veins, then to the IJV.
Nerve supply comes from the IX CN and descending branches of lesser palatine nerves.
Lymphatic drainage is to the upper deep cervical lymph nodes (especially the jugulo-diagastric LN).

Diseases of Tonsils

Inflammatory Diseases:
- Acute conditions: acute tonsillitis and peritonsillar abscess.
- Chronic conditions: chronic or recurrent tonsillitis, chronic specific tonsillitis (diphtheria, syphilitic, tubercular).
Tumors: Benign and malignant tumors.

Acute Tonsillitis

Common in children.
Immunity to common organisms is not always established.
Organisms: Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, and viral infections.

Predisposing Factors for Tonsillitis

Upper respiratory tract infections (URTI).
Chronic sinusitis and chronic tonsillitis.
Exposure to infectious diseases.
Blood dyscrasias.
Excessive cold drinks.
Lowered body resistance.
Excessive pollution.
Foreign body impaction.

Clinical Features of Tonsillitis

Symptoms: Fever, sore throat, odynophagia, thick and muffled voice, trismus (difficulty opening the jaw), pain referred to the ear, and foul breath.
Signs: Markedly congested pillars, enlarged and hyperemic tonsils, crypts filled with purulent material, and enlarged and tender jugulodiagastric lymph nodes.

Investigations of Tonsillitis

Complete blood count (FBC).
Differential count.
Throat swab for culture and sensitivity (C&S).
Plain radiograph, CT, or MRI if malignancy is suspected.

Differentials for Tonsillitis

Scarlet fever.
Infectious mononucleosis.
Diphtheria.
Glandular fever.
Thrush.

Treatment of Tonsillitis

Broad-spectrum antibiotics.
Anti-inflammatory/analgesics.
Soft, warm diet or intravenous fluids.
Bed rest.

Complications of Tonsillitis

Nonsuppurative: Scarlet fever, acute rheumatic fever, poststreptococcal glomerulonephritis.
Suppurative: Peritonsillar abscess (quinsy), parapharyngeal abscess, retropharyngeal space abscess, otitis media, and septicemia.

Quinsy

A collection of pus between the tonsil's fibrous capsule and the superior constrictor muscle of the pharynx, usually at the tonsil's upper pole.
Commonly a complication of acute tonsillitis.
Typically unilateral and more common in young adult males.
Clinical Features: Toxic appearance, fever, severe odynophagia (painful swallowing), dribbling saliva, trismus, muffled voice, and otalgia (ear pain).
Physical Examination Findings: Affected side is congested and bulging, tonsil is pushed downward and medially, asymmetry with edema and hyperemia of the soft palate, congested pillars, halitosis, severe trismus, and enlarged and tender jugulodiagastric lymph nodes.
Complications: Pharyngeal and laryngeal edema with respiratory obstruction, parapharyngeal abscess, retropharyngeal abscess, jugular vein thrombosis, septicemia, and aspiration of pus into the respiratory passage.
Differentials: Abscess related to an upper molar tooth, acute tonsillitis, malignancy of the tonsil, and parapharyngeal abscess.

Treatment of Quinsy

Medical: Broad-spectrum antibiotics, anti-inflammatory/analgesics, soft, warm diet, or intravenous fluids.
Surgical: Incision and drainage (I&D) or tonsillectomy (hot or interval).

Tonsillectomy

Indications: Chronic/recurrent acute tonsillitis, sleep apnea syndrome, malignancy, brachial fistula, chronic otitis media secondary to tonsillitis.
Relative Indications: Quinsy, diphtheria, rheumatic fever (RHD), glandular fever (GN), benign tumors or cysts, tonsillar foreign body, halitosis, and voice changes.

Chronic Adenotonsillar Hypertrophy (ATH)

Typically, tonsils and adenoids are small at birth and progressively enlarge in the first to fourth years of life.
Etiology: Increased immunologic activity, chronic infection, and secondhand smoke exposure.
Complications: Common cause of upper airway obstruction in children, severe cases can lead to cor pulmonale, pulmonary vascular hypertension, and alveolar hypoventilation.
Treatment: Adenoidectomy or tonsillectomy, or both.
Clinical Features: Symptoms of ATH are not due to the increased size of the adenoid mass itself, but rather to a disproportion in size between the nasopharynx and the adenoids.

Grade of Tonsil

Graded based on visibility of the tonsils' medial surface relative to visible anterior pillars. The grading system involves Gr I, Gr II, Gr III, and Gr IV (kissing tonsils).

Complications of Chronic ATH

Common cause of airway obstruction in children.
Severe cases can result in: cor pulmonale, pulmonary vascular hypertension, and alveolar hypoventilation.
Treatment involves adenoidectomy, tonsillectomy or both.

CFS (Chronic Tonsillitis) Presentation Issues

Clinical Features: Symptoms like chronic mouth breathing and drooling saliva, hyponasal voice, nasal discharge, conductive hearing loss due to otitis media, poor feeding/failure to thrive, and craniofacial growth pattern issues in children (adenoid facies).
General Symptoms with chronic adenotonsillar hypertrophy can include failure to thrive, pigeon chest, flat voice, protruding abdomen and halitosis.
Adenoid facies include open mouth, loss of nasolabial groove, pinched and narrow nose, vacant expression, high arched palate, malocclusion, drooling saliva and elongated face.

Diagnostic Assessment of Tonsils

Historical assessment.
Physical examination.
Radiological assessment (lateral postnasal space soft tissue x-ray).
Flexible endoscopic nasopharyngoscopy.

Preoperative Assessment

Coagulation abnormalities.
Chest X-ray (CXR).
Electrocardiogram (ECG).
Cardiology review.
Pulmonary evaluation - only in patients with severe upper airway obstruction.

Complications of Adenotonsillectomy

Hemorrhage (intraoperative, reactionary, secondary).
Pain.
Airway obstruction (edema, more common in patients <3 years).
Postoperative pulmonary edema.
Nasopharyngeal stenosis.
Vocal cord paralysis (VPI).
Cervical spine complications (atlantoaxial subluxation, Grisel's syndrome, common in patients with Down syndrome).

Assignment: Adenoiditis Presentation and Management

Students should discuss the presentation and management of adenoiditis. This will include the symptoms, diagnoses, and treatment options for this condition.

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Description

Test your knowledge on pediatric otolaryngology focusing on conditions like obstructive sleep apnea, adenoiditis, and tonsillitis. This quiz will cover symptoms, anatomical features, and complications related to these conditions in children. Ideal for students and professionals in healthcare fields.