E.N.T (1).pptx

E.N.T (1) By Dr. Mahmoud A. Helal Lecturer of General Surgery Badr University General Surgery Department  Tonsils  Introduction  The tonsils are masses of lymphoid tissue and form an important part of o...

E.N.T (1) By Dr. Mahmoud A. Helal Lecturer of General Surgery Badr University General Surgery Department  Tonsils  Introduction  The tonsils are masses of lymphoid tissue and form an important part of our immune system located at the gateway of the respiratory and digestive tracts.  They act as the first line of defense against ingested or inhaled pathogens.  Four types of tonsils are arranged into a ring around the pharynx ( oropharynx and nasopharynx), known as Waldeyer’s ring of lymphoid tissue.  Microscopically, the tonsil is a mass of lymphoid follicles supported on a connective tissue framework. In addition, the center of each of these nodules is densely packed with lymphocytes, and is referred to as the germinal center. 2  Tonsils  Types of tonsils: 1. Palatine tonsils: These are located between the palatoglossal arch anteriorly and the palatopharyngeal arch posteriorly. 2. Lingual tonsils: These are small round elevations that sit on the most posterior part of the tongue base. They are considered a collection of lymphoid tissue which varies greatly in size and shape. 3. Tubal tonsils: These tonsils are located just posterior to the opening of the Eustachian tube in the nasopharynx. 4. Pharyngeal tonsils/adenoids: These are the most superior tonsils that lie in the superior part of the nasopharynx. It is attached to the periosteum of the sphenoid bone by connective tissue. 3 Tonsils 4 Tonsils 5 Tonsils 6  Tonsillitis  Definition: Tonsillitis is inflammation of the tonsils, two oval-shaped pads of tissue at the back of the throat — one tonsil on each.  causes: › Tonsillitis is most often caused by common viruses, but bacterial infections also can be the cause. › The most common bacterium causing tonsillitis is Streptococcus pyogenes (group A streptococcus), the bacterium that causes strep throat. › Other strains of strep and other bacteria also may cause tonsillitis.  Why do tonsils get infected?  The tonsils are the immune system's first line of defense against bacteria and viruses that enter your mouth. This function may make the tonsils particularly vulnerable to infection and inflammation. However, the tonsil's immune system function declines after puberty — a factor that may account for the rare cases of tonsillitis in adults. 7  Tonsillitis  Clinical picture: I. symptoms:  Tonsillitis most commonly affects children between preschool ages and the midteenage (5-15) years. Common signs and symptoms of tonsillitis include:  Red, swollen tonsils  White or yellow coating or patches on the tonsils  Sore throat  Difficult or painful swallowing  Fever  Enlarged, tender glands (lymph nodes) in the neck  A scratchy, muffled or throaty voice  Bad breath  Stomachache  Headache 8  Tonsillitis II. In young children who are unable to describe how they feel, signs of tonsillitis may include:  Drooling due to difficult or painful swallowing  Refusal to eat  Complications: III. Inflammation or swelling of the tonsils from frequent or ongoing (chronic) tonsillitis can cause complications such as: 1. Disrupted breathing during sleep (obstructive sleep apnea) 2. Infection that spreads deep into surrounding tissue (tonsillar cellulitis) 3. Infection that results in a collection of pus behind a tonsil (peritonsillar abscess) 9  Tonsillitis II. If tonsillitis caused by group A streptococcus or another strain of streptococcal bacteria isn't treated or if antibiotic treatment is incomplete, your child has an increased risk of rare disorders such as: 1. Rheumatic fever, a serious inflammatory condition that can affect the heart, joints, nervous system and skin 2. Complications of scarlet fever, a streptococcal infection characterized by a prominent rash 3. Inflammation of the kidney (post streptococcal glomerulonephritis). 4. Post streptococcal reactive arthritis, a condition that causes inflammation of the joints. 10 Tonsillitis 11  Tonsillitis  Diagnosis: 1. Physical examination of the child (throat, ear, nose) which is possible site of infection and examination of cervical LN. 2. Throat swab. 3. CBC.  Prevention: 1. The germs that cause viral and bacterial tonsillitis are contagious. Therefore, the best prevention is to practice good hygiene. Teach your child to:  Wash his or her hands thoroughly and frequently, especially after using the toilet and before eating  Avoid sharing food, drinking glasses, water bottles. 2. To help your child prevent the spread of a bacterial or viral infection to others:  Keep your child at home when he or she is ill  Ask your doctor when it's all right for your child to return to school  Teach your child to cough or sneeze into a tissue or, when necessary, into his or her elbow  Teach your child to wash his or her hands after sneezing or coughing 12  Tonsillitis  Treatment: I. At home care:  Whether tonsillitis is caused by a viral or bacterial infection, at-home care strategies can make your child more comfortable and promote better recovery.  If a virus is the expected cause of tonsillitis, these strategies are the only treatment. Your doctor won't prescribe antibiotics. Your child will likely be better within seven to 10 days.  At-home care strategies to use during the recovery time include the following: 1. Encourage your child to get plenty of sleep. 2. Provide adequate fluids to keep his or her throat moist and prevent dehydration. 3. Prepare a saltwater gargle: help soothe a sore throat. 4. Avoid throat irritants as smoking. 5. Offer lozenges. Children older than age 4 can suck on lozenges to relieve a sore throat. 6. Treat pain and fever as Ibuprofen. 13  Tonsillitis  Treatment: II. Antibiotics:  If tonsillitis is caused by a bacterial infection, your doctor will prescribe a course of antibiotics. Penicillin taken by mouth for 10 days is the most common antibiotic treatment prescribed for tonsillitis caused by group A streptococcus. If your child is allergic to penicillin, your doctor will prescribe an alternative antibiotic.  Your child must take the full course of antibiotics as prescribed even if the symptoms go away completely. Failure to take all of the medication as directed may result in the infection worsening or spreading to other parts of the body. Not completing the full course of antibiotics can, in particular, increase your child's risk of rheumatic fever and serious kidney inflammation. 14  Tonsillitis  Treatment: III. Surgery: (Tonsillectomy)  Indicated in the following conditions: 1. chronic tonsillitis or bacterial tonsillitis that doesn't respond to antibiotic treatment. 2. if tonsillitis results in difficult-to-manage complications, such as:  Obstructive sleep apnea.  Breathing difficulty.  Swallowing difficulty, especially meats and other chunky foods.  An abscess that doesn't improve with antibiotic treatment. 3. Frequently recurring tonsillitis which is defined as:  At least seven episodes in the preceding year.  At least five episodes a year in the past two years.  At least three episodes a year in the past three years. 15  Adenoid  Introduction  The adenoids are small masses of lymphatic tissue located in the upper airway, between the nose and the back of the throat. Along with the tonsils, the adenoids form part of the lymphatic system, which works to defend the body against microbes.  The anatomical position of the adenoids allows them to help fight infection by preventing germs from entering the body through the mouth or nose. 16  Adenoid hypertrophy  Definition: is the unusual growth (hypertrophy) of the adenoid (pharyngeal tonsil) causes: 1. Infections (viral and bacterial). 2. Allergies and irritants as acid reflux 3. increased exposure to pollution or smoking.  Clinical picture: I. Minor cases: Asymptomatic II. Symptomatic 1. Partial or complete nasal obstruction 2. Mouth breathing 3. It can also lead to the obstruction of sleep, resulting in restlessness, increased snoring, and, in some cases, sleep apnea. 17  Adenoid hypertrophy 4. Nasal obstruction may also cause a blockage of the Eustachian tubes, which connects the middle ear to the nasopharynx (upper throat and the back of the nasal cavity). A blockage of the Eustachian tubes can often result in ear infections, such as otitis media (infection of the middle ear). 5. Persistence of symptoms can ultimately lead to adenoid faces. It is characterized by a long, lean face with an open mouth. With adenoid facies, individuals typically present with increased mouth breathing, an arched palate, underdeveloped upper jaw bones (i.e. hypoplastic maxilla), a short upper lip, elevated nostrils, and dental crowding of the front teeth. It most commonly occurs in children and often presents with chronic nasal obstruction. 18 Adenoid facies 19  Adenoid hypertrophy  Diagnosis: 1. Physical examination of the child (throat, ear, nose) which is possible site of infection and examination of cervical LN. 2. Nasopharyngoscopy. 3. X ray and CT.  Treatment: I. Treatment of the cause: 1. Bacterial infections will usually be treated with a specific antibiotic course depending on the causative agent. 2. viral infections do not respond to antibiotics and will usually resolve themselves within 5 to 7 days. 3. Allergic reactions can be treated with intranasal corticosteroids, oral steroids, or oral antihistamines. 20  Adenoid hypertrophy II. Surgery: (Adenoidectomy)  usually performed between 1 and 7 years of age  Indicated in the following conditions: 1. severe or persistent enlargement. 2. Prescience of complications:  persistent otitis media or a buildup of fluid in the middle ear (i.e. middle ear effusion). 21 Adenoid hypertrophy 22 Thank you