SORETHROAT

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SORETHROAT, SWALLOWING AIRWAY PROBLEMS
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APHTHOUS ULCER
Herpes Simplex
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PREDISPOSING FACTORS FOR CHRONIC
TONSILLITIS Sinusitis Oral sepsis Immunity
(HIV) Mouth breathing Incorrect treatment of
acute tonsillitis Remember!.........Tuberculosis
, Syphilis and HIVin
chronic tonsillitis
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TONSILLECTOMY / ADENOIDECTOMY
Indications Contra-indications (local
systemic)
INFORMED CONSENT
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• INDICATIONS FOR TONSILLECTOMY
• 5 attacks / year
• Severe attacks
• Airway obstruction
• Unilateral enlargement
• Rheumatic fever / Glomerulonephritis
• Quinsy
• Halitosis

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CONTRA-INDICATIONS FOR TONSILLECTOMY Cleft
palate Bleeding disorder Skills of the surgeon
and anaesthetist and ability to management
the complications!
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POST TONSILLECTOMY DIET


Spices
Tomatoes
Bananas
Avoid Pineapples

Avocado
Pawpaw


No Salicylates
Maintain hydration
Jelly ice
cream
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Cartilage framework (trauma) Mucous
membrane Vocal folds Muscles (spasm/paralysis)
Nerve supply
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HYPOTHYROIDISM DIABETES MEDICATION
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SYMPTOMS SIGNS OFAIRWAY OBSTRUCTION
RHINOLALIA OPERTA
RHINOLALIA CLAUSA

• HOT PATATO VOICE
• SNORING
• HOARSENESS
• STRIDOR (3 types)

ANY NOISY BREATHING AIRWAY OBSTRUCTION
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STRIDOR Inspiratory Biphasic Expiratory
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Swallowing

• Mechanism is complex
• Involves the actions of 26 muscles and 5 cranial
  nerves
• CN V -- both sensory and motor fibers important
  in chewing
• CN VII -- both sensory and motor fibers
  important for sensation of oropharynx taste to
  anterior 2/3 of tongue
• CN IX -- both sensory and motor fibers important
  for taste to posterior tongue, sensory and motor
  functions of the pharynx
• CN X -- both sensory and motor fibers important
  for taste to oropharynx, and sensation and motor
  function to larynx and laryngopharynx important
  for airway protection
• CN XII -- motor fibers that primarily innervate
  the tongue
• A normal adult swallows unconsciously 600 times
  in a 24-hour period

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Differential Diagnosis

• Inflammatory lesions
• Thrush (Candida)
• Tonsillitis (PTA vs. lingual tonsillitis)
• Abscesses (retro-, para-)
• Systemic causes
• Scleroderma
• Plummer-Vinson syndrome

• Intrinsic lesions
• Zenkers diverticulum
• Benign tumors (leiomyoma)
• Carcinoma (SCCA, Adeno)
• Strictures
• Achalasia
• Esophageal webs

• Extrinsic lesions
• Thyroid mass
• Dysphagia lusoria
• Aortic aneurysm

• Neuromuscular disorder
• Esophageal spasm
• Pseudobulbar palsy
• CVA
• Multiple Sclerosis
• Myasthenia Gravis
• Dermatomyositis
• Muscular Dystrophy

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Swallowing
problems OTAL
NB!!!
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STRIDOR Inspiratory Biphasic Expiratory
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? New disease (1618 Fabricius) Awareness Diagn
ostic aids available ? Overdiagnosed Lifestyle
changes
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GERD Lower oesophageal sphyncter
Normal 50X per 24 hours
Pepsin does not burn oesophagus
Saliva dilute
acid Symptoms Heartburn esp. when lying
down Shoulder and chest
pain Referred otalgia
Reflex bradycardia
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PREDISPOSING FACTORS Hiatus hernia Pregnancy Lif
ting heavy objects, constipation,
prostatism Overweight Tight clothing Sleeping
after meals Eat in front of TV Computer work No
exercise DIET restaurant menu Medication
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LPR Cricopharyngeal muscle
Pepsin burns Seldom
heartburn Symptoms ENT related

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LPR SYMPTOMS Hoarseness Coughing Globus
sensation Throat clearing Dysphagia Asthma Ear,
sinusses, Laryngospasm Croup Larynx, subglottic
stenosis Hallitosis
PREDISPOSING FACTORS same as GERD