Pharyngology-耳鼻咽喉科學課件

Pharyngology(EENTHospitalofFudanUniversity)AnatomyofpharynxNasopharynxOropharynxLaryngopharynxNasopharynxtopandposterior:adenoidlateral:EustachiantubeanteriorbottomOropharynxfauxtonsilTonsilLaryngopharynxvallecula

epiglotticapyriformsinuspostericoidspaceLaryngopharynxRetropharyngealandparapharyngealspaceWaldeyer’sringPharyngitisAcuteChronicAtrophicPathogenPathologySymptomsSignsDiagnosis&differentiateddiagnosisComplicationsTherapyPathogen(acutepharyngitis)Virus:Coxsackie…BacteriaA--hemolyticstreptococci…PhysicalandchemicalstimulationInflammation

CongestionSwellingFeverSorethroatDysfunctionTreatment:

AntibioticsPathogen(chrnoic

pharyngitis)Regionalrecurrentacutepharyngitischronicupperrespiratorytractinfectionphysical&chemicalstimulationoccupationalGeneral

chronicdiseases…Symptoms:SenseasifthereareforeignbodiesinthroatItchingthroatSenseofdrynessinthroatCoughChronicsimplepharyngitischronicmucosalcongestionChronichypertrophic

pharyngitischronicmucosalcongestion+hyperplasiaoflymphoidtissuesTreatment:RemoveofpathogenyChinesemedicinePathogen(atrophicpharyngitis)AtrophicrhinitisAdenotonsillardiseaseMajordivisionsare:Infection/inflammationObstructiveNeoplasmAcuteTonsilitisSymptoms:general+regionalSigns:Complications:peritonsillarabscess…

rheumatismTherapy:antibioticsAcute

TonsilitisPathogen:

--hemolyticstreptococci

anaerobe

mixedinfectionPathology:

catarrhal

purulent

(follicular+lacunar)AcuteTonsillitisSignsandsymptoms:FeverSorethroatTendercervicallymphadenopathyDysphagiaErythematoustonsilswithexudatesRecurrentAcuteTonsillitisSamesignsandsymptomsasacuteOccurringin4-7separateepisodesperyear5episodesperyearfor2years3episodesperyearfor3yearsChronictonsilitisPathogen:recurrentacutetonsilitisDiagnosis:casehistoryChronicTonsillitisChronicsorethroatMalodorousbreathPresenceoftonsillithsPeritonsillarerythemaPersistenttendercervicallymphadenopathyLastingatleast3monthsChronictonsilitisPathologicmechanismthattheinfectedtonsilbecomesafocusAllergyⅢChronictonsilitis

Howtoidentifywhetherornottheinfectedtonsilisafocus?casehistoryexaminationdiagnostictestblockingtestAcuteadenoiditisSymptomsinclude:PurulentrhinorrheaNasalobstructionFeverAssociatedOtitisMediaRecurrentAcuteAdenoiditis4ormoreepisodesofacuteadenoiditisina6monthperiodSimilarpresentationasrecurrentacuterhinosinusitisInolderchildrennasalendoscopycanhelpChronicadenoiditisSymptomsinclude:PersistentrhinorrheaPostnasaldripMalodorousbreathAssociatedotitismedia>3monthsThinkofrefluxAdenoidalhypertrophySymptoms:

ear(secretory

otitismedia)

nose(nasalobstruction,snoring)

lowerrespiratorytract

“adenoidalface”&chronictoxicExaminations:Xray/CTTherapy:adenoidectomyObstructiveAdenoidHyperplasiaSignsandSymptomsObligatemouthbreathingHyponasalvoiceSnoringandothersignsofsleepdisturbanceObstructiveTonsillarHyperplasiaSnoringandothersymptomsofsleepdisturbanceMuffledvoiceDysphagiaObstructiveSleepApneaAdenotonsillarhypertrophySleepdisturbanceRisingindicationforadenotonsillectomyPE:DarkcirclesundereyesBreathingwithmouthopenSmallamountofclearrhinorrheaTonsilsarealmosttouchinginthemidline

IndicationsofTonsillectomychronic/abscesshypertrophyfocuskeratosis/diphtheriatumorTonsillectomyCurrentclinicalindicatorsofAAO-HNS:3ormoreinfectionsperyeardespiteadequatemedicaltherapyHypertrophycausingdentalmalocclusionoradverselyaffectingorofacialgrowthdocumentedbyorthodontistHypertrophycausingupperairwayobstruction,severedysphagia,sleepdisorder,cardiopulmonarycomplicationsPeritonsillarabscessunresponsivetomedicalmanagementanddrainagedocumentedbysurgeon,unlesssurgeryperformedduringacutestagePersistentfoultasteorbreathduetochronictonsillitisnotresponsivetomedicaltherapyChronicorrecurrenttonsillitisassociatedwithstreptococcalcarrierstateandnotrespondingtobeta-lactamaseresistantantibioticsUnilateraltonsilhypertrophypresumedneoplastic

ContraindicationsofTonsillectomyacuteattackblooddisordergeneraldisorderinfectiousdiseasemenstruation/pregnancyimmunedeficiencyAdenoidectomyCurrentclinicalindicatorsfromAAO-HNS:4ormoreepisodesofrecurrentpurulentrhinorrheainprior12monthsinachild<12.Oneepisodedocumentedbyintranasalexaminationordiagnosticimaging.Persistingsymptomsofadenoiditisafter2coursesofantibiotictherapy.Onecourseofantibioticsshouldbewithabeta-lactamasestableantibioticforatleast2weeks.Sleepdisturbancewithnasalairwayobstructionpersistingforatleast3monthsHyponasalorhypernasalspeechOtitismediawitheffusion>3monthsorsecondsetoftubesDentalmalocclusionororofacialgrowthdisturbancedocumentedbyorthodontistCardiopulmonarycomplicationsincludingcorpulmonale,pulmonaryhypertension,rightventricularhypertrophyassociatedwithupperairwayobstructionOtitismediawitheffusionoverage4Peritonsillarabscessacutetonsillitisperitonsillar

cellulitisabscess--hemolyticstreptococci…types:anterior-superior

posterior-superiorPeritonsillarabscessAbscessformationoutsidetonsillarcapsuleSignsandsymptoms:Fever(>3-5d)SorethroatmuffledvoiceDysphagia/odynophagiaDroolingTrismusUnilateralswellingofsoftpalate/pharynxwithuvuladeviationThoughttobeextensionoftonsillitistoinvolvesurroundingtissuewithabscessformationRecentlydescribedtobeaninfectionofsmallsalivaryglandsinthesupratonsillarfossacalledWeber’sglandsWouldexplainsuperiorpoleinvolvementandtheusualabsenceoftonsillarerythema/exudatesTherapyforPeritonsillarabscesspunctureandincision(diagnosis&therapy)antibioticstonsillectomyRetropharyngealabscessacute

purulentlymphadenitis

trauma/foreignbody

secondarychronic

tuberculosiscoldabscess

Diagnosisofretropharyngealabscesscasehistorysymptomsandsignsxray/CTRetropharyngeal¶pharyngealspaceTherapyforretropharyngealabscessacute:antibiotic

incisionanddrainage(position)chronic:puncture

incision(path?)

anti-tuberculosisCongenitaltonsillarmassesTeratomaHemangiomaLymphangiomaCystichygromaMalignantNeoplasmsMostcommonislymphomaNon-Hodgkin’slymphomaRapidunilateraltonsillarenlargementassociatedwithcervicallymphadenopathyandsystemicsymptomsAngiofibromaofnasopharynxmalejuvenile(10~25)bleedingnasopharygealangiofibromaAngiofibromaofnasopharynxBle