1、Pharyngology,(EENT Hospital of Fudan University),Anatomy of pharynx,Nasopharynx Oropharynx Laryngopharynx,Nasopharynx,top and posterior: adenoid lateral: Eustachian tube anterior bottom,Oropharynx,faux tonsil,Tonsil,Laryngopharynx,vallecula epiglottica pyriform sinus postericoid space,Laryngopharynx
2、,Retropharyngeal and parapharyngeal space,Waldeyers ring,Pharyngitis,Acute Chronic Atrophic,Pathogen Pathology Symptoms Signs Diagnosis & differentiated diagnosis Complications Therapy,Pathogen(acute pharyngitis),Virus: Coxsackie Bacteria A -hemolytic streptococci Physical and chemical stimulation,I
3、nflammation,CongestionSwellingFeverSore throatDysfunction,Treatment :Antibiotics,Pathogen(chrnoic pharyngitis),Regional recurrent acute pharyngitis chronic upper respiratory tract infection physical & chemical stimulation occupational General chronic diseases,Symptoms: Sense as if there are foreign
4、bodies in throatItching throat Sense of dryness in throat Cough,Chronic simple pharyngitischronic mucosal congestionChronic hypertrophic pharyngitischronic mucosal congestion + hyperplasia of lymphoid tissues,Treatment:Remove of pathogenyChinese medicine,Pathogen(atrophic pharyngitis),Atrophic rhini
5、tis,Adenotonsillar disease,Major divisions are: Infection/inflammation Obstructive Neoplasm,Acute Tonsilitis,Symptoms: general+regional Signs: Complications: peritonsillar abscess rheumatism Therapy: antibiotics,Acute Tonsilitis,Pathogen: -hemolytic streptococci anaerobe mixed infection Pathology: c
6、atarrhal purulent (follicular+lacunar),Acute Tonsillitis,Signs and symptoms: Fever Sore throat Tender cervical lymphadenopathy Dysphagia Erythematous tonsils with exudates,Recurrent Acute Tonsillitis,Same signs and symptoms as acute Occurring in 4-7 separate episodes per year 5 episodes per year for
7、 2 years 3 episodes per year for 3 years,Chronic tonsilitis,Pathogen: recurrent acute tonsilitis Diagnosis: case history,Chronic Tonsillitis,Chronic sore throat Malodorous breath Presence of tonsilliths Peritonsillar erythema Persistent tender cervical lymphadenopathy Lasting at least 3 months,Chron
8、ic tonsilitis,Pathologic mechanism that the infected tonsil becomes a focus,Allergy ,Chronic tonsilitis,How to identify whether or not the infected tonsil is a focus?,case history examination diagnostic test blocking test,Acute adenoiditis,Symptoms include: Purulent rhinorrhea Nasal obstruction Feve
9、r Associated Otitis Media,Recurrent Acute Adenoiditis,4 or more episodes of acute adenoiditis in a 6 month period Similar presentation as recurrent acute rhinosinusitis In older children nasal endoscopy can help,Chronic adenoiditis,Symptoms include: Persistent rhinorrhea Postnasal drip Malodorous br
10、eath Associated otitis media 3 months Think of reflux,Adenoidal hypertrophy,Symptoms: ear(secretory otitis media) nose(nasal obstruction, snoring) lower respiratory tract “adenoidal face” & chronic toxic Examinations: X ray / CT Therapy: adenoidectomy,Obstructive Adenoid Hyperplasia,Signs and Sympto
11、ms Obligate mouth breathing Hyponasal voice Snoring and other signs of sleep disturbance,Obstructive Tonsillar Hyperplasia,Snoring and other symptoms of sleep disturbance Muffled voice Dysphagia,Obstructive Sleep Apnea,Adenotonsillar hypertrophy Sleep disturbanceRising indication for adenotonsillect
12、omy,PE: Dark circles under eyes Breathing with mouth open Small amount of clear rhinorrhea Tonsils are almost touching in the midline,Indications of Tonsillectomy,chronic / abscess hypertrophy focus keratosis / diphtheria tumor,Tonsillectomy,Current clinical indicators of AAO-HNS: 3 or more infectio
13、ns per year despite adequate medical therapy Hypertrophy causing dental malocclusion or adversely affecting orofacial growth documented by orthodontist Hypertrophy causing upper airway obstruction, severe dysphagia, sleep disorder, cardiopulmonary complications,Peritonsillar abscess unresponsive to
14、medical management and drainage documented by surgeon, unless surgery performed during acute stage Persistent foul taste or breath due to chronic tonsillitis not responsive to medical therapy Chronic or recurrent tonsillitis associated with streptococcal carrier state and not responding to beta-lact
15、amase resistant antibiotics Unilateral tonsil hypertrophy presumed neoplastic,Contraindications of Tonsillectomy,acute attack blood disorder general disorder infectious disease menstruation/pregnancy immune deficiency,Adenoidectomy,Current clinical indicators from AAO-HNS: 4 or more episodes of recu
16、rrent purulent rhinorrhea in prior 12 months in a child 12. One episode documented by intranasal examination or diagnostic imaging. Persisting symptoms of adenoiditis after 2 courses of antibiotic therapy. One course of antibiotics should be with a beta-lactamase stable antibiotic for at least 2 wee
17、ks. Sleep disturbance with nasal airway obstruction persisting for at least 3 months,Hyponasal or hypernasal speech Otitis media with effusion 3 months or second set of tubes Dental malocclusion or orofacial growth disturbance documented by orthodontist Cardiopulmonary complications including cor pu
18、lmonale, pulmonary hypertension, right ventricular hypertrophy associated with upper airway obstruction Otitis media with effusion over age 4,Peritonsillar abscess,acute tonsillitis peritonsillar cellulitis abscess -hemolytic streptococci types: anterior-superior posterior-superior,Peritonsillar abs
19、cess,Abscess formation outside tonsillar capsule Signs and symptoms: Fever(3-5d) Sore throat muffled voice Dysphagia/odynophagia Drooling Trismus Unilateral swelling of soft palate/pharynx with uvula deviation,Thought to be extension of tonsillitis to involve surrounding tissue with abscess formatio
20、n Recently described to be an infection of small salivary glands in the supratonsillar fossa called Webers glands Would explain superior pole involvement and the usual absence of tonsillar erythema/exudates,Therapy for Peritonsillar abscess,puncture and incision (diagnosis & therapy) antibiotics ton
21、sillectomy,Retropharyngeal abscess,acute purulent lymphadenitis trauma / foreign body secondary chronic tuberculosiscold abscess,Diagnosis of retropharyngeal abscess,case history symptoms and signs x ray / CT,Retropharyngeal & parapharyngeal space,Therapy for retropharyngeal abscess,acute: antibioti
22、c incision and drainage (position) chronic: puncture incision (path ? ) anti-tuberculosis,Congenital tonsillar masses,Teratoma Hemangioma Lymphangioma Cystic hygroma,Malignant Neoplasms,Most common is lymphoma Non-Hodgkins lymphoma Rapid unilateral tonsillar enlargement associated with cervical lymp
23、hadenopathy and systemic symptoms,Angiofibroma of nasopharynx,male juvenile (1025) bleeding nasopharygeal angiofibroma,Angiofibroma of nasopharynx,Bleeding Obstruction / Compression posterior nares Eustachian tube orbit ala-palatine /inferior temporal fossa skull base & cranial nerve soft palate,Ang
24、iofibroma of nasopharynx,Surgery,Carcinoma of nasopharynx,incidence etiology heredity EB virus environment,Carcinoma of nasopharynx,bleeding /+nasal obstruction secretary otitis media metastatic neck lymph nodule,Carcinoma of nasopharynx,headache cranial never paralysis (, ) remote metastasis,Diagnosis of carcinoma of nasopharynx,Clinical symptom and sign Biopsy CT / MRIEB VCA-IgA, NA-IgA scanning & follow up,caution!,Therapy for carcinoma of nasopharynx,Radiotherapy is first of choice Surgery is saving and palliative treatment,Thank you !,
