1. SORETHROAT, SWALLOWING & AIRWAY PROBLEMS

2. APHTHOUS ULCER Herpes Simplex

3. PREDISPOSING FACTORS FOR CHRONIC TONSILLITIS Sinusitis Oral sepsis Immunity (HIV) Mouth breathing Incorrect treatment of acute tonsillitis Remember!.........Tuberculosis, Syphilis and HIVin chronic tonsillitis

4. TONSILLECTOMY / ADENOIDECTOMY Indications Contra-indications (local & systemic) INFORMED CONSENT

5. INDICATIONS FOR TONSILLECTOMY  5 attacks / year  Severe attacks  Airway obstruction  Unilateral enlargement  Rheumatic fever / Glomerulonephritis  Quinsy  Halitosis

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

7. POST TONSILLECTOMY DIET: Spices Tomatoes Bananas Avoid Pineapples Avocado Pawpaw No Salicylates Maintain hydration “Jelly & ice cream”

8. Cartilage framework (trauma) Mucous membrane Vocal folds Muscles (spasm/paralysis) Nerve supply

9. HYPOTHYROIDISM DIABETES MEDICATION

10. SYMPTOMS & SIGNS OF AIRWAY OBSTRUCTION HOT PATATO VOICE SNORING HOARSENESS STRIDOR (3 types) ANY NOISY BREATHING = AIRWAY OBSTRUCTION RHINOLALIA CLAUSA RHINOLALIA OPERTA

11. STRIDOR Inspiratory Biphasic Expiratory

12. 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

13. Differential Diagnosis Inflammatory lesions –Thrush (Candida) –Tonsillitis (PTA vs. lingual tonsillitis) –Abscesses (retro-, para-) Systemic causes –Scleroderma –Plummer-Vinson syndrome Neuromuscular disorder –Esophageal spasm –Pseudobulbar palsy –CVA –Multiple Sclerosis –Myasthenia Gravis Dermatomyositis –Muscular Dystrophy Intrinsic lesions –Zenker’s diverticulum –Benign tumors (leiomyoma) –Carcinoma (SCCA, Adeno) –Strictures –Achalasia –Esophageal webs Extrinsic lesions –Thyroid mass –Dysphagia lusoria –Aortic aneurysm

14. Swallowing problems + OTAL = NB!!!

15. STRIDOR Inspiratory Biphasic Expiratory

16. ? New “disease” (1618 Fabricius) Awareness Diagnostic aids available ? Overdiagnosed Lifestyle changes

17. 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

18. PREDISPOSING FACTORS: Hiatus hernia Pregnancy Lifting heavy objects, constipation, prostatism Overweight Tight clothing Sleeping after meals Eat in front of TV Computer work No exercise DIET: “restaurant menu” Medication

19. LPR: Cricopharyngeal muscle Pepsin burns Seldom heartburn Symptoms: ENT related

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