Problems in otolaryngology Inflammatory swellings Viral and bacterial infection are frequent causes of swellings in the neck. Enlargement of the cervical lymph nodes is most likely but a dormant branchial cyst may suddenly enlarge. An understanding of the distribution of the superficial and deep cervical lymph nodes will help to arrive at a diagnosis (Figure 16.4). Viral and bacterial infections that may cause cervical gland swellings are: Infective mononucleosis. Tonsillitis especially due to haemolytic strepococci. Dental infections. Para-pharyngeal infammatory process. Tuberculosis. Sarcoidosis. Parotid nodes Figure 16.4 The main groups of lymph nodes of the neck Neoplasm Neoplasms that present as a swelling in the neck may be either 106
Swellings of the neck benign or malignant. Benign neoplasm arising in the neck as swellings are: Haemangioma, Lymphangioma, Fibroma, Lipoma, Neurofibroma. In the adult the same group of benign tumour are present but in addition there are chemodectomas, as the carotid body tumour. The carotid body tumour presents a a non-tender mass at the bifurcation of the carotid artery increasing in size slowly. The characteristic feature of the lump is it can move in the horizontal plane, i.e. laterally but not in the vertical plane. The patient presents with cranial nerve lesions or dysphagia. Malignant neoplasms in children are the lymphomas, sarcomas, and leukaemias. Carcinoma are of the thyroid gland, salivary gland and metastases from a primary growth in the head and neck, commonly the nasopharynx. In the adult a swelling in the neck causes concern as it may be a metastasis. Hence the evaluation of a swelling in the neck in an adult must include a thorough clinical examination and investigation to exclude possible primary sites in lung, stomach, larynx, or mouth-pharynx. What to do If the history and clinical findings and investigations warrant treatment with antibiotics then immediate treatment should be commenced. If the practitioner has any doubts then the patient should be referred to the otolaryngologist or surgeon. An inflammatory or infective swelling resolves with treatment and hence there should be no delay in referring to the specialist if the swelling does not subside. 107
Index abscesses, parapharyngeal 103 achalasia of cardia 95-6 adenitis, cervical 74, 99 adenoidectomy indications 97-8, 100 operative age 97 postoperative complications 100--1 rationale 99 results 100 adenoids, age size changes 74-5 adolescents, sore throats 71, 72, 100 adults cervical malignancies 107 hoarseness 80--4 persistent nasal obstruction 56 assessment 57 see also ageing age, lymph node size and disease 104 ageing, hearing loss 28 see also adults aminoglycoside antibiotics, childhood deafness 27 anosmia 51-4 causative disorders 51-2 clinical assessment 52-3 examinations 53 GP care 53 history 52-3 nasal obstruction 51, 57 specialist referral 53 symptoms and outcome 54 antibiotics, childhood deafness induction 27 antrochoanal polyps, carcinoma 58-9 aphasia 84-5 aphonia 84 attico-antral disease 25, 35-6 audiograms conductive deafness 21-2 mixed type deafness 22 sensorineural deafness 24 auditory aphasia 84 Bell's palsy 49 blepharitis 66 brain scan, vertigo 39 cacosmia 51 cardia, achalasia 95-6 cardiorespiratory arrest, airway obstruction 80 carotid body tumours 103, 107 catarrhal child syndrome 98 clinical disorder induction 99 immunological aspects 98 cauterization, nose bleeds 63 cellulitis, peritonsillar 73 cervical adenitis 74, 99 cervical lymph nodes age and size 74-5 108
Problems in otolaryngology disease aspects 104 bacterial and viral infections 103 groups 106 chemodectomas, cervical 107 children catarrhal syndrome 98-9 cervical malignancies 107 congenital and traumatic palsy differences 49 deafness 26-7 early diagnosis 26 facial palsy 49 hoarseness 78-80 persistent nasal obstruction 56 assessment 57 sore throats 71 stridor 78-80 see also adolescents; newborn cholesteatoma deafness 36 middle ear 35-6 conductive deafness 15, 16-24 audiograms 21-2 surgery 24 3rd cranial nerve lesions, diplopia 89 8th cranial nerve section in tinnitus 41 tumours, sensorineural deafness 28-9 crico-arytenoid arthritis 84 croup 78-9, 80, 81-2 cystic hygroma 103, 105 cysts, thyroglossal 103, 105 dacryocystitis 67, 68 deafness 15-29 mixed type 15 tinnitus 42 types 15 see also conductive; sensorineural dermatitis, external ear 32, 33-4 diphtheria, laryngeal 80 diplopia 87-9 causes 87-8 history and assessment 88-9 discharges see postnasal discharges; and various organs dysarthria 85 dysphagia 91-6 causes 92-6 non-organic 92 organic 93-6 109 eczema, external ear 32, 33--4 epiglottitis 74 acute 79,80, 81-2 epiphora 65-9 causes 66-7 clinical assessment 67 practical management aspects 68-9 treatment 67-8 eustachian salpingitis see otitis media, serous external ear, pain 11-12 see also otitis externa external meatus conductive deafness causes 16 growths 16 stenosis 16 eyes care, facial palsy 49 excessive watering 65-9 facial nerve decompression 50 lesion site paralysis degree 46 tests 46 pathway 47 facial palsy congenital 49 management 49-50 facial paralysis 45-50 associated limb paralysis 46 epiphora 67 site and cause relations 46 foreign bodies external ear 12 external meatus 16 laryngeal 80, 82 furuncle cellulitis 31-3 furunculosis differences from acute mastoiditis 23-4 external ear 12, 16 glandular fever 72, 100 globus hystericus 92 glue hear 13, 18, 19, 99, 100 Haemophilus influenzae 72 sore throat 72 hearing aids conductive deafness 24 presbycusis 28
Index herpes oticus 32, 33-4 hoarseness 77-84 associated disorders 77 Hodgkin's disease 104 hygroma, cystic 103, 105 hyposmia 51 hypothyroidism, laryngeal effects 84 immunological reactions, catarrhal child 98 incus, fracture/dislocation 20 infections, childhood deafness 27, 100 infectious mononucleosis 72, 100 labyrinthitis 28 lacrimal ducts congenital obstruction 66 'delayed development' 66 obstruction 65-9 lacrimal sac, anatomical relations 65 laryngeal nerves, lesions 83 laryngitis 74 acute, adult 81,83 acute (croup) 78-9, 80, 81-2 chronic, adult 82-3 laryngotracheobronchitis 80, 81-2 larynx diphtheria 80 disorders causes 77 life-threatening 78 irritants 82-3 neoplasms 83-4 loudness recruitment, sensorineural deafness 29 lower motor neuron paralysis 46-7 lymph nodes, cervical, disorders 103-7 lymphadenopathy, cervical 103 lymphomas, cervical 103 mastoiditis, acute 13 differences from furunculosis 23-4 maxillary antrum, carcinoma nasolacrimal duct obstruction 66 Meniere's disease 27-8 middle ear conductive deafness causes 18-24, 25, 26 pain 12-13 see also otitis media mononucleosis, infectious 72, 100 motor neuron paralysis 45-7 mouth care, facial palsy 49 mucocoele, frontal, diplopia induction 88 nasal discharge 58-60 causes 60 excess., effects 58 postnasal 58-60 nasal obstruction 55-8 clinical assessment 56-7 effects 56 management 58 persistent, causes 56 nasopharynx, carcinoma, postnasal discharge 58-9 neck congenital swellings 103, 105 swellings 103-7 triangles 103, 104 see also under cervical neoplasms, cervical 104, 106-7 nerve deafness 23 neuromuscular disorders, diplopia 89 newborn deafness 25 stridor 78 nose bleeds 61-3 age-sex distribution 61 anterior 61 associated symptoms 62-3 causes 62 conservative management 63 management 63 posterior 61-2 sites 61-2 oesophagus benign strictures 95 carcinoma, dysphagia 94, 95 disorders, dysphagia 92 olfactory sensation innervation 52 loss 51-4 otitis externa 11-12, 16 discharging 31-4 otitis media 110