Common tumors of ear nose and throat (ENT)

Common tumors of ear nose and throat (ENT)

COMMON TUMOURS OF THE NOSE

Malignant tumours of the ear  are commonest in the outer ear where both basal cell carcinoma & squamous carcinoma are found. The small lesion is treated with radiation therapy but the larger one will need surgical excision.

ADENOIDS/ADENITIS

It is the enlargement (inflammation) of nose pharyngeal tonsils. Adenoids (pharyngeal tonsils) consist of lymphatic tissue near the center of the posterior wall of the nasopharynx.

  • Its common in children below 7yrs & usually follows acute tonsillitis.
  • Group A beta-streptococcus is the most common organism associated with tonsillitis and adenoiditis.
Clinical Features
  • There is always enlargement, inflammation or both.
  • Obstruction of the nose leading to mouth breathing, difficulty in eating due to pain, snoring, jaw deformities etc.
  • Obstruction of the Eustachian tube leads to hearing loss
  • Glue ear due to accumulation of fluid in the ear
  • Discharging cough, recurrent cough.
  • Apnea in severe hypertrophy
Investigations
  • Diagnosis is usually based on history, however -Xray of the neck soft tissue, lateral view shows narrowing.
Management
  1. Mild( if symptoms are not marked), Give conservative treatment with chlorphenamine 1-2mg O.d depending on age for 7 days
  2. Topical nasal steroids if available e.g. betamethasone.
  3. Antibiotic e.g Ampicillin500mg-1g 6hly to treat any underlying infection
  4. Analgesic like PCT 500mgs-1g t.d.s for pain or tramadol 75mg in severe pain
  5. Emphasize mouth care
  6. If the patient, doesn’t improve with persistent signs and symptoms, refer to ENT Surgeon for surgery(Adenoidectomy from 1yr)    N.B They normally shrink as the child grows. Find detailed management by clicking here
Complications
  • Otitis media     
  •  Recurrent infections   
  • Quinsy
  • Mastoiditis due to infection

Nasal Polyps

These are new growth of the nose.    OR   These are painless benign growth on the lining of the nose or sinuses. It occurs as a result of prolonged oedema in the nostrils & they may be unilateral or bilateral.

-Its associated with allergic rhinitis in upper part of the nose & tend to re-occur if the underlying infection is not been cured.

CAUSES

-Chronic inflammation due to infection, allergies, drug sensitivity or immune disorders, recurrent nasal sinus infections

Clinical Features
  • There may be nasal discharge which may be yellowish, mucoid or pus
  • Long standing bilateral nasal obstruction which becomes complete from time to time.
  • There may be signs and symptoms of allergy like Nasal congestion, runny nose/stuffy nose, sneezing, loss of taste or smell.
  • Grey freshly masses from nasal cavities which look like skinned grapes
  • Investigations
  • Nasal examination by inspection.
  • X-ray
Management
  • Small polyps resolve spontaneously
  • Treat the cause
  • Antrum washout may be done OR antrostomy
  • Instill 2 drops of betamethasone 50mgs into each nostril b.d for 4 weeks where pt is in the flat position for 3 minutes after instillation of the medication.
  • If the patient does not recover consider surgery i.e. ‘’ polypectomy’’.It can be done under local anaesthesia or general anaesthesia.
  • Under local anesthesia; Spray lignocaine 2% into pts’ nose & adrenaline 1:100,000 and wait for 5 minutes.

     –   With good light open his nostrils with nasal speculum.

    – Pass a polypectomy snare, maneuver top to catch a polyp, remove it’s base. Repeat the process until you have removed as many polyp as you can, If the patient bleeds excessively at the end of the operation, pack his nose as for epistaxis.

Complications
  • Re-occurrence of the polyp
  • Hypertrophy
  • Malignancy
  • infections

TUMOURS OF THE THROAT

  • Fibroma: A begnin tumour that are composed of fibrous or connective tissues.
  • Chondylomal chondroma– Begnin cartilaginous tumour which is capsulated with lobular grown pattern.
  • Squamous cell cancernoma, also called squamous cell cancer. It is a cancer caused by uncontrolled growth of abnormal squamous cells.
Benign tumours of the throat

Common tumors of the larynx include; laryngeal papillomata which are small viral warts that grow in the larynx. They produce hoarseness, stridor & respiratory obstruction & are removed by suction diathermy, cryosurgery. Tracheostomy is done if symptoms are severe, but the papillomata eventually disappear when immunity is gained by the host

Malignant tumours of the throat

A patient suffering from a laryngeal tumour presents with hoarseness . In early stages, the patient is treated with radiotherapy with the preservation of the voice & good prognosis. They need proper/special psychologically care both to the patient & family members pre-operatively because the patient losses his organ of speech. Do pre-operative care like any other patient before taking patient to theatre

Post operative care of the laryngectomy

 He can no longer ask for attention and initially requires the constant presence of a nurse.

  • Many patients are not accustomed to writing and they become intensely anxious, frustrated and depressed
  • Communication is through writing or use of gestures/signs.
  • The pt is provided with a pen /pencil & a pad/papers & a bell for easy communication.

    Feeding at first is by NG Tube as the pharynx defect is healing. The patient is feed mainly on liquidized diet. observe the patients’ weight & maintain Fluid Balance Chart. Observe for vitals and complications.

Tumours of the pharynx
  • These tumours present with dysphagia or with with a gland in the neck.
  • Radiotherapy is often the first treatment of choice but many end up in need of surgery.
  • Pharyngeal tumours often involve the adjacent larynx & so an adequate includes the larynx &pharynx.
  • Post operative mgt is the same like for laryngectomy although problems are worse because of breathing  difficulties.
  • Reassure the patient/relatives because they are deeply depressed.
OTHER TYPES OF TUMOURS OF EAR NOSE AND THROAT:
  • Ear, include keloid, cystic swelling, ear polyp and carcinoma
  • Tumours of the nose include, hemangioma, angiofibroma, tumour of the nasal cavity, inverted papilloma (non-cancerous tumour that form in the posterior aspect of the nasal cavity, and they can be transformed into an aggressive form of cancer called squamous cell carcinoma.
  • Osteoma: A benign slow growing occurring in frontal and ethmoid sinuses.
  • Adenocarcinoma: A malignant tumour formed from glandular structures in epithelial tissue.

ADENOID HYPERTROPHY

Adenoid hypertrophy is an obstructive condition due to enlarged adenoids. This can occur with or without an acute or chronic infection of the adenoids. This condition is more common in children than in adults; Most commonly, enlarged adenoids occur in children under the age of five. After this point, the adenoids usually begin to shrink in size and are less significant in immune response

adenoid hypertrophy

The adenoids are small masses of lymphatic tissue located in the upper airway, between the nose and the back of the throat. Along with the tonsils, the adenoids form part of the lymphatic system, which works to defend the body against microbes, absorb nutrients, maintain proper fluid levels, and eliminate certain waste products. The anatomical position of the adenoids allows them to help fight infection by preventing germs from entering the body through the mouth or nose.

Causes of adenoid hypertrophy
  • The main infectious causes of adenoid hypertrophy occur from viral infections, such as the Epstein–Barr virus, or bacterial infections, such group A Streptococcus.
  • Chronic adenoid inflammation may result from recurring acute infections or persistent infection.
  • Allergies and irritants can also cause adenoid hypertrophy. When allergens or irritants come in contact with the adenoid tissue, the adenoids have a similar inflammatory response through which they can become enlarged.
  • Stomach acid caused by gastroesophageal reflux (also known as acid reflux), can irritate adenoid tissue, triggering inflammation and the enlargement of the adenoids.
  • Many aerobic bacterial species have been implicated in contributing to infectious adenoid hypertrophy including alpha-, beta-, and gamma-hemolytic Streptococcus species, Hemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, Neisseria gonorrhoeae, Corynebacterium diphtheriae, Chlamydophila pneumoniae, and Mycoplasma pneumoniae
Classification of adenoid hypertrophy

Adenoid hypertrophy can be classified according to its anatomical relationship with adjacent structures such as vomer, soft palate and torus tubaris

  1.   Grade 1,  none of the above-cited structures contact with the adenoid tissue
  2. Grade 2,    the adenoid tissue contacts with the torus tubaris
  3.  Grade 3,   the adenoid tissue contacts with torus tubaris and vomer
  4.  Grade 4,   the adenoid tissue contacts with torus tubaris, vomer and soft palate in resting position

Adenoid hypertrophy can be classified according to its size in relation to surrounding tissues

  1.  Grade 1, adenoid occupying less than 25% of the choanal area
  2.  Grade 2, adenoid occupying 25-50% of the choanal area
  3.  Grade 3, adenoid occupying 50-75% of the choanal area
  4.  Grade 4, adenoid occupying 75-100% of the choanal area
Classification by size
Clinical Features of Adenoid Hypertrophy
  • Difficulty breathing through the nose.
  • Bad breath and dry lips from breathing through the mouth.
  • Sounding as if the nose is pinched or stuffed.
  • Frequent sinus symptoms.
  • Snoring.
  • Restless sleep or disruptive sleep apnea.
  • Bad breath
Diagnosis of Adenoid hypertrophy
  • Lateral neck x-ray 
  • Palpation, and nasal endoscopy.
  • The standard diagnostic criteria can only be indicative, and the diagnosis is made via transnasal endoscopy confirmed by an otolaryngologist.

Management 

If your child has minimal symptoms, no treatment is typically needed. 

 Nasal spray to help reduce swelling and potentially an antibiotic if the infection is bacterial.

Another treatment for more severe cases is an adenoidectomy

 

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7 thoughts on “Common tumors of ear nose and throat (ENT)”

      1. 1. Acoustic Neuroma (Vestibular Schwannoma):
        – Definition: A benign tumor that arises from the Schwann cells of the vestibular nerve, which connects the inner ear to the brain.
        – Real-Life Example: Imagine a small benign growth pressing on a telephone line, disrupting the transmission of signals.
        – Management: Treatment options include observation, surgical removal, or radiation therapy, depending on the tumor’s size, symptoms, and patient’s preference.

        2. Glomus Tumor:
        – Definition: A benign tumor that originates from the glomus bodies, which are responsible for regulating blood flow in the ear.
        – Real-Life Example: Think of a small cluster of blood vessels growing within a pipe, potentially affecting the flow of water.
        – Management: Surgical excision is the primary treatment, although embolization (blocking blood supply) or radiation therapy may be considered in certain cases.

        3. Squamous Cell Carcinoma:
        – Definition: A malignant tumor that arises from the skin cells lining the ear canal.
        – Real-Life Example: Similar to skin cancer that can develop from excessive sun exposure on the face or body.
        – Management: Treatment typically involves surgical removal of the tumor, followed by possible radiation therapy or chemotherapy, depending on the extent of the disease.

        4. Basal Cell Carcinoma:
        – Definition: A common type of skin cancer that can occur in the ear, originating from the basal cells of the epidermis.
        – Real-Life Example: Like skin cancer that can develop from prolonged exposure to harmful ultraviolet (UV) rays.
        – Management: Surgical excision is the primary treatment, and in some cases, radiation therapy or topical chemotherapy creams may be used.

        5. Cholesteatoma:
        – Definition: An abnormal collection of skin cells that accumulate in the middle ear, often due to chronic ear infections or eustachian tube dysfunction.
        – Real-Life Example: Imagine a pocket forming within a pipe due to debris accumulation, potentially causing blockage or damage.
        – Management: Surgical removal of the cholesteatoma is necessary to prevent complications, followed by appropriate ear care and treatment of underlying causes.

        6. Paraganglioma:
        – Definition: A rare tumor that originates from the paraganglia, specialized cells involved in regulating blood pressure and blood flow.
        – Real-Life Example: Similar to a growth affecting the nerves responsible for controlling blood pressure in specific areas of the body.
        – Management: Treatment options include surgical removal, radiation therapy, or embolization, depending on the tumor’s location, size, and symptoms.

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