Answer:

Singer’s nodes is a condition that usually affects professional voice users and screaming children’. Following either excessive or inappropriate use of the voice, the patient complains of hoarseness of voice and inability to reach high notes without extra effort. On indirect laryngoscopy white, symmetrical, sessile nodules are seen at the junction of the anterior third and posterior two thirds of the vocal cords. The nodules are less than 2 mm in size. Pathologically there is benign localised keratosis.
Treatments include;

• voice rest
• elimination of focal sepsis in the URT
• microlaryngoscopic excision if the problem persists despite voice rest
• speech therapy

Answer:

In children up to 60% of persistent parotid enlargement is caused by

• haemangioma,
• lymphangioma, and
• neurofibroma, where as these tumours are causes of parotid swelling in the adults.

Other causes of parotid enlargement in children are

• chronic sialdenitis,
• leukaemias, and
• lymphomas.

Answer: 

This an association of
a) oropharyngeal ulceration (aphthous type)
b) genital ulceration and
c) iritis.
In this idiopathic condition multisystem involvements is now recognised. Encephalitis and blindness are rare complications.
Steroids, azathioprine and cyclophosphamide may be used in the severe case.

Answer: 

This tumour has the synonyms of papillary cystadenoma lymphomatosum
and Warthin’s tumour. It accounts for 20% of the benign tumours of the parotid gland. It is a disease of the elderly and affects approximately 7 men to 1 woman.
Lymphoid element is prominent on histological examination and the tumour is believed to arise from a residue of salivary duct epithelium within an intraparotid lymph node.
As a rule, there is never malignant degeneration. Clinically, they may appear suddenly and fluctuate in size. These soft and cystic tumours are bilateral in 10% of cases.
Occasionally they are discovered as incidental findings during an operation on the neck. Treatment is usually with superficial parotidectomy to obtain a histopathological diagnosis. Fine needle aspiration biopsy may alter this treatment policy.

Answer:

1. Malignancy eg. Carcinoma of bronchus, oesophagus, thyroid and metastatic carcinoma of the nasopharynx
2. Surgical trauma eg surgery to thyroid, oesophagus and great vessels
3. Idiopathic
4. Inflammatory eg. Apical or mediastinal scarring due to Tuberculosis
5. Non-surgical trauma eg. Sharp and blunt injuries to the neck.
6. Miscellaneous eg. Connective disorders (rheumatoid arthritis), syphilis, thrombosis of subclavian vein
7. Stretching of the nerve eg. By an aortic aneurysm, non-malignant thyroid or parathyroid disease , an enlarged heart or lymph nodes.
8. Neurological

• Peripheral Neuritis eg. Diabetes, alcoholism, lead poisoning, viral.
• central and general neurological disorders eg. Cerebrovascular accident, syringomyelia, multiple sclerosis.

Answer: 

This is a cyst which develops in the line of a persistent thyroglossal duct which runs from the foramen caecum through or in front of the hyoid bone to the thyroid gland.
The thyroglossal cyst, the commonest cause of a midline cyst , usually presents in childhood.
No age group, however, is exempt. In the majority there is a painless midline mobile cyst which moves upwards on swallowing or protrusion of the tongue. Occasionally the cyst may be situated just lateral to the midline (usually left) and atypical presentation includes infection and fistulisation.
Treatment involves excision of the cyst plus the duct including the body of the hyoid bone.

Answer:

In glandular fever there may be a very prominent tonsillar enlargement such that the tonsils may even meet in the midline.
These tonsils are hard and this contribute to the symptoms of dysphagia and oral respiratory difficulty.
The managements includes:

• confirm the diagnosis
• admission to hospital if any complications develop
• most patients will breathe comfortably through the nose. Those patients with nasal obstruction may be helped with vasoconstrictor nasal drops or by insertion of nasopharyngeal airway
• steroids to reduce the tonsillar swelling
• The role of antibiotics is controversial. In the presence of a superadded infection they may be of use. Ampicillin should be avoided
• general support such as adequate hydration and oxygen if appropriate
• rarely a tracheostomy may be required.

Answer:

This is an air or fluid containing prolongation of the laryngeal saccule from the ventricle. It is believed that the saccule becomes encysted secondary to ostial obstruction. Should the cyst discharge then fluid is replaced by air in the sac. It is commoner in elderly men.
Most are unilateral and there is an association of increased incidence of laryngocoele with laryngeal carcinoma.
Laryngocoeles can be

1. External- herniating around or through the thyrohyoid membrane and presenting as a neck swelling which expands on coughing and empties on pressure
2. Internal- confined within the laryngeal framework
3. Combined external and internal.

A muffled and hoarse voice is usually present. Radiographic examination during the valsalva manoeuvre may demonstrate an air containing lesion.
Treatment of the internal type involves marsupialising the lesion endoscopically, where as the external approach and excision is required for the external type.

Answer:

Management may include:

1. Reassurance – Up to 20% of parotidectomy patients may complain of this
   symptom. The majority improve within 6 months
2. Topical therapy – The drying agents that are available in antiperspirants may be used to good effect, such as zinc oxide
3.  Anticholinergics – such as atropine or hyoscine have been used but the side
   effects are often worse than the condition and the results are poor
4. Surgical – The objective is to interrupt the parasympathetic fibres.
   i) re-evaluate the skin flap over the parotid
   ii) section of the auriculo-temporal nerve
   iii) perform a tympanic neurectomy and chorda tympanectomy
   iv) perform a middle cranial fossa geniculate ganglion and lesser petrosal nerve
   section. Of these the tympanic neurecttomy is at present the favoured method. The results, however, are not as good as might be expected.