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    Faculty of Medicine Medical Education-Damietta University: Level 1 Semester II

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    This document provides information about a lecture on diseases of the upper respiratory tract given by Dr. Hazem Abdullah at Damietta University. The lecture covers topics like nasal polyps, rhinoscleroma, diseases of the nasopharynx, tonsils, larynx, and tumors in the upper respiratory tract. It includes learning outcomes, a case study, histological images, and descriptions of various conditions discussed in the lecture. Contact information for Dr. Abdullah is also provided.

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    Faculty of Medicine Medical Education-Damietta University: Level 1 Semester II

    Uploaded by

    Sounds of Mind
    14 views34 pages
    This document provides information about a lecture on diseases of the upper respiratory tract given by Dr. Hazem Abdullah at Damietta University. The lecture covers topics like nasal polyps, rhinoscleroma, diseases of the nasopharynx, tonsils, larynx, and tumors in the upper respiratory tract. It includes learning outcomes, a case study, histological images, and descriptions of various conditions discussed in the lecture. Contact information for Dr. Abdullah is also provided.

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    This document provides information about a lecture on diseases of the upper respiratory tract given by Dr. Hazem Abdullah at Damietta University. The lecture covers topics like nasal polyps, rhinoscleroma, diseases of the nasopharynx, tonsils, larynx, and tumors in the upper respiratory tract. It includes learning outcomes, a case study, histological images, and descriptions of various conditions discussed in the lecture. Contact information for Dr. Abdullah is also provided.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    14 views34 pages

    Faculty of Medicine Medical Education-Damietta University: Level 1 Semester II

    Uploaded by

    Sounds of Mind
    This document provides information about a lecture on diseases of the upper respiratory tract given by Dr. Hazem Abdullah at Damietta University. The lecture covers topics like nasal polyps, rhinoscleroma, diseases of the nasopharynx, tonsils, larynx, and tumors in the upper respiratory tract. It includes learning outcomes, a case study, histological images, and descriptions of various conditions discussed in the lecture. Contact information for Dr. Abdullah is also provided.

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    Faculty of Medicine

    Medical Education-
    Damietta University

    Level 1
    Semester II
    Module 4 A
    Diseases of upper
    respiratory tract
    by:
    Dr Hazem Abdullah
    Instructor information
    • Contact: ……………..Department.

    • Official email: drhazem_abdullah@yahoo.com

    • Mobile (optional): 01146710982


    • Academic hours: any time
    ……………day: 00:00-00:00 AM
    …………...day: 00:00-00:00 AM
    Lecture Outline
    Nasal polyp.
    •Rhinoscleroma.
    • Diseases of nasopharynx.
    •Diseases of tonsils.
    •Diseases of larynx
    •Tumors of upper respiratory tract:
    *tumors of nose & paranasal sinuses.
    *tumors of nasopharynx.
    *tumors of tonsils.
    *tumors of larynx.
    Learning Outcomes
    • To identify the histological structure of Trachea.
    • Define & describe inflammatory nasal polyps and mention its
    complications.
    • Define, mention cause, describe & mention the complications of
    rhinoscleroma.
    • Recognize pathologic aspect of nasopharyngeal diseases
    (nasopharyngitis – adenoids).
    • Recognize pathologic aspect of tonsillar diseases (diphtheria, acute &
    chronic tonsillitis)
    • Recognize pathologic aspect of laryngitis.
    Case Scenario
    A young lady complains of nasal obstruction. ENT
    examination shows a polypoid lesion in the nasal
    cavity and paranasal sinuses. Biopsy examination
    shows edematous stroma with numerous
    eosinophils.
    A.What is the diagnosis?

    B.Is this lesion precancerous or not?

    C.What are the expected complications?


    Trachea

    • Epithelium: pseudo-stratified columnar ciliated with goblet cells.


    • A longitudinal elastic membrane in the deeper region of lamina
    propria.
    • Muco-serous tracheal glands in the submucosa.
    • C-shaped plate of hyaline cartilage.
    Inflammatory Nasal Polyps

    • Definition: finger like projections arising from the


    mucosa of the nose and paranasal sinuses due to
    inflammatory process.

    • Causes:
    1. Chronic hypertrophic rhinitis and sinusitis.
    2. Repeated attacks of allergic rhinitis and
    sinusitis.
    N/E:
    Site: On the middle turbinate bones &
    within the maxillary sinus.
    Size: Variable sizes.
    Shape: Pedunculated (may be
    sessile).
    Surface: Smooth and shiny surface
    (opaque with squamous
    metaplasia).

    Consistency: Soft in consistency


    (gelatinous).
    Color: Pink or gray (mucoid).
    Number: Multiple and bilateral.
    M/E:

    1- Covering epithelium:
    - Hypeplastic pseudostratified ciliated.

    - Squamous metaplasia is common.

    2- Core of connective tissue with:

    Edema.

    Hyperplastic mucous glands, some cystic.

    Mixed acute & chronic Inflammatory cells.

    If eosinophils predominate; the polyps are allergic.


    Complications:

    Nasal obstruction.

    Epistaxis.
    2) Chronic Specific inflammation (Granuloma)

    • Tuberculosis

    • leprosy

    • Syphilis

    • Rhinoscleroma may involve and destroy the


    nasal structures.
    Rhinoscleroma
    • A destructive infective granuloma of
    upper respiratory tract

    • primarily in the nose

    • caused by Klebsiella
    Rhinoscleromatis.

    • It is endemic in Egypt.
    • N/E:
    1) The primary site is the nose:
    - It is enlarged & hard.
    - Mucous membrane is thick, granular & a nodular
    stage or single large mass.

    2) Extend to upper lip, nasal sinuses, naso- or


    oropharynx, larynx and trachea with soft
    tissue destruction
    • M/E:

    - Surface epithelium: hyperplasia or squamous


    metaplasia.
    - Subepithelium:
    a- Mickulicz cells (hydropic degeneration of
    macrophages).
    b- Russel bodies (hyaline change of plasma
    cells).
    c- Lymphocytes and plasma cells.
    d- Granulation tissue ending in fibrosis.
    • Complications:
    - Nasal obstruction.
    - Nasal deformity
    - Epistaxis.
    - Spread of inflammation to upper lip, nasal
    sinuses, naso- or oro-pharynx
    (pharyngoscleroma), larynx (laryngoscleroma) &
    trachea.
    - Ulceration and 2ry bacterial infection.
    - Squamous cell carcinoma.
    Nasopharynx
    A- Inflammation (Nasopharyngitis)

    (1) Acute Nasopharyngitis:


    - It is the most common cause of sore throat
    - Causes: Viral or Bacterial.
    - Pathology: Acute catarrhal, mucopurulent, or
    purulent inflammation.

    (2) Chronic Nasopharyngitis:


    - It follows acute Nasopharyngitis.
    - Pathology: hypertrophic inflammation which passes to
    atrophic one (pharyngitis sicca).
    (3) Adenoids:

    Definition: Inflammatory hyperplasia

    of lymphoid tissue in the posterior


    wall of nasopharynx

    usually in children.

    Cause: it follows rhinitis,


    nasopharyngitis, tonsillitis.
    - Adenoid Facies:
    * Narrow nasal openings.
    * Open mouth.
    * Short upper lip.
    * Protruding central upper
    incisors.
    * Absent nasolabial fold.
    * Fibrosis and atrophy occurs
    after puberty
    N/E:
    Swelling in the nasopharynx
    which reachs maximum size
    at 3 years of age producing
    obstruction and mouth
    breathing.
    M/E:
    hyperplasia of the lymphoid tissue with
    chronic non-specific inflammation.

    Complications:
    - Nasal obstruction and mouth
    breathing.

    - 2ry infection with spread to middle


    ear (otitis media) or down the
    respiratory tract).
    Tonsils
    I- Inflammation

    A- Acute Inflammations:

    (1) Diphtheria:

    - Acute infectious fever caused by


    corynebacterium diphtheriae, in unimmunised
    children between 2-5y
    - Method of infection: droplet infection.

    - Pathology:
    via exotoxin:

    1- Locally: pseudomembranous inflammation.

    2- Reach distant organs via blood →→Acute toxemia

    3- The draining cervical L.Ns and spleen show

    lymphoid hyperplasia and focal necrosis.


    Acute tonsillitis naked eye vs.microscopic picture
    Larynx
    I- Inflammation (Laryngitis)
    A- Acute laryngitis:
    Causes:
    - Infective: mostly viral
    - Non infective: Excessive or faulty use of vocal cords,
    tobacco smoke, and atmospheric pollution
    Pathology:
    - Acute catarrhal which may pass to muco-purulent, or
    purulent inflammation.
    Acute Laryngitis naked eye vs. microscopic picture
    Nasopharyngeal fibroma (Juvenile angiofibroma)
    Incidence: Uncommon, male children.

    Origin: From the fibrous tissue of periosteum.

    N/E: Non capsulated grayish pink


    highly vascular mass
    projecting in the nasopharynx
    may extend to nasal cavity, cheek, orbit.
    cause bone destruction by pressure atrophy.
    M/E: Small vascular spaces set in poorly cellular fibrous
    tissue.

    Complication:
    Bleeding (epistaxis).
    Nasopharyngeal carcinoma

    • Adenocarcinoma: related to wood


    dust (e.g. in furniture workers)

    • Squamous cell carcinoma.

    • Anaplastic carcinoma (related to


    Epstein Barr virus). Nasopharyngeal carcinoma
    Squamous Cell Carcinoma of the Larynx
    Incidence: is a common tumour of the larynx.
    Percancerous lesions are:
    - Squamous cell papilloma (of adult). - Leukoplakia
    Pathology:
    1) Verrucous carcinoma:
    2) Classic invasive squamous cell carcinoma.
    Intrinsic Extrinsic
    Incidence 80% 20%
    Sex Male Female
    Age Above 50 years Below 50 years
    N/E:
    Site: From vocal cords. (Glottic) Outside the vocal cords.
    Shape: Fung.> Ulcer > infiltrating Infiltrating>Ulcer> fung.
    M/E: Well diff. Sq. C. Carcinoma. Poorly diff Sq C Carcinoma.
    Prognosis: Good due to: Bade due to:
    *Early diagnosis (early * Late diagnosis (dysphagia
    hoarseness of voice) then laryngeal signs &
    symptoms).
    * Slowly growing. * Rapidly growing.
    * Well differentiated tumor. * Undifferentiated.
    * Easily removed due to * Difficult removal due to
    fungating growth. infiltrative growth
    Radiosensitivity Radiosensitive. Radiosensitive.
    Spread. Local to surrounding structure
    Lymphatic to cervical L.N.
    Blood: late and disseminates extensively
    Glottic
    Carcinoma

    Supra-Glottic
    Carcinoma
    Descripe the pathological feature
    THANK YOU

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