M. RATHIS LECTURER

Tonsillitis

Is the inflammation of the tonsils that can be acute, sub-acute, and chronic due to causative factors affecting it.

Acute tonsillitis can either be bacterial or viral in origin. Subacute tonsillitis is caused by the bacterium Actinomyces. Chronic tonsillitis, which can last for long periods if not treated, is mostly caused by bacterial infection.

Tonsils are made –up of adenoids tissue that secretes lymphocytes that help in fighting against systemic infection of the body.

Causative agents:

1. Bacteria (streptococci, staphylococci)2. Virus (Adenovirus, mononucleosis)3. Spirochetes4. Treponema

Causative factors enter the upper respiratory tract via nose and mouth

Enters the nose and mouth causing inflammation to the tonsils.

Signs and symptoms are;

1. Sore throat as referred pain to the ears2. Painful or difficult swallowing (Dysphagia)3. Crouch coughing4. Headache, fever, chills5. Red swollen tonsils with pus6. Swelling and tenderness of the submandibular

glands

Diagnostic procedures:

1. Buccal swab for Culture & sensitivity test to identify streptococci and staphylococci infections

2. Complete blood count for elevated white blood cells & lymphocytes

Incubation period:

Acute Tonsillitis is 72 hours.Sub-acute tonsillitis is 2-3 days.Chronic Tonsillitis is 4-6 days.Recurrent Tonsillitis is 1-2 weeks.

Treatment:

1.Saline gargle (Mouthwash if needed)2.Analgesics (Ponstan, Brufen)3.Antipyretics & Increase fluid intake4.Soothing Lozenges (Orofar-L, Strepsils)5.Antibiotics (Penicillin is drug of choice) but may use erythromycin & cefuroxime6.Tonsillectomy for recurrent chronic cases

1.Peritonsillar abscess (tonsils with pus)2.Lemierres syndrome (septicemia)3.Hypertrophy of tonsils (snoring, mouth breathing,

disturbed sleep and obstructive sleep apnea)4.Rheumatic heart disease5.Glomerulonephritis6.Tonsillolith (tonsil debris in whitish color)7.Halitosis (bad breath)

Complications:

PHARYNGITIS

Is the inflammation of the pharynx called sore throat that can be acute or chronic due to causative factors affecting it. It is usually precedes illness of colds and flu that doesn’t require antibiotics unless otherwise caused by bacterial infection because most disappear by their own in weeks or less.

Causative Agents

1. Bacteria (Streptococci, Staphylococci)2. Virus (Adenovirus, Mononucleosis)3. Allergens (dust, mist, pollens, smokes)4. Alcohol5. Use of tobacco

Causative agent enters the upper Causative agent enters the upper respiratory tract, causing inflammation of respiratory tract, causing inflammation of the pharynx.the pharynx.

Signs and symptoms:

I. Pharyngitis with colds 1.Sneezing 2.Cough 3.Low fever 4.Mild headache

II. Pharyngitis with flu 1. Fatigue 2. Body aches 3. High fever 4. Chills

III. Pharyngitis with bacterial infection 1.Enlarges lymph nodes in neck & armpit 2.Headache 3.Anorexia 4.Swollen spleen 5.Swollen tonsils 6.Liver inflammation 7. Dysphagia 8. Red & edematous pharynx with exudates

IV. Pharyngitis with viral infection 1. sore throat 2. coryza 3. body malaise & fatigue 4. hoarseness of voice 5. Low-grade fever

Diagnostic procedures:

1. Buccal swab for culture & sensitivity test to identify bacterial infection.2. Complete blood count for increase white blood cell and its differentials.

Incubation Period

Acute Pharyngitis is 72 hours.Sub-acute Pharyngitis is 2-3 days.Chronic pharyngitis is 7-10 days.Recurrent Pharyngitis is 1-2 weeks.

Treatment

1.Saline gargle (Mouth wash if needed)2.Analgesics (Ponstan, Brufen)3.Antipyretics (Panadol extra)4.Increase fluids but not soft drinks & not too sweet juices5.Removal of allergens6.Antiobiotics (Penicillin is drug of choice)7.Vitamin-C for viral infection as the case don’t need

medication for it disappear by its own.8. Hospitalization if cannot swallow fluids to provide I.V.

hydration.

Complications

1. Tuberculosis2. Liver cirrhosis3. Rheumatic heart disease

PharyngotonsillitisIs the inflammation of the pharynx and tonsils due

to infectious (bacterial & viral) and non-infectious (pollens, dust, mist, sandstorms) factors affecting it that can be acute, sub-acute, and chronic.

Causative agents:

1.Bacteria (Group-A betahemolytic streptococci)2.Virus (Adenovirus, Mononucleosis)3.Non-infectious (chemicals, dust, mist, pollens)

Causative agents enters the upper respiratory tract and inflamed the pharynx and tonsils.

Signs and Symptoms

I. Pharyngitis with bacterial infection 1.Fever 2.Sore throat 3.Nausea and vomiting 4.Erythema of the pharynx and tonsils 5.Enlarged cervical glands 6.Exudative tonsils 7.Palatal petechia 8.Scarlet fever rash

II. Pharyngotonsillitis with viral infection 1. Cough 2. Rhinitis 3. Conjunctivitis 4. Diarrhea 5. Sore throat 6. Fever

Diagnostic procedures:

1. Buccal swab for culture and sensitivity to detect infectious agent.

2. Complete blood count for increase white blood cell and its differentials.

Incubation period:

Acute Pharyngotonsillitis is 72 hours.Sub-acute Pharyngotonsillitis is 2-3 days.Chronic Pharyngotonsillitis is 4-10 days.Recurrent Pharyngotonsillitis is 2-3 weeks.

Treatment:

1. Saline gargle (mouth wash if needed)2. Analgesics3. Antipyretics4. Lozenges5. Antibiotics (Penicillin is best but may use amoxicilin &

augmentin if allergy to Pen-G)6. Increase fluids to correct dehydration of the pharynx

and tonsils.7. Humidify the air inhaled.8. Vitamin-C intake

Complications:

1. Tuberculosis2. Rheumatic heart disease3. Septicaemia

LaryngitisIs the inflammation of the larynx (voice box)

due to overuse, irritation, infection (bacterial & viral), and non-infectious agents (mist, pollens, dews, sandstorms, dust, chemicals, smokes) that can be acute, sub-acute, and chronic.

Causative agents: Acute Laryngitis 1.Virus infection (colds, measles) colds secretions enter the larynx via nasopharynx &

caused inflammation 2.Voice overuse over talking dries the larynx tissues causing irritation and inflammation 3.Bacterial infection (diptheria) airborne microorganism invades the larynx & caused inflammation

II. Chronic Laryngitis 1.Irritants inhalation 2.Chronic sinusitis 3.Acid reflux (gastroeasophageal) 4.Excess alcohol intake 5.Smoking

Larynx- it opens and closes during sounds production

Causative agents enter the upper respiratory tract and inflamed the larynx.Normal Larynx or not inflamed Inflamed Larynx

Signs and symptoms:

1.Hoarseness of voice due to distortion of the larynx during vibration of sound production.

2.Loss or weakness of voice.3.Tickling sensation and rawness of the throat.4.Dry, sore throat.5.Dry cough.

Diagnostic procedures:

1. Laryngoscope confirmed exudates, redness and inflamed larynx.2. Biopsy of the larynx.3. Culture and sensitivity swab to identify the

causative agent.

Incubation period:

Acute laryngitis is 72 hours.Sub-acute laryngitis is 2-3 days.Chronic laryngitis is 4-10 days.Recurrent laryngitis is 2-3 weeks.

Treatments:

1. Steam inhalation2. Rest / no talking to relax larynx3. Increase fluids to dehydrate larynx4. Saline gargle, mouth wash if needed5. Analgesics6. Antipyretics

7. Antibiotics8. Corticosteroids9. Acid reflux medication10. Heart burns treatment11. Provide communication pads12. Anticipate patient needs instead of asking13. Maintain air humidification

Complications:

1. Cancer of the larynx2. Rheumatic heart disease3. Tuberculosis4. Permanent loss of voice / hoarseness