Tonsillitis

• Tonsils are large lymphoid tissue situated in the lateral wall of the oropharynx.

Definition

• Infection of the tonsils

Types

• Acute tonsillitis• Chronic tonsillitis

Etiology• Pre-existing URTI• Pre-existing chronic tonsillitis• Sinusitis• Low resistance• Ingestion of cold drinks and foods• Foreign body• Beta-haemolytic streptococcus• Staphylococcus• Haemophilus influenzae• Pneumococcus

Pathological types• Acute parenchymatous tonsillitis• Acute follicular tonsillitis

Symptoms•Raw sensation in the throat•Pain in the throat•Refusal to eat because of odynophagia•Voice may be thick• Jugulodigastric node enlargement and painful•Halitosis•Secretions increase and become tenacious

Complications• Quinsy• Laryngeal edema• Pharyngeal and retropharyngeal abscess• Acute otitis media• Rhematism, Sub-acute Bacterial Endocarditis and acute nephritis• Septecemia• Chronic tonsillitis

Treatment

• Bed Rest and soft diet• Antibiotics• Analgesics• Warm saline gargles• Lozenges

Catarrhal tonsillitis

• When tonsils are inflamed as part of the generalised infection of the oropharyngeal mucosa it is called catarrhal tonsillitis.

Membranous tonsillitis.• Some times exudation from

crypts may coalesce to form a membrane over the surface of tonsil, giving rise to clinical picture of membranous tonsillitis.

Parenchymatous tonsillitis

• When the whole tonsil is uniformly congested and swollen it is called acute parenchymatous tonsillitis

Surgery

• Tonsillectomy

Post Op Management

• NBM till gag reflex returns• First 48 hours Cold foods• Soft non-spicy food for one week after the third day• Following GA- Tonsillar position is given• Following LA- Semi-sitting position is given• Condy’s gargles (1:4000 Potassium Permanganate) or diluted

Hydrogen peroxide gargles for 8-10 days• Ask patient to blow balloons to stretch the palate

Peritonsillar Abscess or Quinsy

• It is a collection of pus between fibrous capsule of the tonsil usually at its upper pole and the superior constrictor muscle of pharynx.

Types

•Anterior •Posterior •Lingual •Tonsillar

Etiology

•More common in males•Recurrent tonsillitis•Foreign body embedded in the tonsils•Tonsillar tag left behind after tonsillectomy

PathophysiologyRecurrent tonsillitis

Fibrosis of tonsillar crypt

Closure of tonsillar crypt due to new infections

Pus breaks through the capsule of tonsil

Peritonsillar cellulitis

Peritonsillar abscess

Signs • Ill looking patient• Pyrexia• Often with severe trismus• Striking asymmetry with

oedema and hyperaemia of the soft palate.• Enlarged hyperaemic and

displaced tonsil• Trismus• Halitosis• Rupture of the abscess

Symptoms

• Throat pain• Trismus• Increased salivation• Thick speech

Complications

• Parapharyngeal abscess• Phlebitis of the Internal jugular

vein• Septecemia• Hemorrhage• Supraglottic edema

Treatment• Analgesics and antibiotics. • Adequate hydration• I & D• Tonsillectomy• Quincy tonsillectomy

AdenoidsWhen hypertrophied nasopharyngeal tonsil starts producing symptoms the condition is referred to as adenoids.

The normal involution of nasopharyngeal tonsil starts from the onset of puberty, but sometimes it can persist for a longer period.

Etiology

• Between 3-10 years of age.• TB and other infections• Causes similar to tonsillitis.

Clinical manifestations

• Nasal obstruction, mouth breathing• Pigeon chest and Harrison’s sulcus• Rhinolalia Clausa (Voice becomes flat

and toneless)• E. tube obstruction• Purulent nasal discharge• Post nasal discharge, pharyngitis• Lymphadenitis• OM• Aggravation of asthma and bronchitis

Diagnosis

• Clinical manifestations• Posterior rhinoscopy• Digital palpation• Radical examination

Treatment•Antibiotics•Decongestants•Breathing exercises

•Adenoidectomy•Antral lavage to drain sinusitis•Grommet may be inserted to ear of a patient having

secretary OM

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