TONSILITTIS Medrockets.com

The tonsils Tonsils are subepithelial collections of lymphoid tissue scattered in the pharynx. Anatomically the tonsils are classified based on their location into : palatine (faucial), nasopharyngeal (“adenoids”), lingual and tubal tonsils. Generally, the palatine tonsils referred to as “the tonsils”. Medrockets.com

Waldeyer's tonsillar ring Waldeyer's tonsillar ring (pharyngeal lymphoid ring orWaldeyer's lymphatic ring) is an anatomical term collectively describing the annular arrangement of lymphoid tissue in the pharynx. The Waldeyer’s ring is formed by : Palatine tonsils Nasopharyngeal tonsil Lingual tonsils Tubal tonsils Lateral pharyngeal bands Posterior pharyngeal nodules Medrockets.com

Anatomy of tonsils *Site: lateral walls of oropharynx, between the anterior and posterior pillars- tonsillar fossa *Shape: almond shape *2 surfaces: medial, lateral *2 poles: upper, lower * 10-12 primary crypts, secondary crypts *Plica semilunaris and plica triangularis Medrockets.com

Functions of Tonsils Immunity Lymphocyte formation Antibodies formation Barrier to infections Medrockets.com

Tonsillitis Tonsillitis is inflammation of the tonsils most commonly caused by a viral or bacterial infection. Tonsillitis is divided into acute, sub-acute and chronic. Acute tonsillitis tends to be bacterial or viral in nature, while sub-acute tonsillitis is caused by the bacterium Actinomyces. Chronic tonsillitis generally lasts for a long time and is caused by bacteria. Medrockets.com

Acute tonsillitis - Acute infection of the tonsils involving the surface epithelium, crypts and lymphoid tissue Mostly affects children in the age group of 5-15 years, may also affect adults Organisms  beta-hemolytic streptococci (most common), staphylococci, pneumococci, H.influenzae Symptoms: sore throat, difficulty in swallowing, fever, ear ache, constitutional symptoms Medrockets.com

Predisposing factors Endogenous URTI Postnasal discharge due to sinusitis Residual tonsillar tissue after tonsillectomy Exanthemata Blood dyscrasias Exogenous Cold drinks and foods Contact with infected persons Crowded and ill-ventilated environment Imbedded foreign body Medrockets.com

Types of Acute Tonsillitis Acute superficial tonsillitis Acute parenchymatous tonsillitis Acute follicular tonsillitis Acute membranous tonsillitis Medrockets.com

Acute catarrhal/superficial Here tonsillitis is a part of generalized pharyngitis, mostly seen in viral infections

Acute follicular infection spread into the crypts with purulent material, presenting at the opening of crypts as yellow spots.

Acute membranous follows stage of acute follicular tonsillitis where exudates coalesce to form membrane on the surface

Acute parenchymatous tonsil is uniformly enlarged and congested

Clinical Manifestation of Acute Tonsillitis Symptoms: 1. Sore throat – raw sensation in the throat 2. Refusal to eat due to odynophagia 3. Earache – either referred pain from the tonsil or due to acute otitis media 4. Voice becomes thick and muffled 5. Jugulodigastric nodes are enlarged and painful 6. Fever, may be associated with chills and rigor. Headache, tachycardia. Medrockets.com

Clinical Manifestation of Acute Tonsillitis Signs: 1.Tonsils appear congested and swollen Yellowish spots – follicular Whitish membrane – membranous Red and enlarged – parenchymatous 2.Hyperemia of pillars, uvula, soft palate 3.Halitosis, impeded movements of palate and increased secretions 4.Enlarged and tender jugulodigastric nodes Medrockets.com

Differential Diagnosis of Membranous tonsillitis Diphtheria Vincents angina Infectious mononucleosis Agranulocytosis Leukaemia Traumatic ulcer Aphthous ulcer malignancy Medrockets.com

TREATMENT Bed rest Plenty of oral fluids Analgesics Antimicrobial therapy penicillin In case of penicillin sensitivity erythromycin are given. Antibiotics should be continued for 7_10 days Medrockets.com

COMPLICATIONS chronic tonsillitis peritonsillar abscess parapharyngeal abscess cervical abscess acute otitis media rheumatic fever acute glomerulo nephritis sub acute bacterial endocarditis Medrockets.com

Chronic follicular tonsillitis Chronic parenchymatous tonsillitis CHRONIC TONSILLITIS Characterised by recurrent acute attacks Aetiology: Complication of acute tonsillitis Sub clinical infection of tonsil Chronic sinusitis or dental sepsis Mostly affects children and young adults Types Chronic follicular tonsillitis Chronic parenchymatous tonsillitis Chronis Fibroid tonsillitis Medrockets.com

Types of chronic tonsillitis 1). Chronic follicular tonsillitis tonsillar crypts are full of cheesy material resulting in yellow spots on the surface. 2). Chronic parenchymatous tonsillitis tonsils are very much enlarged almost touching each other and may interfere with speech, deglutition and respiration, long standing cases may develop pulmonary hypertension 3).Chronic fibroid tonsillitis Tonsils are small but infected , with history of repeated sore throat. Medrockets.com

CLINICAL FEATURES recurrent attacks of sore throat chronic irritation in throat with cough halitosis dysphagia odynophagia thick speech Medrockets.com

Examination Tonsil may show varying degree of enlargement depending on the type Irwin-moore sign tonsils are small but pressure on the anterior pillar expresses pus or cheesy material ,mainly seen in fibroid type There may be yellowish beads of pus on the medial surface of tonsils chronic follicular tonsillitis Flushing of the anterior pillar compared to rest of the pharyngeal mucosa Enlargement of the jugulo-digastric node, soft non tender

TREATMENT Conservative management Pay attention to the general health ,diet,and treatment of co- existent infections of teeth , nose , and sinuses. Tonsillectomy when recurrent attacks ,interference with speech , deglutination & respiration.

COMPLICATIONS Peritonsillar abscess Parapharyngeal abscess Retro pharyngeal abscess Intra tonsillar abscess Tonsillar cyst Tonsillolith Focus of infection for RF, AGN Medrockets.com