1. tonsillitis

2. Acute tonsillitis Infection of the tonsil May effect any age group but most frequently found in children.

3. aetiology Viral infectionViral infection : 50% influenza,parainfluenza,adenovirus, & rhinovirus Bacterial infectionBacterial infection: - B-haemolytic streptococcus - Strept.pneumonia, - H influenzae - Staph. Aureus - Moraxella catarrahlis - Anaerobic organisms

4. Pathology: 1.Acute paranchymatous type: whole ts. is infected causing generalized swelling, reddened & edematous surface.

5. 2. Acute follicular ts. : crypts of ts. Filled with pus giving spotted appearance

6. Clinical features: 1.Sorethroat 2.Pyrexia 3.Odynophagia 4.Malaise 5.Earache 6.Thickened speech 7.In severe cases rigor & signs of toxaemia 8.Appendicitis may be simulated/ mesenteric adenitis.

7. Examination: Congested & enlarged ts. Congested pillars. Spots of pus or fibrin fill the crypts Furred tongue & halitosis Enlarged tender cx Ln.

8. Investigation: 1.Throat swab for c/s 2.Throat swab for K.L.B. 3.Blood film / mono spot test (I.m.n.)

9. DDX: 1.Scarlet fever 2.Diphtheria 3.Vincent`s infection 4.Agranulocytosis 5.I.M.N. ( glandular fever)

11. Treatment: Bed rest, soft diet,fluid intake Analgesic drug Systemic AB.

12. Complications: 1. Peritonsillar abscess 2. Parapharyngeal abscess 3. Retropharyngeal abscess 4. Edema of the larynx 5. Acute rheumatism 6. Acute nephritis 7. Septicemia 8. Acute OM.

13. Recurrent acute tonsillitis Clinical features: Clinical features: 1. persistent or recurrent sore throat 1. persistent or recurrent sore throat 2. marked ts. enlargment. 2. marked ts. enlargment. 3. injected ant. pillars 3. injected ant. pillars 4. halitosis 4. halitosis 5. persistent cx. adenitis. 5. persistent cx. adenitis. treatment: treatment: tonsillectomy tonsillectomy

14. tonsillectomy Indications: 1- recurrent ts. : 6//1 year or 3//2 years 2- recurrent episodes of peritonsillar abscess 3- suspected neoplasm ( unilat enlargement,or ulceration)

15. Contraindications: 1. Recent ts. infection or URTI 2. Bleeding disorders 3. Using of contraceptives 4. Cleft palate 5. Epidemics of poilo

16. Complications of tonsillectomy: A. Peroperative: 1- anaesthetic reaction 1- anaesthetic reaction 2- haemorrhage 2- haemorrhage 3- damage to teeth, uvula, or 3- damage to teeth, uvula, or to post. Pharyngeal wall to post. Pharyngeal wall 4- dislocation of the 4- dislocation of the temporomandibular joint temporomandibular joint

17. B. Post operative: Reactionary hemorrhage / 1 st,24hs Reactionary hemorrhage / 1 st,24hs Anaesthetic complications Anaesthetic complications Secondary haemorrhage / 5 th – 10 th day Secondary haemorrhage / 5 th – 10 th day Infection of the ts. bed Infection of the ts. bed Earache Earache Pneumonia Pneumonia Tonsillar remanant Tonsillar remanant

18. Post ts, haemorrhage Reactionary (primary): Reactionary (primary): secondary secondary

19. Reactionary haemorrhage: ~2% ~2% Within 24hs Within 24hs Signs of the bleeding : Signs of the bleeding : - obvious bleeding - obvious bleeding - gurgling sound in throat on breathing - gurgling sound in throat on breathing - repeated swallowing - repeated swallowing - vomiting - vomiting - rising pulse rate & lowering of the Bp. - rising pulse rate & lowering of the Bp.

20. Management: Blood sample for cross matching Blood sample for cross matching IV, infusion IV, infusion Identifying the bleeding site Identifying the bleeding site Application of 1:1000 adrenaline soaked gauze or using hydrogen peroxide gurgle Application of 1:1000 adrenaline soaked gauze or using hydrogen peroxide gurgle If failed >>> 2 nd anaesthesia >>stop the bleeding If failed >>> 2 nd anaesthesia >>stop the bleeding

21. Secondary haemorrhage 5 th - 10 th day 5 th - 10 th day Infection Infection R/: admission & observation R/: admission & observation Blood for cross match Blood for cross match AB. AB. If failed 2 nd anaesthesia suturing the pillars. If failed 2 nd anaesthesia suturing the pillars.

22. Peritonsillar abscess(quinsy) Def; Def; pus collects between ts. & sup. Cons.m. pus collects between ts. & sup. Cons.m. Aetiology; Aetiology; - follows tonsillitis - follows tonsillitis - mostly unilateral - mostly unilateral

23. Clinical features: 1) -severe pain 2) -pyrexia up to 40 C° 3) -headache & malaise 4) -trismus 5) -earache 6) -intense salivation 7) Thickened speech 8) Foetor oris

24. examination Marked hyperaemic edematous tonsil and palatal region Marked hyperaemic edematous tonsil and palatal region Oedematous uvula & pushed towards other side Oedematous uvula & pushed towards other side

25. complications Parapharyngeal abscess Parapharyngeal abscess Oedema of the larynx Oedema of the larynx septicemia septicemia

26. treatment 1. Conservative in early stage( cellulitis) - rest, AB., analgesia - rest, AB., analgesia 2. Surgery : - incision of the abscess - incision of the abscess - abscess-tonsillectomy - abscess-tonsillectomy