1. Pharyngeal tonsils
Tonsils

2. Tonsils are large lymphoid tissue situated in the lateral wall of the oropharynx.
4 types of tonsil – tubal, palatine, pharyngeal and lingual tonsils.
Tonsils have small pockets over the surface is called as CRYPTS.

3. Tonsillits – inflammation of the tonsils most commonly caused by viral or bacterial infection

4. causes Viral infection – most common cause Adenovirus Rhinovirus
Influenza
Coroavirus
Respiratory syncytial virus
Epstein barr virus, HSV, HIV

5. Bacterial infection
Streptococcus
Stap. Aureus
Strep pneumoniae

6. Pathophysiology Due to etiological factors
The process of inflammation originate within the tonsil
hyperemia and oedema with conversion of lymphoid follicles in to small abscesses which discharge into crypts.
Clinical features
When inflammatory exudate collects in tonsillar crypts these present as multiple white spots on inflamed tonsillar surface giving rise of follicular tonsillitis.

7. Classification / types
Acute
Chronic
Bacterial
Viral – resolve within one week.
Follicular
Catarrhal
Membraneous
Parenchymatous tonsillitis

8. Follicular tonsillitis
It is an inflammation of the tonsils and their crypts. The onset is sudden and the tonsils will appear red, white pus spots over the swollen tonsils

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

10. Membranous tonsillitis.
Some times exudation from crypts may coalesce to form a membrane over the surface of tonsil, giving rise to membranous tonsillitis.

11. Parenchymatous tonsillitis
When the whole tonsil is uniformly congested and swollen it is called acute parenchymatous tonsillitis

12. COMPLICATIONS
Peri tonsillar Abscess or quincy
Para Pharyngeal Abscess
SOM
Acute nephritis
RHEUMATIC Fever
Laryngeal edema
Septicemia
Bacterial endocarditis

13. Signs and symptoms
Swollen congested tonsils with white pus filled spots
Halitosis
Chills
Sometimes yellowish exudate from crypts
Discomfort in throat
Sore throat
Difficulty in swallowing
Generalized body ache
Fever
Earache and Thick speech

14. Diagnosis History collection Physical examination Throat swabs
RSAT – rapid streptococcal antigen test
Monospot test – a blood test can detect certain antibodies, which can help confirm that a person symptoms are due to mononucleosis.
CBC

15. Management Analgesics – to reduce pain Sore throat relief measures
Antibiotics – penicillin or amoxicillin
If viral origin – complete recovery is made within one week. In chronic cases surgery will do.
Home mgt

16. Tonsillectomy Removal of the inflamed tonsil Methods
1. Dissection and snare method – removal of the tonsil by use of a forceps and snare scissors. The tonsils are completely removed and the remaining tissue is cauterized. There will be minimal post operative bleeding

17. Electrocautery – it uses electrical energy to separate the tonsillar tissue and assists in reducing blood loss through cauterization.
But thermal injury to surrounding tissue is common

18. Radiofrequency ablation – radiofrequency energy is used to the tonsil tissue through probes to remove the tonsil
Coblation tonsillectomy – it combines radiofrequency energy with the use of ionized sodium molecules to ablate tissues
Harmonic scalpel – it uses ultrasonic energy to vibrate the blade.

19. Laser assisted serial tonsillectomy (LAST)
Microdebrider – powered rotary shaving device with continuous suction

20. Care of a patient after tonsillectomy
Position patient on side until fully awake after general anesthesia or in mid – fowlers position when awake
Monitor for signs of hemorrhage: frequent swallowing (inspect throat), bright red vomitus, rapid pulse, restlessness
Promote comfort : apply ice collar to neck (reduce the bleeding by vasoconstriction), use acetaminophen

21. Give appropriate food and fluids
Give ice –cold fluids and bland foods during initial period (ex- ice chips, frozen juice bars)
Milk is usually not given because it may increase mucus and cause patient to clear throat.
Never give dark colored or red colored juices or fluids – because if vomitus contain blood it will be difficult to identify.

22. Instruct patient to :
Avoid attempting to clear throat immediately after surgery (may initiate bleeding)
Avoid coughing, sneezing, vigorous nose blowing, and vigorous exercise for 1-2 weeks
Drink lots of fluids (2-3L/day).
Avoid hard, scratchy foods
Report signs of bleeding
Expect stool to be black or dark for a few days due to swallowed blood
Résumé normal activity immediately