Tonsillitis
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  • 1. TONSILLITISDEPT OF OTORHINOLARYNGOLOGY JJM M C DAVANAGERE
  • 2. ANATOMY OF PALATINE TONSIL Paired structures situated in lateral wall of oropharynx between anterior and posterior pillars Consists of two surfaces (medial and lateral) and two poles (upper and lower) Medial surface is covered by non keratinizing stratified squamous epithelium There are 12-15 crypts on the medial surface Largest crypt is called crypta magna or intratonsillar cleft
  • 3. ANATOMY OF PALATINE TONSIL Lateral surface of tonsil presents a well defined fibrous capsule Loose areolar tissue lies between the tonsillar bed and the capsule, it is the site for collection of pus in peritonsillar abscess (Quinsy) Upper pole of tonsil extends into soft palate, its medial surface is covered by semilunar fold plica semilunaris Lower pole of tonsil is attached to the tongue, triangular fold of mucous membrane extends from anterior pillar to antero-inferior part of tonsil enclosing plica triangularis Tonsil is seperated from the tongue by tonsilo- lingual sulcus
  • 4. ANATOMY OF PALATINE TONSIL
  • 5. TONSILLAR BED Formed by Loose areolar tissue containing paratonsillar vein Pharyngo-basilar fascia Superior constrictor muscle Bucco-pharyngeal fascia Styloglossus Medial pterygoid muscle Glossopharyngeal nerve Facial artery
  • 6. BLOOD SUPPLY OF TONSIL
  • 7. LYMPHATIC DRAINAGE Lymphatics pierce the superior constrictor and drain into upper deep cervical (jugulo- digastric) node
  • 8. FUNCTIONS OF TONSIL It is the component of inner waldeyer’s ring It has a protective role and acts as a sentinal at portal of air and food passage Crypts increase the surface area for contact with foreign substances
  • 9. ACUTE TONSILLITIS 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
  • 10. ACUTE TONSILLITIS-TYPES 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 parenchymatous  tonsil in uniformly enlarged and congested Acute membranous  follows stage of acute follicular tonsillitis where exudates coalesce to form membrane on the surface
  • 11. Acute catarrhal/superficial
  • 12. Acute follicular
  • 13. Acute membranous
  • 14. SIGNS Halitosis Coated tongue Congestion of pillars, soft palate and uvula Jugulo-digastric nodes enlarged and tender Tonsils are congested and enlarged depending on type of acute tonsillitis
  • 15. TREATMENT Bed rest Plenty of oral fluids Analgesics Antimicrobial therapy penicillin In case of penicillin sensitivity macrolides are given
  • 16. COMPLICATIONS chronic tonsillitis peritonsillar abscess parapharyngeal abscess cervical abscess acute otitis media rheumatic fever acute glomerulo nephritis sub acute bacterial endocarditis
  • 17. DIFFERENTIAL DIAGNOSIS OF MEMBRANE OVER THE TONSIL Membranous tonsillitis Diphtheria Vincents angina Infectious mononucleosis Agranulocytosis Leukaemia Traumatic ulcer Aphthous ulcer malignancy
  • 18. CHRONIC TONSILLITIS Aetiology: Complication of acute tonsillitis Sub clinical infection of tonsil Chronic sinusitis or dental sepsis Mostly affects children and young adults
  • 19. TYPES OF CHRONIC TONSILLITIS Chronic follicular tonsillitis Chronic parenchymatous tonsillitis : tonsils are very much enlarged uniformly and may interfere with speech, deglutition and respiration, long standing cases may develop pulmonary hypertension Chronic fibroid tonsillitis
  • 20. CLINICAL FEATURES recurrent attacks of sore throat chronic irritation in throat with cough halitosis dysphagia odynophagia thick speech
  • 21. SIGNS Tonsil may show varying degree of enlargement depending on the type Irwin-moore sign pressure on the anterior pillar expresses frank pus or cheesy material  mainly seen in fibroid type Flushing of the anterior pillar compared to rest of the pharyngeal mucosa Enlargement of the jugulo-digastric node  soft non tender
  • 22. TREATMENT conservative management tonsillectomy
  • 23. COMPLICATIONS Peritonsillar abscess Parapharyngeal abscess Retro pharyngeal abscess Intra tonsillar abscess Tonsillar cyst Tonsillolith Focus of infection for RF, AGN
  • 24. Peritonsillar abscess
  • 25. STYALGIA (EAGLE’S SYNDROME) Due to elongated styloid process or calcification of stylohyoid ligament Patient complains of pain in tonsillar fossa and upper neck which radiates to ipsilateral ear It gets aggravated on swallowing Diagnosis is by transoral palpation in tonsillar fossa X-ray Townes view is helpful in diagnosis Treatment is by excision of styloid process by transoral or cervical approach