Tonsilitis, types , clinical feature, Tonsillectomy , ENT

1. ‫څانګه‬ ‫ستونې‬ ‫او‬ ‫پزه‬،‫غوږ‬ ‫پوهنځی‬ ‫طب‬ ‫ننګرهار‬

2. TONSILITIS
Nangarhar University/ Medical Faculty
Department : Oto-Rhino-larngylogy
Presenter : Azeem Rasouli

3. APPLIED ANATOMY OF PALATINE
(FAUCIAL) TONSILS
Palatine tonsils are two in number. Each tonsil is an
ovoid mass of lymphoid tissue situated in the lateral
wall of oropharynx between the anterior and posterior
pillars.

4. The tonsils lie between the
Two pillars

5. ANATOMY
• Medial surface
• Lateral surface
• Upper pole
• Lower pole
• Bed of the tonsil

6. CRYTS
• Primary crypts
• Secondary crypts
• Crypta magna

7. Blood supply
• Tonsillar branch
• Descending palatine
• Ascending palatine,
• Ascending pharyngeal
• Dorsal linguae

8. Lymphatic Drainage
• Jugulodigastric or tonsilar lymph node
• No Afferent
• Efferent

9. Adenoid and Palatine tonsil

11. Etiology
Acute tonsillitis often affects
school-going children
also affects adults.
 It is rare in infants and in
persons whoa re above 50 years
of age .

12. Organisms
 Haemolytic streptococcus
 Staphylococci
 Pneumococci
 H.influenzae

13. Tonsils
• Primarily, the tonsil consists of
• (a) surface epithelium
• (b) crypts
• (c) lymphoid tissue.

14. CLASSIFICATION

15. ACUTE CATARRHAL OR SUPERFICIAL
TONSILLITIS.

16. ACUTE FOLLICULAR
TONSILLITIS

17. ACUTE PARENCHYMATOUS TONSILLITIS.

18. ACUTE MEMBRANOUS TONSILLITIS

19. Symptoms
• 1. Sore throat.
• 2. Difficulty in swallowing.
• 3. Fever.
• 4. Earache.
• 5. Constitutional symptoms. headache, general
body aches, malaise and constipation abdominal
pain

20. SIGNS
1. Breath is foetid and tongue is coasted.
2.Hyperaemia of pillars, soft palate and
uvula.
3.Tonsils are
4.The jugulodigastric lymph nodes are
enlarged and tender.

21. Treatment
1. bed and encouraged to take plenty of
fluids.
2. Analgesics
3. Antimicrobial therapy(7-1 0 days)

22. COMPLICATIONS
A. supporative
1. Chronic tonsillitis with recurrent acute at tacks.
2. Peri tonsillar abscess .
3. Parapharyngeal abscess .
4. Cervical abscess
5. Acute otitis media.
B.Non-Supporative
4. Rheumatic fever .
5. Acute glomerulonephritis.
8. Subacute bacterial endocarditis.

23. Complications
Chronic tonsillitis
- Peritonsillar abscess
- Parapharyngeal abscess
- Retropharyngeal abcess
- Rheumatic fever (carditis and
arthritis)
- Acute glomerulonephritis
Quinzy

24. Chronic tonsillitis

25. Etiology
• Complication of acute tonsillitis
• Sub acute tonsillitis
• Chronic sinusitis
• Chronic rhinitis

26. Types
• Chronic paranchymatous
• Chronic atrophic
• Chronic folicular

27. Clinical feature
• Sore throats
• Reccurent attack of acute tonsillitis
• Chronic cough
• Cardinal sign
– Ervine moor sign or squeez test
– Ant pillar congestion
– Tonsilar node hypertrophy
– Tonsil enlargement

28. Grading of Tonsilar
Hypertrophy

29. Complications
• Peritonsillar abscess
• Parapharyngeal abscess
• Intratonsillar abscess
• Tonsilloliths
• Tonsillar cyst

30. Treatment
• Conservative
• Tonsillectomy

31. Tonsillectomy
• Indications
• Contraindications
• Complications

32. Indications
A. Absolute
B. Relative
C. With other operations

33. A. absolute
HARMS
• Hypertrophy
• (Abscess)Quinsy
• Recurrent
• Malignancy(Malignancy)
• Seizure(Febrile)

34. B.Relative
• Diphtheria carrier
• Strpt carrier
• Bad taste and Halotosis
• Recurrent tonsillitis (RVH)

35. C. Other operations
1. Palatopharyngoplasty:
2. Glosspharyngeal neurectomy
3. Removal of long styloid process(Eagle’s
Syndrome)

36. Contra indications
• Physiologic
• Pathologic

37. Physiologic
• Pediatric
• Period
• Pregnancy
• Production of voice

38. Pathologic
Primary HTN
Pus( infection)
Pruiritic spots
Bleeding disoroders
Pancreas disorders
Pills for contraception
Poliomyelitis
Pump Failure
P:ulmonary disorders
Palate disorders Poor Nutrition

39. Post operative care
• Aims
1. Avoidance of bleeding
2. Avoidance of infection
3. Avoidance of trauma

40. Post operative care
• Immediate general care
• Diet
• Oral hygiene
• Analgesic
• Antibiotic

41. Complications
Immediate
• Primary bleeding
• Reactionary bleeding
• Trauma
• Aspiration
• Facial oedema
• Surgical emphysema
Late
• Secondary bleeding
• Infection
• Scar
• Lingual tonsil hypertrophy
• Lung complication
• Tonsilar remnant

43. REFERENCES
Dhingra PL ,ENT disease & Head and neck
surgery ,7th edition ,2018
Johan Jacob,James B, Ballenger’s
Otorhinolaryngolgoy ,16th edition ,2009
Ludman herold, ABC of ENT ,5th edition
,2010
Maqbool Mohmmmad,12th editon ,2014

44. Thank You !
Questions ?