This was prepared by Drs during Medical school lecture on ENT at St. Francis university college of health and allied sciences-Ifakara, Tanzania.
Cc Dr. Rajabu Jumanne Mlaluko (MD), Dr. Swaumu Shein (MD) and Dr. Stephano Phabian (MD).
2. Outline
Anatomy of tonsils
Physiology of tonsils
Definition of acute tonsillitis
Etiology of acute tonsillitis
Types of acute tonsillitis
Diagnosis
Treatment
Complications
3. Anatomy of Tonsils
Tonsils are the lymphoid tissue mass which are
found in the pharynx. They form part of waldeyer’s
ring and opens into respiratory and digestive
system.
Lateral part is formed by palatine tonsils and tubal
tonsils which found around auditory tube opening
Upper part by pharyngeal tonsil (on the roof of
nasopharynx)
Lower part by Lingual tonsil ( on posterior 1/3 of
tongue)
5. Palatine tonsil
Lateral surface of tonsil presents a well defined
fibrous capsule and 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 separated from the tongue by
10. Physiology/Function of tonsils
It is the component of inner waldeyer’s ring
It has a protective role and acts as a sentinel at
portal of air and food passage
Crypts increase the surface area for contact with
foreign substances
NB: As the person grow tonsils tend to decrease in
size and become fibrosed. That’s why Tonsillitis
unlikely to occur in elder otherwise there other risk
factor for infection.
11. Acute tonsillitis
It is the inflammation of tonsils. It can be of
palatine, pharyngeal or lingual tonsils.
It is mostly common caused by virus but
sometimes by bacteria.
12. Etiology of acute tonsillitis
Viral tonsillitis (70-80%)
In children less than 5 years and young adults.
Mostly self limiting in 3-4 days. Influenza, Para
influenza, coxsackies A, rhinovirus etc.
Bacterial tonsillitis(15-30%)
In children 5-15 years and rarely in less than 2
years. It is also called streptococcal tonsillitis. Since
the most common bacteria is Group A streptococcal
(GAS). Others organisms are staphylococci and
anaerobes.
17. Cont..
Acute membranous ;follows stage of acute
follicular tonsillitis where exudates coalesce to
form membrane on the surface
18. Diagnosis
Through History and physical exam
S/S Fever, sore throat, painful swallowing.
Supportive investigations
FBP (Leukocytosis), increased CRP and ESR (not
specific), ASO- titer (risk for RF)
MODIFIED CENTOR SCORE for diagnosis of
bacterial tonsillitis
C-cough
E-Exudates
N-Nodes
T-Temp
OR- young or old
19. CENTOR cont…
Criteria
Signs and symptoms
No cough (1 point)
Tender anterior cervical adenopathy ( 1point)
Fever (1 point)
Tonsillar exudates (1 point)
Age
3-14 years (1 point)
15-44 years ( 0 point)
More than 45 ( -1 point)
20. Cont…
Approach from CENTOR score
Score less or equal to 1 means no further
diagnostic testing or abx is indicated
Score 2-3 means rapid antigen detection testing
(RADT)/ throat culture indicated
Score more than 4 means needs empirical abx
21. Treatment
Conservative tx
Rest, fluid intake, analgesics, salt water gargles
Avoid Aspirin in children
Abx if GAS confirmed. Pen V if allergic give
Macrolides
22. Cont..
Surgery tx ( tonsillectomy)
Types
1) Subtotal. Capsule is spared. No bleeding. Risk
of relapse
2) Total. Tonsil + capsule. Risk of bleeding. No
relapse
Indications
1. Recurrent and chronic
2. Extreme hypertrophy of tonsils
3. Hx of peritonsillar abscess
4. Tonsillitis that resist abx
23. Cont…
Post Op Management
NPO till gag reflex returns
First 48 hours Cold foods
Soft non-spicy food for one week after the first 48
hours
Following GA- Tonsillar position is given
Following LA- Semi-sitting position is given
Condy’s gargles (1:4000 Potassium Permanganate)
or diluted Hydrogen peroxide gargles for 8-10 days
Ask patient to blow balloons to stretch and strenghens
the palate (Nasal speech tx)
25. Cont…
Non suppurative comps
1. Rheumatic fever
2. Scarlet fever (fever, flushed cheek, strawberry
tongue)
3. Post streptococcal glomerulonephritis. Occurs
mostly at age of 10-30 years following Impetigo/
tonsillopharyngitis
4. Sub acute bacterial endocarditis