1. Diseases of the Tonsils (vol-1)
Recurrent acute Ts ; many patient experience episodes of acute Tonsillitis with complete recovery
between episodes.
Numerous Crypts harber Bacteria ,aggressive medical therapy may not be sufficient to prevent
additional episode.
Indication
1)Patient with Recurrent acute Ts 6-7 episodes in one yr.
2) 5 episodes to 2 consecutive yrs.
3) 3 episodes for 3 consecutive yrs.
Chr. Ts
Chr. Ts defined by persistent sore throat ,anorexia ,Dysphagia,Pharyngotonsillar erythaema also
malodorouse Tonsillar concretion,enlargement of jugudigastic Lymph node.
Normal flora
The most commonly identified from surface of Tonsil.
Group A Beta Streptococcus -40% normal individual,
HI
Staphylococcus aureus
Α -Haemolytic Streptococcus
Branhamelle sp
Mycoplasma
Chlamydia
Varies Anaerobes
Core sample from Tonsil (FNAC)in health & disease , Normal Tonsil >No growth.Recurrent
Tonsillitis> Predominate organism HI, Staphalococcous aureus , Mixed organism common,GABHS
less common.

2. Complication of Tonsillitis
Nonsuppurative;
1)Scarlet fever; .Fever severe dysphagia, a yellowish membrane covering the Tonsil & pharynx, RX –
penicillin
2) ARF- occur 18days after an infection,Endo Myo, Pericarditis >Penicillin Prophylasis Or
Tonsillectomy.
3) Post streptococcal AGN; Occur 10days after infection,Antibiotic treatment has not been shown to
affect the incidence of the disease.
4) Obsessive Compulsive disorder; Obessive thoughts,Fears, Ritualistic Compulsion, Tics, Anxiety
disorder.
Supportive disorder
Peritonsillar abscese.
Functions of the The Tonsil
Have no afferent Lymphatics ,Lymphoid germinal centre located submucosally.
Exposure to antigen diferention to plasma cells>IgG &Iga.
They generate B cell which express Polymeric IgAb which migrate to the upper resperitory tract
mucasa & associated front line mucosal surface.(local &systemic immunity)
Contact with allergens in the upper Respiratory Tract enhances local immunity & systemic immunity.
Whether or not Tonsillitis represents a swaping of defence mechanism at local level or an
exaggeration of the normal response is not known,
Tonsillitis tends to less frequent with time suggest problem lies within the immune system rather
than within end organ itself.
Polymeric IgA production in Tonsillar B cells is markedly reduced in children with recurrent Ts.
No evidence that Tonsillectomy perse result in impaired immunity due to extensive back up in the
immume system.
Synergistic action with presence of latent viruses (EPV, adenovirus Herpes simplex) sensitizing the
pathogenic Bacteria of Tonsil.>Tonsillitis.

3. Complications of Ts
Ts &psoriasis.
Recurrent Ts: Acute episode appear to follow even wks or months, No evidence that antibiotic will
prevent recurrent Ts.
Chr. Ts ; Chr. Low low grade symptoms affecting their quality of life ,inspissated pus in crypt.
Treatment
Acute Ts is common & self limiting. Complications are rare,
Treatment is largely symptomatic with an emphasis on analgesic & rehydration.
Antibiotic therapy has a small but measurable effect on out come.
A simple dose of Dexamethasone as adjuvant therpy reduces pain.
Perioperative & post operative management ,
1)Analgesic> Narcotic at recovery then P/C+ NSIAD.
2)Local anaesthesia infiltration into Tonsillar bed reduce postoperative pain.
3)Antiemitic > ondansetron
4)Steroid: Peroperative single dose Dexamethasone was an effective.
5) Prophylactic antibiotic; very small reduction in time to resumption of normal activities.
6)There is no evidence that the benefit of Tonsillectomy for recurrent sore throat are prolonged
beyond 2yrs.
Tonsil & Variant Creutzfeld –jakob diseaae.
Fatal Neurodegenerative disease, Intracellar vacuolation in nervous system> progressive Spongiform
encephalopathy> Tonsillar Tissue is invariable infected with Prion (enter through food chain)>
normal Sterilization don’t destroy Prions.> Prion could be passed from one patient to another on
contaminated Tonsillectomy instruments.