The document discusses the anatomy, functions, and types of acute and chronic tonsillitis. It describes the location and structures of the palatine tonsils. Acute tonsillitis is usually caused by bacterial or viral infections and causes sore throat, fever, and difficulty swallowing. It can be superficial, follicular, membranous, or parenchymatous. Chronic tonsillitis is a complication of repeated acute infections and can be follicular, parenchymatous, or fibroid. Symptoms include recurrent sore throats and tonsil enlargement may require tonsillectomy.

1. Acute & Chronic Tonsillitis

2. Introduction
• The palatine tonsil is an ovoid mass of lymphoid tissue located in the
oropharynx between the anterior and posterior pillars
• It has 2 surfaces –
1. medial surface
2. lateral surface
It has 2 poles –
1. upper pole
2. lower pole

3. Medial surface
• It is lined by stratified squamous non
keratinising epithelium which dips into the crypts
• The crypts are 12-15 in number
• Secondary crypts arise from the primary crypts and
extend into the substance of the tonsil
• One of the crypts located in the upper part is larger
than the rest – crypta magna
• The crypts serve to increase the surface area of the
tonsil
• The crypts may be filled with cheesy material –
epithelial debris, food particles and bacteria

4. Lateral surface
• It is covered by the fibrous capsule of the tonsil
• The tonsillar bed is separated from the capsule by loose
areolar tissue
• This makes it is easy to dissect the tonsil from its bed
during tonsillectomy
• It is the site of collection of pus in peritonsillar
abscess(quinsy)
• Some fibers of palatoglossus and palatopharyngeus
muscles get attached to the capsule of tonsil

5. Upper pole
• It extends into the soft palate
• There is a semilunar fold of mucous membrane which covers the
medial part of the upper pole
• It extends from anterior pillar to posterior pillar
• It encloses a potential space – supratonsillar fossa

6. Lower pole
• It is attached to the tongue
• A triangular fold of mucous membrane extends from the anterior tonsillar
pillar to the lower pole
• It encloses a space – anterior tonsillar space
• The lower pole is separated from the tongue by the tonsillo-lingual sulcus
• This sulcus may harbour carcinoma

7. Structures related to the
bed of tonsils

9. Function on tonsils
• It has a protective function in that it prevents
entry of pathogens through the nasal and
oral route
• The crypts on the surface of the tonsil serve
to increase the surface area and increase the
efficiency of protection against pathogens
• It forms a part of Waldeyer’s lymphatic Ring.

10. Tonsillitis
• Inflammation 0f tonsils due
to bacterial or viral infection
causing a sore throat , fever,
and difficulty in swallowing is
called tonsillitis.
• There are 2 types of
1.Acute tonsillitis
2. chronic tonsillitis

11. 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.influenza
• Symptoms: sore throat, difficulty in swallowing,fever, ear ache,
constitutional symptoms

12. Types of acute
tonsillitis
• 1).Acute catarrhal/superficial -
tonsillitis is a part of generalized
pharyngitis, mostly seen in viral
infections

13. 2).Acute follicular infection spread into
the crypts with purulent material,
presenting at the opening of crypts as
yellow spots.

14. 3).Acute membranous follows stage
of acute follicular tonsillitis where
exudates coalesce to form
membrane on the surface

15. 4).Acute parenchymatous tonsil is
uniformlyenlarged and congested

16. TREATMENT
• Bed rest
• Plenty of oral fluids
• Analgesics
• Antimicrobial therapy penicillin
• In case of penicillin sensitivity
• erythromycin are given.
• Antibiotics should be continued for 7-10days

17. COMPLICATIONS
• chronic tonsillitis
• peritonsillar abscess
• parapharyngeal abscess
• cervical abscess
• acute otitis media
• rheumatic fever
• acute glomerulo nephritis
• sub acute bacterial endocarditis

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
• 1). Chronic follicular tonsillitis tonsillar crypts are full of
cheesy material resulting in yellow spots on the surface.
• 2). Chronic parenchymatous tonsillitis tonsils are very
much enlarged almost touching each other and may
interfere with speech,deglutition and respiration, long
standing cases may develop pulmonary hypertension

20. 3).Chronic fibroid tonsillitis Tonsils are small but infected , with history
of repeated sore throat.

21. CLINICAL FEATURES
• recurrent attacks of sore throat
• chronic irritation in throat with cough
• halitosis
• dysphagia
• odynophagia
• thick speech

22. Examination
• Tonsil may show varying degree of enlargement
depending on the type
• Irwin-Moore sign tonsils are small but pressure on the
anterior pillar expresses pus or cheesy material mainly
seen in fibroid type
• There may be yellowish beads of pus on the medial
surface of tonsils chronic follicular tonsillitis
• Flushing of the anterior pillar compared to rest of the
pharyngeal mucosa
• Enlargement of the jugulo-digastric node soft non
tender

23. Treatment
Conservative management
• Pay attention to the general health ,diet, and treatment of co-
existent infections of teeth , nose , and sinuses.
Tonsillectomy
• when recurrent attacks , interference with speech , deglutination &
respiration.