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).

1. PRESENTERS
RAJABU JUMANNE MLALUKO
STEPHANO PHABIANO
SWAUMU SHENI
ACUTE TONSILLITIS

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)

4. Cont….

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

6. Anatomy of Palatine tonsil

7. Tonsilar bed
Tonsilar bed is 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
 Submandibular salivary gland

8. Blood supply

9. Lymphatic drainage
 Lymphatics pierce the superior constrictor and
drain into upper deep cervical(jugulodigastric)
node

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.

13. Risk factors
 Pre-existing URTI
 Pre-existing chronic tonsillitis
 Sinusitis
 Low resistance; HIV, Immunosuppresant
 Ingestion of cold drinks and foods
 Foreign body
 Alcohol
 DM

14. Types of acute tonsillitis
 Acute catarrhal/superficial; here tonsillitis is
apart of generalized pharyngitis, mostly seen in
viral infections

15. Cont…
 Acute follicular ; infection spread into the crypts
with purulent material, presenting at the opening
of crypts as yellow spots

16. Cont..
 Acute parenchymatous ;tonsil in uniformly
enlarged and congested

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)

24. Complications
Suppurative comp.
1) Chronic tonsillitis
2) Peritonsillar abscess (Quinsy)
3) Retropharyngeal abscess
4) Mastoiditis
5) Internal jugular thrombophlebitis (Lemmiere
syndrome). Caused by Fusobacterium (oral
flora). Features; Neck pain, throat pain, fever,
respiratory distress
6) Otitis media
7) Parapharyngeal abscess

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

26. THANKS FOR YOUR ATTENTION