This document discusses diseases of the tonsils and adenoids. It describes the anatomy and functions of the tonsils and adenoids. The tonsils and adenoids are part of the lymphatic system and help fight infections in children. Common diseases that can affect the tonsils include acute and chronic tonsillitis. Acute tonsillitis causes symptoms like sore throat and fever. Complications may include peritonsillar abscesses if not treated. Adenoids are located in the nasopharynx and can cause nasal obstruction if enlarged. Adenoidectomy is the surgical removal of enlarged adenoids.

1. DISEASES OF TONSILS AND
ADENOIDS
Dr. Junaid Shahzad
MBBS, FCPS
Senior Registrar
ENT department
ANMCH, Isra University
Islamabad Campus

2. Waldeyer's ring
Definition :
collection of lymphoid tissue scattered through out
the pharynx
Members of Waldeyer's ring are
1. Nasopharyngeal tonsil or the adenoids
2. Palatine tonsils or simply the tonsils
3. Lingual tonsil
4. Tubal tonsils ( fossa of rosenmuller)

4. • • Situated at the opening of the pharynx to the external
• environment, the tonsils and adenoid are in a position
• to provide primary defense against foreign matter.
• • produce lymphocytes
• • are active in the synthesis of immunoglobulins
• • Lymphoid tissue of Waldeyer ring is most
• immunologically active between 4 and 10 yr of age,
• with a decrease after puberty.
• • No major immunologic deficiency has been
• demonstrated after removal of either or both of the
• tonsils and adenoid.

5. Anatomy of tonsils
The word tonsil is derived from Latin word “Tonsilla”
meaning collection.
Types of tonsils
There are many tonsils in the body e.g.
Palatine Tonsil (faucial tonsils/Oropharyngeal tonsils)
Lingual Tonsil
Tubal Tonsil
Nasopharyngeal Tonsils (Adenoids)

8. Anatomy of tonsils
Location
lying in tonsillar/ Palatine fossa between Anterior &
posterior faucial pillars in the lateral wall of oropharynx.
Anterior Faucial pillar → Palato- glossus muscle
Posterior Faucial pillar → Palato- pharyngeus muscle

9. Blood supply of tonsil

10. Anatomy of tonsil
Lymphatic drainage
Jugulo-digastric (Tonsillar) nodes
Nerve supply Glossopharyngeal Nerve
Functions
a) Development of immunity in Childhood
b) Confine infection, its sampling & preventing its spread
c) Bread & butter for ENT surgeons

11. Acute tonsillitis :
Definition:
Acute infection of the Tonsils.
In many primary infection viral e.g adenovirus but bacteria are
Secondary invaders.
Disease of children: Age 5-6 years peak incidence

12. • Acute Infection
• • Symptoms :include odynophagia, dry throat,
• malaise, fever and chills, dysphagia, referred
• otalgia, headache, muscular aches, and enlarged
• cervical nodes.
• • Signs include dry tongue, erythematous enlarged
• tonsils, tonsillar or pharyngeal exudate, palatine
• petechiae, and enlargement and tenderness of
• the jugulodigastric lymph nodes

13. Types
• Acute catarrhal/superficial here tonsillitis is a part of
• generalized pharyngitis, mostly seen in viral infections
• • Acute follicular infection spread into the crypts with
• purulent material, presenting at the opening of crypts as
• yellow spots
• • Acute parenchymatous tonsil in uniformly enlarged
• and congested
• • Acute membranous follows stage of acute follicular
• tonsillitis where exudates coalesce to form membrane
• on the surface

16. Acute tonsillitis
Aetiology :
predisposing factors
A) Endogenous
local Pre- existing URTI
Ch. tonsillitis
Tonsillar remnant
General delibitating diseases
B) Exogenous
b) Over crowding
c) Poor nutrition
d) In adequate ventilation
e) Fatique and exposure to cold

17. Acute tonsillitis
II Exciting factors :
In many viruses are primary infective & bacteria secondary invaders where
as in others bact may be primary infective agent
Viruses :
Adenovirus, Resp syncyteal, Rhino viruses
Bacteria :
Streptococcus Haemolyticus 40%
Staph aureus, Pneumococi, H influenza
Anaerobes, Bacteriods
Pathology : Acute catarrhal
Ac follicular

18. Clinical features
Depends upon severity of infection & host resistance.
Local :
 Dryness in throat
 Pain in throat mild to severe
 Odynophagia
 Earache ……………… Otalgia
 Painful swelling in neck
Systemic :
 Fever mild to high accompanied with rigors
 Headache
 Pain & aches in body

19. Clinical features (Cont.)
Examination:
 Flushed face
 Mild Trismus
 Bad breath
 Tongue coated dirty white
 Tonsils-red, swollen, pus exudation may coalease
 J.D lymph nodes enlarged and tender
 Temp. raised
 Pulse rises in proportion to rise of temperature
(For each F◦ rise in temperature, pulse rises by
10 in number)

20. Investigations
1. Throat swab & culture sensitivity
2. TLC raised /DLC Neutrophils increased in number

21. Differential Diagnosis
Scarlet Fever
Diptheria
Vincent Angina
Thrush
Infectious Mononucleosis
Agranulocytosis
Keratosis of Tonsils

22. Treatment
Depends upon severity of infection.
Mild cases:
.Analgesics
.Warm salt water gargles

24. • Chronic Infection
• • Children with chronic or cryptic tonsillitis
• often present with halitosis, chronic sore
• throats, foreign body sensation, or a history of
• expelling foul-tasting and foul-smelling cheesy
• lumps.
• • Examination can reveal tonsils of almost any
• size and often they contain copious debris
• within the crypts

25. Severe cases
1. Bed rest
2. Analgesics and Antipyretics
3. Plenty of liquids especially warm
4. Antibiotics
Penicillin is a drug of the choice
Augmentin and 3rd generation cephalosporin are
very effective Antibiotic may be
changed according to c/s report

26. Complications
Local General
 Peritonsillar abscess
 Para-pharyngeal abscess
 Retro pharyngeal abscess
 Ac. laryngeal oedema
 Ac. Suppurative cervical
lymphadenitis
 Ac. Otitis media
 Tonsillar cyst
 Tonsillolith
 Ch. Tonsillitis
 Common with strep. Haemolyticus
 Ac. Glomerulonephrits
 Sub acute bacterio- endocarditis
 Rheumatic fever
 Exacerbation of Psoriasis
 Septicemia
 Myocarditis

27. Prognosis
8-10 days .
If not treated → High risk of complications.

28. Anatomy of Adenoids
(Nasopharyngeal tonsils)
Part of Waldeyer's ring
Surface epithelium — Ciliated columnar respiratory
epithelium
Location
Situated at the junction of roof &
Postero – superior wall
of Nasopharynx

29. Physiology of Adenoids
Adenoids tissue is present at birth
Clinically not visible up to 1 month of age
Detectable by 4 months of age
Physiological Hypertrophy : Between the ages of
2 to 8 years
Atrophy At puberty & almost completely disappears by
the age of 20 years, sometimes it may persist for a
longer period.

30. Blood supply of Adenoids
Ascending palatine branch of facial artery
Ascending pharyngeal branch of external carotid artery
Pharyngeal branch of the third part of maxillary artery
Ascending cervical branch of inferior thyroid artery of
thyrocervical trunk

31. Lymphatic drainage of Adenoids
1) Retro-pharyngeal lymph nodes
2) Para-pharyngeal lymph nodes

33. Adenoids conti. • Normally, in children.
• in the posterosuperior wall
of the Nasopharynx
• just above and behind
the Uvula
• usually absent in adults.
• lacking crypts.
• Pseudostratified Columnar
Ciliated Epithelium
• Moist cushion helps to filter
impurities out of the air

34. Microbiology:
Haemophilus influenzae
group A beta-hemolytic
Streptococcus
Staphylococcus aureus
Moraxella catarrhalis
and Streptococcus
Pneumonia

35. Signs & symptoms:
1) Nasal symptoms:
Nasal obstruction, Sinusitis
2) Aural symptoms:
Sec. Otitis media,
Conductive deafness
3) Oral / pharyngeal
symptoms
Mouth breathing, cough, PND,
Change in voice
4) General symptoms
Adenoid facies, Dull minded
cor-pulmonale

36. Adenoid Facies:
 Chronic nasal obstruction and mouth breathing due
to enlarged adenoids leads to typical appearance of
face called
“ Adenoid Facies”.
 Face is elongated
 Dull looking face
 Open mouth
 Prominent and crowded upper teeth
 High arched palate
 Hitched up upper lip
 Pinched nose (due to disuse atrophy of alae nasi)

37. DIAGNOSIS
History and clinical features
Post. Rhinoscopy
Flexible Naso-endoscopy
X-ray Post nasal space for soft tissues

39. Treatment:
 Medical treatment:
 Surgical treatment (Adenoidectomy)

40. Adenoid Curette

41. Position of Patient during Adenoidectomy

42. Adenoidectomy
Definition:
Removal of Adenoids
Indications
A) Adenoid hypertrophy causing recurrent rhino- sinusitis
B) Sleep Apnoea Syndrome
C) Adenoid with secretary Otitis media
D) Adenoid hypertrophy causing repeated attacks of ASOM
leading to CSOM
E) Abnormal dental occlusion

43. Adenoidectomy conti.
Contraindications:
A) Acute upper respiratory infection
B) Bleeding disorders
C) Cleft palate/Short palate/ Sub mucus Cleft palate
D) During Polio epidemics

44. Complications of Adenoidectomy
 Hemorrhage
 Eustachian tube injury
 Otitis media
 Regrowth of residual adenoid tissue
 Rhinolalia aperta
 Velopharyngeal insufficiency
 Nasopharyngeal stenosis
 Injury to Pharyngeal musculature and vertebrae

45. Complications IF NOT Treated
1) Sec . Otitis Media
2) Acute Suppurative Otitis Media
3) Chronic Suppurative Otitis Media