This document discusses the anatomy, causes, symptoms, diagnosis and treatment of tonsillitis. It describes the anatomy of the palatine tonsils and their location in the oropharynx. It explains that tonsillitis is commonly caused by bacterial or viral infections, and presents as sore throat, difficulty swallowing and fever. The types of acute tonsillitis - catarrhal, follicular and membranous - are outlined. Treatment involves rest, fluids, analgesics and antibiotics. Complications and differential diagnoses are also summarized.

1. TONSILLITIS
DEPT OF OTORHINOLARYNGOLOGY
JJM M C
DAVANAGERE

2. ANATOMY OF PALATINE TONSIL
 Paired structures situated in lateral wall of
oropharynx between anterior and posterior
pillars
 Consists of two surfaces (medial and lateral) and
two poles (upper and lower)
 Medial surface is covered by non keratinizing
stratified squamous epithelium
 There are 12-15 crypts on the medial surface
 Largest crypt is called crypta magna or
intratonsillar cleft

3. ANATOMY OF PALATINE TONSIL
 Lateral surface of tonsil presents a well defined
fibrous capsule
 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 seperated from the tongue by tonsilo-
lingual sulcus

4. ANATOMY OF PALATINE TONSIL

5. TONSILLAR BED
 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

6. BLOOD SUPPLY OF TONSIL

7. LYMPHATIC DRAINAGE
 Lymphatics pierce the superior constrictor
and drain into upper deep cervical (jugulo-
digastric) node

8. FUNCTIONS OF TONSIL
 It is the component of inner waldeyer’s
ring
 It has a protective role and acts as a
sentinal at portal of air and food passage
 Crypts increase the surface area for
contact with foreign substances

9. 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.influenzae
 Symptoms: sore throat, difficulty in
swallowing, fever, ear ache, constitutional
symptoms

10. ACUTE TONSILLITIS-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

11. Acute catarrhal/superficial

12. Acute follicular

13. Acute membranous

14. SIGNS
 Halitosis
 Coated tongue
 Congestion of pillars, soft palate and uvula
 Jugulo-digastric nodes enlarged and
tender
 Tonsils are congested and enlarged
depending on type of acute tonsillitis

15. TREATMENT
 Bed rest
 Plenty of oral fluids
 Analgesics
 Antimicrobial therapy penicillin
 In case of penicillin sensitivity macrolides
are given

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

17. DIFFERENTIAL DIAGNOSIS OF
MEMBRANE OVER THE TONSIL
 Membranous tonsillitis
 Diphtheria
 Vincents angina
 Infectious mononucleosis
 Agranulocytosis
 Leukaemia
 Traumatic ulcer
 Aphthous ulcer
 malignancy

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
 Chronic follicular tonsillitis
 Chronic parenchymatous tonsillitis : tonsils
are very much enlarged uniformly and
may interfere with speech, deglutition and
respiration, long standing cases may
develop pulmonary hypertension
 Chronic fibroid tonsillitis

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

21. SIGNS
 Tonsil may show varying degree of
enlargement depending on the type
 Irwin-moore sign pressure on the
anterior pillar expresses frank pus or
cheesy material  mainly seen in fibroid
type
 Flushing of the anterior pillar compared to
rest of the pharyngeal mucosa
 Enlargement of the jugulo-digastric node
 soft non tender

22. TREATMENT
 conservative management
 tonsillectomy

23. COMPLICATIONS
 Peritonsillar abscess
 Parapharyngeal abscess
 Retro pharyngeal abscess
 Intra tonsillar abscess
 Tonsillar cyst
 Tonsillolith
 Focus of infection for RF, AGN

24. Peritonsillar abscess

25. STYALGIA (EAGLE’S
SYNDROME)
 Due to elongated styloid process or
calcification of stylohyoid ligament
 Patient complains of pain in tonsillar fossa
and upper neck which radiates to
ipsilateral ear
 It gets aggravated on swallowing
 Diagnosis is by transoral palpation in
tonsillar fossa
 X-ray Townes view is helpful in diagnosis
 Treatment is by excision of styloid process
by transoral or cervical approach