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Tonsillitis
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- 2. ACUTE TONSILLITIS ◦ Acuteinflammatory condition of Faucial tonsils usually occurring in children, which may involve the mucosa, crypts, follicles or tonsillar parenchyma. ◦ ETIOLOGY: Bacteria: Beta- hemolytic Streptococcus Staphylococci Pneumococci Hemophilus influenzae Secondary to viral infections
- 3. TYPES ◦Acute catarrhal (Superficial Tonsillitis) ◦Acutefollicular tonsillitis ◦Acute parenchymatous tonsillitis ◦Acute membranous tonsillitis
- 5. SYMPTOMS Sore throat Odynophagia Fever (38-40°C)with chills and rigor Earache (referred otalgia <9thCN> or from Acute Otitis Media) Constitutional symptoms (headache, general body ache, malaise and constipation, abdominal pain –mesenteric lymphadenitis)
- 6. SIGNS • Dry coatedtongue and halitosis • Hyperemia of pillars, soft palate and uvula • Yellowish spots at opening of crypts (acute follicular tonsillitis) • Whitish membrane present which can be easily wiped away with a swab (acute membranous tonsillitis) • Congested and enlarged tonsils, which may meet in midline along with edema of uvula and soft palate (acute parenchymatous tonsillitis) • Enlarged and tender jugulodigastric lymph nodes
- 7. INVESTIGATIONS & TREATMENT Rapidstrep tests - Latex agglutination or ELISA methods extract antigen (group-A streptococcal) from a swab-highly specific ,but less sensitive Throat culture - Culture from swab from posterior pharynx and tonsillar area. Conservative • Bed rest with plenty of fluids • Analgesics to relieve local pain and bring fever down • Antibiotics for 7-10 days - Penicillin or amoxicillin (drug of choice) - Erythromycin in patients allergic to penicillin.
- 8. COMPLICATIONS • Chronic tonsillitiswith recurrent acute attacks (incomplete resolution or persistent of micro-abscess) • Peritonsillar abscess • Parapharyngeal abscess • Cervical abscess due of suppuration of jugulodigastric lymph nodes • Acute otitis media-seen in recurrent acute tonsillitis • Rheumatic fever- Group A- beta hemolytic Streptococci • Acute glomerulonephritis (rare) • Subacute bacterial endocarditis-Streptococcus viridans
- 9. CHRONIC TONSILLITIS ETIOLOGY ◦ Resultsfrom inadequately treated acute tonsillitis ◦ Subclinical infection of tonsils ◦ Predisposing factors: Chronic sinusitis Dental infection PATHOGENESIS Recurrent tonsillitis Minute abscess within lymphoid follicles Abscesses walled of fibrous tissue Surrounded by inflammatory cells Chronic tonsillitis (affects children & young adults commonly)
- 10. TYPES ◦Chronic follicular tonsillitis (infectedcheesy material in crypts- yellowish spots) ◦Chronic parenchymatous tonsillitis (hyperplasia of lymphoid tissue) ◦Chronic fibroid tonsillitis (small but infected with H/O repeated sore throats)
- 11. SYMPTOMS • History ofrecurrent sore throat or acute tonsillitis • Chronic irritation in throat with cough • Bad taste in mouth • Foul breath due to pus in crypts • Thick speech • Difficulty in swallowing • Choking spells in night
- 12. SIGNS • Nontender enlargementof jugulodigastric lymph nodes bilaterally • Yellowish beads of pus on medial surface (chronic follicular type) • Varying degree of tonsillar enlargement (chronic parenchymatous type) • Features of cor pulmonale (long-standing chronic parenchymatous type) • Small tonsils but express frank pus or cheesy material on pressing anterior pillar (chronic fibroid type) • Positive tonsillar squeeze (Ervin-Moore sign) Expression of purulent cheesy material from tonsillar crypts on pressure on anterior pillar
- 13. TREATMENT Conservative • Improvement ofgeneral health • Nutritious diet and vitamins • Antibiotics to control infection • Analgesics to relieve pain • Treatment of coexistent infections in nasal and oral cavity Operative • Tonsillectomy
- 14. COMPLICATION • Peritonsillar abscess •Parapharyngeal abscess • Intratonsillar abscess • Tonsilloliths • Tonsillar cysts • Septic foci for rheumatic fever, acute glomerulonephritis, ocular and dermatological disorders.