Tonsillitis is an inflammation of the tonsils, which are masses of lymphoid tissue located in the throat that help the immune system. The most common cause is a bacterial infection like streptococcus. Symptoms include sore throat, fever, earache. Treatment involves pain relief, antibiotics, and potentially tonsillectomy for chronic cases. Complications can include abscesses if left untreated. Chronic tonsillitis can lead to recurring sore throats and difficulty swallowing if infections are not resolved.

1. Dr Raju S N
PG SCHOLOR DEPARTMENT OF SHALAKYA TANTRA
SJGAYURVEDA COLLEGE KOPPAL
TUNDIKERI, TONSILLITIS

2. तुण्डिके रि
1.Tundikeri is explained under the talugata rogas by
sushrutha among the तालुगत िोग.
2.Acharya vagbhata explained under the कडट गत िोग
3.Acharya charaka explained under मुखिोग

3. Classical refferences ….
१)शोफ: स्थूलस्तोद दाह प्रपाकी प्रागुक्ताभ्ाां तुण्डिके ि मता तु I
सु .नि १६/४२
There will be swelling , its big in size , pricking type of pain
,burning sensation are the symptoms of tundikeri .
२) तुण्डिके रि वनकापपसिक तत्पलानुकाि व््ाधिि्म ्I
हनुिांध््ाधितः कां टे कापपिीफल िण्ननभः II
पपण्छिलो मांदरुक् शोफः कटटणस्तुण्डिके रिका III
अ.ह्रु.उ २१/४७
Due to vitiated kapha and raktha doshas it will cause big
cystic swelling resembling the fruit of vanakaarpasa , and the
complaints will be burning sensation ,pricking pain in the throat
with suppurative cyst.

4. धिककत्िा िूत्र
• The treatment modalities for tundikeri explained by our
acharyas in ayurveda is two types
• शमि चिकित्सा – shoolahara ,shotha hara , grandhi
hara aushadhi will subsides the tundikeri िवल ,गन्डूष ,
धूम ,िस्य.
• शस्र चिकित्स –
• तुण्डडिे रि अध्रुषे संघाते तलुपुप्पुटे I
एष एव ववचधिः िायय ववशेषिः शस्रिमयणि II su .chi २२/५७
• even though it can be cured by shasthra chikitsa but
Dalhana explains the treatment for the tundikeri as
bhedya sadhya vyadhi.
• तुण्डडिे िी भेध्य तालुपुप्पुटिोअवप I

5. YAVAKSHAARADI VATI

6. PANCHAVALKALA KWATHA

9. TONSILS
• The tonsils are masses of lymphoid tissue and form
an important part of our immune system located at
the gateway of respiratory and digestive tract.
• They act as the first line of defense against
ingested or inhaled pathogens.
• Four types of tonsils are arranged into a ring
around the oropharynx and nasopharynx , known
as Waldeyer’s ring of lymphoid tissue.

10. WALDEYERS RING
• Heinrich Wilhelm Gottfried von Waldeyer-Hartz first
described the incomplete ring of lymphoid tissue,
situated in the naso-oropharynx, in 1884. The ring
acts as a first line of defence against microbes that
enters the body via the nasal and oral routes.
Waldeyer’s ring consists of four tonsillar structures
as well as small collections of lymphatic tissue
disbursed throughout the mucosal lining of
the pharynx.

11. TYPES
• Tonsils are four types namely,
1. Pharyngeal
2. Tubal,
3. Palatine
4. Lingual tonsils.

12. 1. Pharyngeal Tonsil (Adenoids)
Situated superior-posteriorly to the torus tubaris
(elevation around the pharyngeal opening of
the Eustachian tube, in the roof of
the nasopharynx, the pharyngeal tonsil is
primarily responsible for ‘screening’ the air that
enters through the nostrils.
The pharyngeal tonsil is lined by pseudo-
stratified ciliated columnar
epithelium (respiratory epithelium). Unlike the
other tonsils, there are no crypts (invaginations
in the surface of the tonsil) present in this tonsil.

14. Blood supply and venous
drainage
• Blood supply to the pharyngeal tonsil arise from the
• ascending pharyngeal and palatine arteries.
• tonsillar branch of the facial artery.
• pharyngeal branch of the maxillary artery.
• artery of the pterygoid canal.
• basosphenoid artery.
• Venous blood is returned to circulation via the
pharyngeal plexus, which drains indirectly to the
internal jugular veins (IJV).

15. TUBAL TONSIL (Gerlach’s
Tonsils)
• The tubal tonsils are also located in the roof of
the nasopharynx. They are bilateral and posterior to the
torus tubaris, in the fossa of Rosenmüller (pharyngeal
recess). Due to the relative closeness of the tubal
tonsils to the torus tubaris, it is sometimes referred to
as “the tonsils of the torus tubaris”. The term “tubal
tonsils” is also synonymous with Eustachian tonsils and
Gerlach’s tonsils.
• These lymphoid structures are also lined by respiratory
epithelium; additionally, crypts are present and
infiltrated by lymphatic tissue.

17. BLOOD SUPPLY AND VENOUS
DRAINAGE
• Gerlach’s tonsils receive arterial blood by branches
of the sphenopalatine and the ascending pharyngeal
arteries. Lymphatic drainage is achieved via the
retropharyngeal and the deep cervical lymph nodes.

18. LINGUAL TONSIL
• The numerous protrusions located at the posterior
third of tongue are collectively known as the lingual
tonsils. They are also covered by stratified non-
keratinized squamous epithelium.

20. BLOOD SUPPLY AND VENOUS
DRAINAGE
• The dorsal lingual branch of the lingual artery and
the lingual vein are responsible for the vascular
supply and return of these lymphatic aggregates,
while the glossopharyngeal nerve innervates them,
along with the posterior of the tongue.

21. PALATINE TONSIL
• The palatine tonsils have been historically referred
to as “the tonsils.” They are readily visible in
the oropharynx when inflamed. These bilateral
lymphoid aggregates each rest within a tonsillar
cleft, bordered anteriorly by the palatoglossal
arch and posteriorly by the palatopharyngeal
arch. Unlike the adenoids, the palatine tonsils are
covered by stratified non-keratinized squamous
epithelium.

22. • They are two in number
• Each tonsil is an ovoid mass of
lymphoid tissue
• Tonsils are present in the lateral
wall oropharynx between the
anterior and posterior pillars.
• Actual the size of the tonsil is
bigger than the one that appears.as
it extend upwards into soft pallate
and downwards into the base of
tongue and anteriorly into
palatoglossal arch.

23. TONSIL PRESENTS……….
• Surfaces are two 1) Medial
2)Lateral
• Poles are two 1) Upper pole
2)Lower pole

24. MEDIAL SURFACE
• Is covered by non keratinizing stratified squamous
epithelium which dips into the substance of tonsil in
the form of crypts.
• 12-15 crypts are seen.
• Crypta Maghna .
• Secondary crypts arise from primary crypts.
• Crypts may be filled with cheesy materials
consisting of epithelial cells , bacteria , food debris.

26. LATERAL SURFACE
• It presents well defined fibrous capsule .
• There is loose areolar tissue between capsule and
bed of tonsil which makes easy to dissect during
the tonsillectomy.
• It is also the site for the collection of pus in
peritonsilar abscess.

27. UPPER POLE
• Upper pole of the tonsil extends into the soft
palate.
• Its medial surface is covered by semilunar fold ,
extending between anterior and posterior pillars and
enclosing a potential space called supratonsillar
fossa.

28. LOWER POLE
• The tonsil is attached to the tongue .
• The tonsil is separated from the tongue by a
sulcus called tonsillolingual sulcus.

29. BED OF TONSIL
• Its formed by superior constrictor and styloglossus
muscle.
• The glossopharyngeal nerve and styloid process ,if
enlarged may lie in relation to the lower part of
tonsillar fossa.
• Outside the superior constrictor ,tonsil is related to
the facial artery ,submandibular salivary gland
,posterior belly of digastric muscle ,medialpterygoid
muscle and the angle of the mandible.

30. BLOOD SUPPLY
• Tonsil is supplied by
• Tonsilar brnch of facial artery.
• Ascending pharyngeal artery from external carotid.
• Ascending palatine branch of facial artery.
• Dorsal lingual branches of lingual artery.
• Descending palatine branch of maxillary artery.

32. VENOUS DRAINAGE
Paratonsilar vein which joins the common facial vein
and pharyngeal venous plexus.

33. LYMPATIC DRAINAGE
• Tonsils drains into the jugulodigastric lymph node (
tonsilar )(deep cervical node )

34. NERVE SUPPLY
• lesser palatine branches of sphenopalatine
ganglion
• Glossopharyngeal nerve provides sensory nerve
supply

35. TONSILITIS
• Tonsillitis is inflammation of the tonsils,typically of
rapid onset.

36. TYPES OF TONSILITIS
Acute tonsilitis -
• Acute catarrhal or superficial tonsilitis –its part of
generalised pharyngitis its mostly seen in viral infections.
• Acute follicullar tonsilitis –infection spreadsinto the crypts
which become filled with the purulent material which
present at the opening of the crypts as yellowish.
• Acute parenchymatous tonsilitis –here tonsil substance is
affected. Tonsil is uniformly enlarged and red.
• Acute membranous tonsilitis – its later stage of acute
tonsilitis where there will be exudation from the crypts will
form a membrane over the tonsil.

38. AETIOLOGY
• Usually seen in childrens but we can see in adults
also.
• Less in the infants and the persons above the fifty
years .
• The usual causative organism of tonsilitis are
haemolytic streptococus is the most commonly
infecting organism .other organisms are
staphylococci, pneumococci or H.influenza.

39. SIGNS
• Breath is foetid
• Hyperaemia of pillars , soft pallate and uvula.
• Tonsils are red swollen yellowish spots filled with
purullent material.
• There may be membrane over the tonsil.
• Enlarged jugulodigastric lymphnodes.

40. SYMPTOMS
• Sore throat
• Fever
• Ear ache
• Constitutions symptoms like generalise myalgia
headache , abdominalpain due to mysentric
lymphedinitis , nausea,vomitting

41. TREATMENT
• Adviced to take plenty of water .
• Avoiding oily and cold beverages.
• Analgesics.
• Antimicrobial therapy.

42. COMPLICATIONS
• Chronic tonsillitis
• Peritonsillar abscess
• Parapharyngeal abscess
• Cervical abscess
• Acute otitis media
• Acute glomerlonephritis
• Sub acute bacterial endocarditis. –due to infection from
streptococcus viridans infection valvular disease
patient may end up in sub acute bacterial endocarditis.

43. DIFFERENTIAL DIAGNOSIS
• Membranous tonsilitis –it occurs due to pyogenic
organism. An exudate membrane will forms over
the medial surface of the tonsil.
• Diptheria –the membrane will be extends beyond
the tonsil on to the soft palate and is dirty and
grey incolour . On removal of the adhered
membrane leaves bleeding surface.
• c/s of throat swab will show corynebacterium
diptheriae.

45. • Vincent angina- the membrane can be
removed easily , on removal we can see
irregular ulcer on tonsil.
• On c/s of throat swab fusiform bacilli and
spirochaets.
• Infectious mononucleus- in this both tonsils
are very much enlarged, congested , and
covered with membrane .
• Splenomegaly noted , lymphonodes are
enlarged in posterior triangle of neck.

46. • Agranulocytosis –it presents with the
ulcerative necrotic lesions over the tonsil also
it may extends into the oropharynx.
• Leukamia
• Apthous ulcers –they may involve any part of
oral cavity of oropharynx.sometimes it may
involue tonsil also.. It may be small but its
painfull.
• Malignancy tonsil

54. CHRONIC TONSILITIS
• It may be the complication of the acute
tonsilitis.
• Subclinical infection of tonsils without an
acute attack.
• Chronic infection in the teeth and sinuses may
also be the pre disposing factor.

55. TYPES
• CHRONIC FOLICULAR TONSILITIS –the crypts
are full of infected cheesy material
• CHRONIC PARANCHYMATOUS TONSILLITIS –
There will hyperplasia of lymphoid tissue .
Tonsils are enlarged and interfere with the
speech , deglutition, and respiration.
• CHRONIC FIBROID TONSILLITIS-tonsils are
small but infected , with the history of
repeated sore throats.

56. CLINICAL FEATURES
• Recurrent attack of sore throat or acute
tonsillitis.
• Chronic irritation in throat with cough.
• Foul breath , bad taste .
• Thick speech , difficulty in swallowing.

57. ON EXAMINATION
• Tonsils may show varying degree of
enlargement.
• Yellowish beads of pus on the medial surface
of tonsil.
• Enlargement of jugulodigastric lymphnodes.
• Tonsils are small but pressure on the anterior
pillar expressfrank pus or cheesy material.

58. TREATMENT
• Conservative treatment
• Tonsillectomy

59. COMPLICATION
• Peritonsillar abscess
• Parapharyngeal abscess
• Intratonsillar abscess
• Tonsilloliths
• Tonsillar cyst
• Rhd , glomerulonephritis, eye and skin
diseases.

60. • TONSILLOLITHS- it is seen in chronic tonsillitis
when its crypt is blocked with retention of debris.
 Inorganic salts of calcium and magnesium are
then deposited leading to formation of stone.
• INTRATONSILLAR ABSCESS- It is accumulation of
pus within the substance of tonsil.
There will be blocking of the crypts opening.
• TONSILLAR CYST-it is due to blockage of tonsillar
crypt and appears as a yellowish swelling over
the tonsil.
It can be easily drained.