Acute tonsillitis

Dr. Barbara Pieper

Palatine tonsils

Palatine tonsils

• Each tonsil is an ovoid mass of lymphoid tissue

• Situated in the lateral wall of oropharynx between anterior and posterior pillars

Palatine tonsils

• Actual size is bigger than it appears from the surface

• Tonsils extend upwards in the soft palate , downwards into base of tongue,

• Anteriorly into palatoglossal arch

Palatine tonsils

• A tonsil presents two surfaces - a medial and a lateral

• And two poles an upper and a lower

Palatine tonsils

• The medial surface of the tonsil is covered by non-keratinising stratified squamous epithelium which dips into the tonsils in form of crypts (tube-like invaginations)

• The lateral surface presents as well defined fibrous capsule

• Foreign material is directly transported to the lymphoid cells via tonsillar crypts

Arterial supply of tonsil

Lymphatic drainage

• Drainage goes into upper deep cervical nodes particularly the iugulodigastric (tonsillar) nodes situated below the angle of mandible

Classification of tonsillitis

• Acute catarrhal or superficial tonsillitis, part of generalised pharyngitis

• Acute follicular tonsillitis, infection spreads into the crypts

• Acute parenchymatous tonsillitis, tonsil substance is affected, tonsil is uniformly enlarged and red

• Acute membranous tonsillitis, stage ahead of follicular tonsillitis

Aetiology of acute tonsillitis

Most commonly infecting organisms

- haemolytic streptococcus

- staphylococcus

- pneumococcus

- Haemophilus influenzae

Symptoms of acute tonsillitis

• Sore throat• Difficulty in swallowing - the child may

refuse to eat anything• Fever - from 38° to 40°C, may be

associated with chills and rigors• Earache• Constitutional symptoms include

headache, malaise, abdominal pain

Signs of acute tonsillitis

• Foetid breath, tongue coasted• Hyperaemia of pillars, soft palate and uvula• Tonsils are red and swollen with yellowish

spots (follicular) or whitish membrane (membranous)

• Tonsils may be enlarged and congested (parenchymatous)

• The iugulodigastric lymph nodes are enlarged and tender

Treatment of acute tonsillitis

• Patient is put to bed and encouraged to take plenty of fluids

• Analgesics (e.g.Paracetamol) to relieve local pain and bring down the fever

• Antimicrobial therapy for 7-10 days penicillin is the drug of choice, alternativly in case of penicillin-allergy erythromycin

Complications of acute tonsillitis

• Chronic tonsillitis• Peritonsillar abscess• Parapharyngeal abscess• Cervical abscess• Acute otitis media• Rheumatic fever• Acute glomerulonephritis• Subacute bacterial endocarditis

Differential diagnosis of membrane over the tonsil

• Diphteria slower in onsetless local discomfortmembrane is adherent and removal leaves a bleeding surfaceculture: corynebacterium diphteriae

• Vincent´s anginaless fever, less discomfortmembrane over one tonsilremoval leaves irregular ulcer under membraneculture: fusiform bacili, spirochaetes

Differential diagnosis of membrane over the tonsil

• Infectious mononucleosis - glandular fever

young adults affected both tonsils enlarged, congested,covered with membrane

marked local discomfortenlarged lymphnodes in posterior triangleof neck, hepato- and splenomegalycaused by Epstein-Barr virusfailure of antibiotic treatmentblood smear: 50% lymphocytes, 10% atypical

Differential diagnosis of membrane over the tonsil

• Agranulocytosis • Ulcerative necrotic lesions elsewhere in the

oropharynx• Total leucocytic count < 2000/cu mm• Patient is severely ill

• Aphtous ulcersany part of oral cavity

very painful

• Malignancy tonsil• Traumatic ulcer

any injury heals by formation of a membrane

Try to get a look inside