TONSILLITISBURHANUDDIN SALIMDEPARTMENT OF OTORHINOLARYNGOLOGYHOSPITAL TAWAU

OUTLINE Anatomy Acute Tonsilitis Faucial Diphteria Chronic Tonsilitis Indications for surgery Summary

ANATOMY Weldeyer’s

ring “Tonsils” -

Palatine tonsils

ANATOMY

ANATOMY

ANATOMY

ANATOMY

ACUTE TONSILITIS Affects school-going children and

adults. Rare in infants and above 50 yo Types of acute tonsilitis

Acute superficial tonsitilits Acute follicular tonsilitis Acute parenchymatous tonsilitis Acute membraneous tonsilitis

ACUTE TONSILITIS Acute superficial tonsilitis

ACUTE TONSILITIS Acute follicular tonsilitis Acute membranous tonsilitis

ACUTE TONSILITIS - AETIOLOGY Haemolytic streptococcus Staphylococci, pneumococci,

H.influenza

ACUTE TONSILITIS - SYMPTOMS

Sore throat Odynophagia Fever – may be only symptom in a child Earache Constitutional symptoms

ACUTE TONSILITIS - SIGNS Foetid breath Hyperaemia of anterior pillar, uvula,

soft palate Coated tongue Red, swollen tonsils Tender jugulodigastric lymph nodes

ACUTE TONSILITIS - TREATMENT Bed rest Fluid intake Analgesics Antimicrobial – penicillin group, 7-10

days

Admission if unable to take orally

ACUTE TONSILITIS - COMPLICATIONS Chronic tonsilitis Peritonsillar abscess Parapharyngeal abscess Cervical abscess Acute otitis media Rare: rheumatic fever, AGN, SBE

ACUTE TONSILITIS - COMPLICATIONS

FAUCIAL DIPHTERIA Caused by Corynebacterium diphteriae

Rare Often in non-immunised children

Between 2-10 years of age Organisms multiply in throat causing

toxin Greyish-white adherent membrane

over tonsils, spreads to soft palate and PPW

FAUCIAL DIPHTERIA Patients usually ill, refuses to eat Cervical lymphadenopathy Investigations: throat swab, Schick’s

test Management

Secure airway if larynx involved Treat with antitoxin and antibiotics Isolation

FAUCIAL DIPHTERIA

CHRONIC TONSILITIS - AETIOLOGY Acute tonsilitis Subclinical tonsil infections Chronic sinusitis Chronic odontogenic infection

CHRONIC TONSILITIS – CLINICAL FEATURES

Recurrent sore throats or acute tonsilitis

Chronic cough Halitosis Thick speech Difficulty swallowing Choking spells at night

CHRONIC TONSILITIS - EXAMINATION Tonsils may be enlarged – kissing

tonsils Yellowish beads of pus Flushing of anterior pillars Enlargement of jugulodigastric nodes

CHRONIC TONSILITIS - TREATMENT General – diet, oral hygiene, treatment

of co-existent infections Tonsillectomy

CHRONIC TONSILITIS - COMPLICATIONS Peritonsillar abscess Parapharyngeal abscess Intratonsillar abscess Tosilloliths Tonsilar cysts

CHRONIC TONSILITIS - COMPLICATIONS

CHRONIC TONSILITIS - COMPLICATIONS

INDICATIONS FOR SURGERY Absolute Relative Part of another operation

ABSOLUTE INDICATIONS Recurrent tonsilitis

≥ 7 episodes in 1 year ≥ 5 episodes per year for 2 years ≥ 3 episodes per year for 3 years ≥ 2 weeks of lost school/work days in a

year Peritonsillar abscess

After 1 episode in children After 2nd episode in adults

ABSOLUTE INDICATIONS Febrile seizures Symptomatic hypertrophy of tonsils

Airway obstruction (OSA) Difficulty in degluttition Interference with speech

Suspicion of malignancy Unilateral tonsillar hypertrophy

(lymphoma, epidermoid carcinoma)

RELATIVE INDICATIONS Diphteria carriers Streptococcal carriers Chronic tonsilitis with halitosis or

unresponsive to medical treatment Recurrent streptococcal tonsilitis in a

patient with valvular disease

AS PART OF OTHER PROCEDURES Palatopharyngoplasty for OSA Glossopharyngeal neurectomy Removal of styloid process

SUMMARY Common condition Medical treatment mainstay of

management Think about diphteria in the non-

immunised child Indications for tonsillectomy – hence

ENT referral!

THANK YOU!!