TONSILLITISTONSILLITIS

DEPT OF OTORHINOLARYNGOLOGYDEPT OF OTORHINOLARYNGOLOGY

J J M M CJ J M M C

DAVANAGEREDAVANAGERE

ANATOMY OF PALATINE TONSILANATOMY OF PALATINE TONSIL

Paired structures situated in lateral wall of Paired structures situated in lateral wall of oropharynx between anterior and posterior oropharynx between anterior and posterior pillarspillars

Consists of two surfaces (medial and Consists of two surfaces (medial and lateral) and two poles (upper and lower)lateral) and two poles (upper and lower)

Medial surface is covered by non Medial surface is covered by non keratinizing stratified squamous epitheliumkeratinizing stratified squamous epithelium

There are 12-15 crypts on the medial There are 12-15 crypts on the medial surfacesurface

Largest crypt is called crypta magna or Largest crypt is called crypta magna or intratonsillar cleft intratonsillar cleft

ANATOMY OF PALATINE TONSILANATOMY OF PALATINE TONSIL Lateral surface of tonsil presents a well Lateral surface of tonsil presents a well

defined fibrous capsule defined fibrous capsule Loose areolar tissue lies between the Loose areolar tissue lies between the

tonsillar bed and the capsule, it is the site tonsillar bed and the capsule, it is the site for collection of pus in peritonsillar abscess for collection of pus in peritonsillar abscess (Quinsy) (Quinsy)

Upper pole of tonsil extends into soft palate, Upper pole of tonsil extends into soft palate, its medial surface is covered by semilunar its medial surface is covered by semilunar foldfold plica semilunaris plica semilunaris

Lower pole of tonsil is attached to the Lower pole of tonsil is attached to the tongue, triangular fold of mucous tongue, triangular fold of mucous membrane extends from anterior pillar to membrane extends from anterior pillar to antero-inferior part of tonsil enclosing plica antero-inferior part of tonsil enclosing plica triangularistriangularis

Tonsil is seperated from the tongue by Tonsil is seperated from the tongue by tonsilo-lingual sulcus tonsilo-lingual sulcus

ANATOMY OF PALATINE TONSILANATOMY OF PALATINE TONSIL

TONSILLAR BEDTONSILLAR BED

Formed byFormed by Loose areolar tissue containing paratonsillar Loose areolar tissue containing paratonsillar

veinvein Pharyngo-basilar fasciaPharyngo-basilar fascia Superior constrictor muscleSuperior constrictor muscle Bucco-pharyngeal fasciaBucco-pharyngeal fascia StyloglossusStyloglossus Medial pterygoid muscleMedial pterygoid muscle Glossopharyngeal nerveGlossopharyngeal nerve Facial arteryFacial artery Submandibular salivary glandSubmandibular salivary gland

BLOOD SUPPLY OF TONSILBLOOD SUPPLY OF TONSIL

LYMPHATIC DRAINAGELYMPHATIC DRAINAGE

Lymphatics pierce the superior Lymphatics pierce the superior constrictor and drain into upper deep constrictor and drain into upper deep cervical (jugulo-digastric) nodecervical (jugulo-digastric) node

FUNCTIONS OF TONSILFUNCTIONS OF TONSIL

It is the component of inner It is the component of inner waldeyer’s ringwaldeyer’s ring

It has a protective role and acts as a It has a protective role and acts as a sentinal at portal of air and food sentinal at portal of air and food passagepassage

Crypts increase the surface area for Crypts increase the surface area for contact with foreign substances contact with foreign substances

ACUTE TONSILLITISACUTE TONSILLITIS

Mostly affects children in the age group Mostly affects children in the age group of 5-15 years, may also affect adultsof 5-15 years, may also affect adults

Organisms Organisms beta-hemolytic beta-hemolytic streptococci (most common), streptococci (most common), staphylococci, pneumococci, staphylococci, pneumococci, H.influenzaeH.influenzae

Symptoms: sore throat, difficulty in Symptoms: sore throat, difficulty in swallowing, fever, ear ache, swallowing, fever, ear ache, constitutional symptomsconstitutional symptoms

ACUTE TONSILLITIS-TYPESACUTE TONSILLITIS-TYPES Acute catarrhal/superficial here here

tonsillitis is a part of generalized tonsillitis is a part of generalized pharyngitis, mostly seen in viral infectionspharyngitis, mostly seen in viral infections

Acute follicular Acute follicular infection spread into the infection spread into the crypts with purulent material, presenting crypts with purulent material, presenting at the opening of crypts as yellow spotsat the opening of crypts as yellow spots

Acute parenchymatousAcute parenchymatous tonsil in tonsil in uniformly enlarged and congesteduniformly enlarged and congested

Acute membranousAcute membranous follows stage of follows stage of acute follicular tonsillitis where exudates acute follicular tonsillitis where exudates coalesce to form membrane on the surfacecoalesce to form membrane on the surface

Acute catarrhal/superficial

Acute follicularAcute follicular

Acute membranousAcute membranous

SIGNS SIGNS

Halitosis Halitosis Coated tongueCoated tongue Congestion of pillars, soft palate and Congestion of pillars, soft palate and

uvulauvula Jugulo-digastric nodes enlarged and Jugulo-digastric nodes enlarged and

tendertender Tonsils are congested and enlarged Tonsils are congested and enlarged

depending on type of acute tonsillitisdepending on type of acute tonsillitis

TREATMENTTREATMENT

Bed restBed rest Plenty of oral fluidsPlenty of oral fluids AnalgesicsAnalgesics Antimicrobial therapyAntimicrobial therapy penicillin penicillin In case of penicillin sensitivity In case of penicillin sensitivity

macrolides are givenmacrolides are given

COMPLICATIONSCOMPLICATIONS

chronic tonsillitischronic tonsillitis peritonsillar abscessperitonsillar abscess parapharyngeal abscessparapharyngeal abscess cervical abscesscervical abscess acute otitis mediaacute otitis media rheumatic feverrheumatic fever acute glomerulo nephritisacute glomerulo nephritis sub acute bacterial endocarditis sub acute bacterial endocarditis

DIFFERENTIAL DIAGNOSIS OF DIFFERENTIAL DIAGNOSIS OF MEMBRANE OVER THE TONSILMEMBRANE OVER THE TONSIL

Membranous tonsillitisMembranous tonsillitis DiphtheriaDiphtheria Vincents anginaVincents angina Infectious mononucleosisInfectious mononucleosis AgranulocytosisAgranulocytosis LeukaemiaLeukaemia Traumatic ulcerTraumatic ulcer Aphthous ulcerAphthous ulcer malignancymalignancy

CHRONIC TONSILLITISCHRONIC TONSILLITIS

Aetiology: Aetiology: Complication of acute tonsillitisComplication of acute tonsillitis Sub clinical infection of tonsilSub clinical infection of tonsil Chronic sinusitis or dental sepsisChronic sinusitis or dental sepsis

Mostly affects children and young Mostly affects children and young adultsadults

TYPES OF CHRONIC TYPES OF CHRONIC TONSILLITISTONSILLITIS

Chronic follicular tonsillitisChronic follicular tonsillitis Chronic parenchymatous tonsillitis : Chronic parenchymatous tonsillitis :

tonsils are very much enlarged tonsils are very much enlarged uniformly and may interfere with uniformly and may interfere with speech, deglutition and respiration, speech, deglutition and respiration, long standing cases may develop long standing cases may develop pulmonary hypertensionpulmonary hypertension

Chronic fibroid tonsillitisChronic fibroid tonsillitis

CLINICAL FEATURESCLINICAL FEATURES

recurrent attacks of sore throatrecurrent attacks of sore throat chronic irritation in throat with coughchronic irritation in throat with cough halitosishalitosis dysphagiadysphagia odynophagiaodynophagia thick speech thick speech

SIGNSSIGNS

Tonsil may show varying degree of Tonsil may show varying degree of enlargement depending on the typeenlargement depending on the type

Irwin-moore signIrwin-moore sign pressure on the pressure on the anterior pillar expresses frank pus or anterior pillar expresses frank pus or cheesy material cheesy material mainly seen in mainly seen in fibroid typefibroid type

Flushing of the anterior pillar Flushing of the anterior pillar compared to rest of the pharyngeal compared to rest of the pharyngeal mucosamucosa

Enlargement of the jugulo-digastric Enlargement of the jugulo-digastric node node soft non tender soft non tender

TREATMENTTREATMENT

conservative managementconservative management tonsillectomytonsillectomy

COMPLICATIONSCOMPLICATIONS Peritonsillar abscessPeritonsillar abscess Parapharyngeal abscessParapharyngeal abscess Retro pharyngeal abscessRetro pharyngeal abscess Intra tonsillar abscessIntra tonsillar abscess Tonsillar cystTonsillar cyst TonsillolithTonsillolith Focus of infection for RF, AGNFocus of infection for RF, AGN

Peritonsillar abscessPeritonsillar abscess

STYALGIA (EAGLE’S STYALGIA (EAGLE’S SYNDROME)SYNDROME)

Due to elongated styloid process or Due to elongated styloid process or calcification of stylohyoid ligamentcalcification of stylohyoid ligament

Patient complains of pain in tonsillar Patient complains of pain in tonsillar fossa and upper neck which radiates to fossa and upper neck which radiates to ipsilateral earipsilateral ear

It gets aggravated on swallowingIt gets aggravated on swallowing Diagnosis is by transoral palpation in Diagnosis is by transoral palpation in

tonsillar fossatonsillar fossa X-ray Townes view is helpful in diagnosisX-ray Townes view is helpful in diagnosis Treatment is by excision of styloid Treatment is by excision of styloid

process by transoral or cervical process by transoral or cervical approachapproach