Tonsillitis

tonsillitis

Acute tonsillitis
Infection of the tonsil May effect any age group but most frequently found in children.

aetiology

Viral infection : 50% influenza ,parainfluenza,adenovirus, & rhinovirus Bacterial infection: - B-haemolytic streptococcus - Strept.pneumonia, - H influenzae - Staph. Aureus - Moraxella catarrahlis - Anaerobic organisms

Pathology:

Acute paranchymatous type: whole ts. is infected causing generalized swelling , reddened & edematous surface.

2. Acute follicular ts. : crypts of ts. Filled with pus giving spotted appearance

Clinical features:
Sorethroat Pyrexia Odynophagia Malaise Earache Thickened speech In severe cases rigor & signs of toxaemia Appendicitis may simulated/ mesenteric adenitis.

Examination:

Congested & enlarged ts. Congested pillars. Spots of pus or fibrin fill the crypts Furred tongue & halitosis Enlarged tender cx Ln.

Investigation:

Throat swab for c/s Throat swab for K.L.B. Blood film / mono spot test (I.m.n.)

DDX:

Scarlet fever Diphtheria Vincent`s infection Agranulocytosis I.M.N. ( glandular fever)

Treatment:

Bed rest , soft diet ,fluid intake Analgesic drug Systemic AB.

Complications:

Peritonsillar abscess Parapharyngeal abscess Retropharyngeal abscess Edema of the larynx Acute rheumatism Acute nephritis Septicemia Acute OM.



Recurrent acute tonsillitis
Clinical features: 1. persistent or recurrent sore throat 2. marked ts. enlargment. 3. injected ant. pillars 4. halitosis 5. persistent cx. adenitis. treatment: tonsillectomy

tonsillectomy

Indications: 1- recurrent ts. : 6//1 year or 3//2 years 2- recurrent episodes of peritonsillar abscess 3- suspected neoplasm ( unilat enlargement,or ulceration)

Contraindications:

Recent ts. infection or URTI Bleeding disorders Using of contraceptives Cleft palate Epidemics of poilo

Complications of tonsillectomy:

Peroperative: 1- anaesthetic reaction 2- haemorrhage 3- damage to teeth, uvula, or to post. Pharyngeal wall 4- dislocation of the temporomandibular joint

B. Post operative:

Anaesthetic complicationsReactionary hemorrhage / 1st,24hsSecondary haemorrhage / 5th – 10th dayInfection of the ts. bedEarachePneumoniaTonsillar remnant

Post ts, haemorrhage

Reactionary (primary): secondary



Reactionary haemorrhage:
~2% Within 24hs Signs of the bleeding : - obvious bleeding - gurgling sound in throat on breathing - repeated swallowing - vomiting - rising pulse rate & lowering of the Bp.

Management:

Blood sample for cross matching IV, infusion Identifying the bleeding site Application of 1:1000 adrenaline soaked gauze or using hydrogen peroxide gurgle for 20 minutes If failed >>> 2nd anaesthesia >>stop the bleeding

Secondary haemorrhage

5th- 10th day Infection R/: admission & observation Blood for cross match AB. Removal of the clot , H2O2 gargle>>20minutes .if failed>> adrenaline socked gauze>>20minutes If failed 2nd anesthesia suturing the pillars .

Peritonsillar abscess(quinsy)

Def; pus collects between ts. & sup. cons.m. Aetiology; - follows tonsillitis - mostly unilateral

Clinical features:

examination
Marked hyperaemic edematous tonsil and palatal region Oedematous uvula & pushed towards other side

complications

Parapharyngeal abscess Oedema of the larynx Septicemia

treatment

1. Conservative in early stage( cellulitis) - rest , AB. , analgesia 2. Surgery : - incision of the abscess - abscess-tonsillectomy