ACUTE TONSILLITIS

Anatomy of palatine tonsils:*Consists of paired aggregates of lymphoid tissue

*Located in the pocket formed by the palatoglossus and palatopharyngeus muscles and the overlying fold of mucosa,which make up the

ant & post pillars.

*Two surfaces(medial, lateral),

two Pole(upper ,lower).

• Supratonsillar fossa.

•Anterior tonsillar space.

•Bed of the tonsil.

Primary &secondary crypts.

Bed of the tonsil.

Blood supply

Venous drainage :Paratonsillar vein.

Lymphatic drainage:Drain into jugulodigastric node.

Nerve supply:Lesser palatine branches of sphenopalatine

ganglion and glossopharyngeal nerve provide sensory nerve supply.

FUNCTIONS OF TONSILS:

Providing local immunity Providing a surveillence mechanism so

that the entire body is prepared for defence.

Tonsilitis :Inflammation of the tonsil due to bacterial or viral infection causing sore throat, difficulty in swallowing and fever is called tonsillitis.

•Acute tonsillitis

• Subacute tonsillitis

•Recurrent tonsillitis

•Chronic tonsillitis

Aetiology :

Most commonly: Group A β Haemolytic streptococcus.

Others:StaphylococciPneumococciH.influenzae . secondary to viral infection.

surface epithelium

Tonsil crypts

lymphoid tissue

Acute Infection of tonsil involve all these components.

Classification:Acute catarrhal or superficial tonsillitis.

Acute follicular tonsillitis.

Acute parenchymatous tonsillitis.

Acute membranous tonsillitis.

Acute catarrhal /superficial tonsillitis:

Acute follicular tonsillitis:

Acute parenchymatous tonsillitis :

Acute Membranous tonsillitis:

Symptoms: Sore throat

Fever Malaise

•Odynophagia .

• Ear ache .

Signs :

•Breath is foetid and tongue coasted.

•Hyperaemia of pillars ,soft palate and uvula.

• Tonsil red and swollen with yellowish spots (acute follicular tonsillitis),whitish membrane (acute membranous tonsillitis).

• Jugulodigastric lymph node –enlarged and tender.

Clinical evaluation:•Diagnosis of acute tonsillitis is clinical.

•Based on the h/o pyrexial illness , sore throat with difficulty in swallowing and the finding of pharyngeal erythema with/without tonsillar exudates and painful cervical adenopathy (Jugulodigastric lymphnode).

GRADING :

I. Congested tonsil within the tonsillar fossa

II. Enlarged tonsil uptil the rim of the tonsillar fossa, posterior pillar is visible .

III. Beyond the posterior pillar without touching each other

IV. Kissing tonsil/ touching each other

Management :

INVESTIGATIONS:

Blood tests:

Hb , AEC,DLC,TLC,ESR,BT,CT, groping. Throat swab & culture for sensitivity . x ray nasopharynx to rule out adenoid

hypertrophy .

Primary management :Management is supportive ,

• Adequate hydration.

• Analgesia .(paracetamol -0.3-0.6g 6-8hourly,

child -10-15mg/kg)

• Antimicrobial therapy .

amoxicillin / amoxicillin +clavulinic acid.

adult:1.2gm BD i.v , 625mgBD orally.

child: 625mg i.v , 375mgBD orally.

• Warm salt water gargle,

• encouraged to drink warm water.

• avoid cold food.

Complications :a) Chronic tonsillitis

b) Peritonsillar abscess

c) Retropharyngeal abscess

d) Parapharyngeal abscess

e) Acute otitis media

f) Rheumatic fever

g) Acute glomerulonephritis

h) Subacute bacterial endocarditis.

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