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Tonsilitis
- 1. TONSILLITIS BURHANUDDIN SALIM DEPARTMENT OF OTORHINOLARYNGOLOGY HOSPITAL TAWAU
- 2. OUTLINE Anatomy Acute Tonsilitis Faucial Diphteria Chronic Tonsilitis Indications for surgery Summary
- 3. ANATOMY Weldeyer’s ring “Tonsils” - Palatine tonsils
- 4. ANATOMY
- 5. ANATOMY
- 6. ANATOMY
- 7. ANATOMY
- 8. 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
- 9. ACUTE TONSILITIS Acute superficial tonsilitis
- 10. ACUTE TONSILITIS Acute follicular tonsilitis Acute membranous tonsilitis
- 11. ACUTE TONSILITIS - AETIOLOGY Haemolytic streptococcus Staphylococci, pneumococci, H.influenza
- 12. ACUTE TONSILITIS - SYMPTOMS Sore throat Odynophagia Fever – may be only symptom in a child Earache Constitutional symptoms
- 14. ACUTE TONSILITIS - SIGNS Foetid breath Hyperaemia of anterior pillar, uvula, soft palate Coated tongue Red, swollen tonsils Tender jugulodigastric lymph nodes
- 15. ACUTE TONSILITIS - TREATMENT Bed rest Fluid intake Analgesics Antimicrobial – penicillin group, 7-10 days Admission if unable to take orally
- 16. ACUTE TONSILITIS - COMPLICATIONS Chronic tonsilitis Peritonsillar abscess Parapharyngeal abscess Cervical abscess Acute otitis media Rare: rheumatic fever, AGN, SBE
- 17. ACUTE TONSILITIS - COMPLICATIONS
- 18. 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
- 19. 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
- 21. CHRONIC TONSILITIS - AETIOLOGY Acute tonsilitis Subclinical tonsil infections Chronic sinusitis Chronic odontogenic infection
- 22. CHRONIC TONSILITIS – CLINICAL FEATURES Recurrent sore throats or acute tonsilitis Chronic cough Halitosis Thick speech Difficulty swallowing Choking spells at night
- 23. CHRONIC TONSILITIS - EXAMINATION Tonsils may be enlarged – kissing tonsils Yellowish beads of pus Flushing of anterior pillars Enlargement of jugulodigastric nodes
- 25. CHRONIC TONSILITIS - TREATMENT General – diet, oral hygiene, treatment of co- existent infections Tonsillectomy
- 26. CHRONIC TONSILITIS - COMPLICATIONS Peritonsillar abscess Parapharyngeal abscess Intratonsillar abscess Tosilloliths Tonsilar cysts
- 27. CHRONIC TONSILITIS - COMPLICATIONS
- 28. CHRONIC TONSILITIS - COMPLICATIONS
- 29. INDICATIONS FOR SURGERY Absolute Relative Part of another operation
- 30. 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
- 31. 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)
- 32. RELATIVE INDICATIONS Diphteria carriers Streptococcal carriers Chronic tonsilitis with halitosis or unresponsive to medical treatment Recurrent streptococcal tonsilitis in a patient with valvular disease
- 33. AS PART OF OTHER PROCEDURES Palatopharyngoplasty for OSA Glossopharyngeal neurectomy Removal of styloid process
- 34. SUMMARY Common condition Medical treatment mainstay of management Think about diphteria in the non-immunised child Indications for tonsillectomy – hence ENT referral!
- 35. THANK YOU!!
Notes de l'éditeur
- Assalamualaikum and good afternoon, my name is burhan, MO from ENT and today I will be talking about tonsillitis
- We will start with an overview of the anatomy of the tonsils, followed by a walkthrough of acute and chronic tonsilitis, we will also touch on faucal diphteria which is especially important in the paediatric population, and we will also talk about when surgery is warranted, whch also means, when should an ENT referral be done
- The tonsils are located in the pharynx, and actually are a group of lymphoid tissue scattered in the pharynx. They form what is known as the Weldeyer’s ring. As u can see, what we normally refer to as the tonsils are acgtually the palatine tonsils, theres also the lingual tonsils, the pharyngeal tonsils or also known as the adenoid, and other bands of tissue. Palatine tonsils drain to the JD nodes so you alsmost always get a tender LN with tonsilitis.
- This are the tonsils as seen from a throat examination, bounded anteriorly by the ant pillar or the palatoglossal arch, and posteriorly by the posterior pillar or the palatopharyngeal arch. What u see is actualy only a part of the palatine tonsils, because as u can see it extendes upwards to the soft palate, downwards to the base of tongue, and anteriorly along the palatoglossal arch.
- This is a cross section of the right palatine tonsil. Medial wall is made of stratified squamous epithelieum, which dips into the substance of the tonsils as crypts. Inside these crypts are the lymphoid tissues.These can be filled with debris and cheesy material. The lateral wall is actually a fibrous capsule, inside of which are loose areolar tissue, which can be affected by infection causing peritonsillar and parapharygeal abscess, both of which area complications of tonsilitis.
- The bed of the tonsil is what we see after the tonsil is removed. As u can see there are many structures related the tonsillar bed. Of interest are the glossopharyngeal nerve and the styloid process, both of which can be surgically approached after removal of tonsils.
- Blood supply of the tonsil is via 5 arteries, main one being the tonsillar artery from the facial artery. Other are the dorsal linguae,…. That’s why bleeding can be disastrouous in tonsil surgery
- Surface epithelieum in continuity with oropharyngeal lining, crypts, and the lymphoid tissues.
- This is a very rare condition these days considering the effectiveness of the universally administered vaccinations under the immunization schedule.