TONSILLITIS IN CHILDREN

1. TONSILLITIS
AMRUTHA R

2. TONSILLITIS
• Inflammation of tonsils
• 3-7yrs

4. RESEARCH
• Health news of NHS choices
• Admission rates for tonsillectomy has
reduced between 1999 and 2010

5. Tonsils

8. WALDEYERS RING

9. TONSILS

10. TONSILLITIS DEFINITION
• Infection of tonsils which are glands on
either side of the throat.

11. CAUSES
• Bacterial
• Viral
• Infectious mononucleosis

12. Bacterial
• Group A beta hemolytic streptococcus
VIRAL
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Adenovirus
Rhinovirus
Influenza virus
Para influenza virus
Entero virus

13. Infectious mononucleosis
• Epstein barr virus

14. Types
ACUTE
• Catarrhal stage
• Follicular
• Parenchymatous
• Peritonsillar abscess/ quincy

15. Catarrhal
Follicular
Parenchymatous
Peritonsillar
abscess/ quincy

16. Chronic
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Repeated attacks
Enlarged spongy appearance
Fibrous tissue
Scarring of tissue
Adults

17. Pathophysiology

18. tonsillitis - pathogenesis
• disruption of the drainage function of the lacunae,
accumulation of a secretion and waste products of
microbes;
• disturbance of tissue metabolism in the tonsils;
• reduction of barrier properties of the tonsils, including
production of secretory immunoglobulins A;
• appearance of inflammatory reactions in the form of
frequent pain and metatonsillar complications.

19. Clinical features
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Frequent throat infections
Breathing difficulties
Dysphagia
Redness of anterior pillers
Breathing through mouth
Dry mucous membrane
Oedema

20. Clinical features
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Drooling
Fever
Loss of appetite
General feeling of unwell
Swollen tonsils
Change in sound

21. Clinical features
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Nausea vomiting
Abdominal pain
Furry tongue
Halitosis
Trismus

22. Local signs of tonsillitis
Unpleasant
mouth
odor
Unpleasant
feeling in
the throat
Lymph nodes
are small and
dense
Pus or tonsil
stones in
lacunae

23. Local signs of tonsillitis - changes
in the palatine arches
Hyperemia
Slight
swelling

24. Investigations
• History collection
• Physical examination

26. • Throat swab
• Blood tests
• ASO titre

27. Management
General measures
• Gargles
• Rest
• Hydration
• Foods
• Air
• Lozenges
• Avoid irritants

28. DRUGS
Analgesics
• Ibuprofen
• Acetaminophen
Antibiotics

29. ANTIBIOTICS
• Penicillin V 25-50 mg/kg/day divided q6h for
10d or
• Benzathine penicillin G 25,000 U/kg IM once
(maximum 1.2 million U) or
• Amoxicillin 50 mg/kg/day PO in 2 or 3
divided doses for 10d or

30. ANTIBIOTICS
• Amoxicillin-clavulanate 500-875 mg PO
q12h for 10d
• Cefdinir 14 mg/kg PO once daily for
10d or
• Cefuroxime axetil 10 mg/kg PO BD for 410d

31. ANTIBIOTICS
• Azithromycin 12 mg/kg PO once daily for
5d or
• Clarithromycin 250 mg PO q12h for
10d or
• Erythromycin succinate 20 mg/kg PO BID
for 10d or
• Clindamycin 20 mg/kg/day PO in 3
divided doses (maximum 1.8 g/d) for 10d

32. RESEARCH
• JOURNAL of antimicrobial chemotherapy
• Sept 1993- J HAMMIL

33. SURGICAL
MANAGEMENT

34. Surgery
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Indications
Obstructive sleep apnoea
Breathing difficulty
Absess
Dysphagia
Malignant growth

35. TONSILLECTOMY

36. METHODS
• Cold stress
• Diathermy
• Coblation
• Electrocautery

37. CARE AFTER SURGERY
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Antibiotics
Analgesics
Fluid intake
Food
Prevention of complications

38. COMPLICATIONS

39. Research
• Child health news in Feb. 2011
• Tonsillectomy increases the risk of
pediatric obesity
• 795 children selected

40. Nursing management
ASSESSMENT

41. DIAGNOSIS

42. INTERVENTION
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Promoting airway clearance
Maintaining fluid volume
Pain management
Prevent complications
Health education

43. Evaluation