1. TONSILLITIS
DEPT OF OTORHINOLARYNGOLOGY
JJM M C
DAVANAGERE

2. ANATOMY OF PALATINE TONSIL
 Paired structures situated in lateral wall of
oropharynx between anterior and posterior
pillars
 Consists of two surfaces (medial and lateral) and
two poles (upper and lower)
 Medial surface is covered by non keratinizing
stratified squamous epithelium
 There are 12-15 crypts on the medial surface
 Largest crypt is called crypta magna or
intratonsillar cleft

3. ANATOMY OF PALATINE TONSIL
 Lateral surface of tonsil presents a well defined
fibrous capsule
 Loose areolar tissue lies between the tonsillar
bed and the capsule, it is the site for collection of
pus in peritonsillar abscess (Quinsy)
 Upper pole of tonsil extends into soft palate, its
medial surface is covered by semilunar fold
plica semilunaris
 Lower pole of tonsil is attached to the tongue,
triangular fold of mucous membrane extends
from anterior pillar to antero-inferior part of tonsil
enclosing plica triangularis
 Tonsil is seperated from the tongue by tonsilo-
lingual sulcus

4. ANATOMY OF PALATINE TONSIL

5. TONSILLAR BED
 Formed by
 Loose areolar tissue containing paratonsillar
vein
 Pharyngo-basilar fascia
 Superior constrictor muscle
 Bucco-pharyngeal fascia
 Styloglossus
 Medial pterygoid muscle
 Glossopharyngeal nerve
 Facial artery

6. BLOOD SUPPLY OF TONSIL

7. LYMPHATIC DRAINAGE
 Lymphatics pierce the superior constrictor
and drain into upper deep cervical (jugulo-
digastric) node

8. FUNCTIONS OF TONSIL
 It is the component of inner waldeyer’s
ring
 It has a protective role and acts as a
sentinal at portal of air and food passage
 Crypts increase the surface area for
contact with foreign substances

9. ACUTE TONSILLITIS
 Mostly affects children in the age group of
5-15 years, may also affect adults
 Organisms  beta-hemolytic streptococci
(most common), staphylococci,
pneumococci, H.influenzae
 Symptoms: sore throat, difficulty in
swallowing, fever, ear ache, constitutional
symptoms

10. ACUTE TONSILLITIS-TYPES
 Acute catarrhal/superficial  here tonsillitis is a
part of generalized pharyngitis, mostly seen in
viral infections
 Acute follicular  infection spread into the crypts
with purulent material, presenting at the opening
of crypts as yellow spots
 Acute parenchymatous  tonsil in uniformly
enlarged and congested
 Acute membranous  follows stage of acute
follicular tonsillitis where exudates coalesce to
form membrane on the surface

11. Acute catarrhal/superficial

12. Acute follicular

13. Acute membranous

14. SIGNS
 Halitosis
 Coated tongue
 Congestion of pillars, soft palate and uvula
 Jugulo-digastric nodes enlarged and
tender
 Tonsils are congested and enlarged
depending on type of acute tonsillitis

15. TREATMENT
 Bed rest
 Plenty of oral fluids
 Analgesics
 Antimicrobial therapy penicillin
 In case of penicillin sensitivity macrolides
are given

16. COMPLICATIONS
 chronic tonsillitis
 peritonsillar abscess
 parapharyngeal abscess
 cervical abscess
 acute otitis media
 rheumatic fever
 acute glomerulo nephritis
 sub acute bacterial endocarditis

17. DIFFERENTIAL DIAGNOSIS OF
MEMBRANE OVER THE TONSIL
 Membranous tonsillitis
 Diphtheria
 Vincents angina
 Infectious mononucleosis
 Agranulocytosis
 Leukaemia
 Traumatic ulcer
 Aphthous ulcer
 malignancy

18. CHRONIC TONSILLITIS
 Aetiology:
 Complication of acute tonsillitis
 Sub clinical infection of tonsil
 Chronic sinusitis or dental sepsis
 Mostly affects children and young adults

19. TYPES OF CHRONIC
TONSILLITIS
 Chronic follicular tonsillitis
 Chronic parenchymatous tonsillitis : tonsils
are very much enlarged uniformly and
may interfere with speech, deglutition and
respiration, long standing cases may
develop pulmonary hypertension
 Chronic fibroid tonsillitis

20. CLINICAL FEATURES
 recurrent attacks of sore throat
 chronic irritation in throat with cough
 halitosis
 dysphagia
 odynophagia
 thick speech

21. SIGNS
 Tonsil may show varying degree of
enlargement depending on the type
 Irwin-moore sign pressure on the
anterior pillar expresses frank pus or
cheesy material  mainly seen in fibroid
type
 Flushing of the anterior pillar compared to
rest of the pharyngeal mucosa
 Enlargement of the jugulo-digastric node
 soft non tender

22. TREATMENT
 conservative management
 tonsillectomy

23. COMPLICATIONS
 Peritonsillar abscess
 Parapharyngeal abscess
 Retro pharyngeal abscess
 Intra tonsillar abscess
 Tonsillar cyst
 Tonsillolith
 Focus of infection for RF, AGN

24. Peritonsillar abscess

25. STYALGIA (EAGLE’S
SYNDROME)
 Due to elongated styloid process or
calcification of stylohyoid ligament
 Patient complains of pain in tonsillar fossa
and upper neck which radiates to
ipsilateral ear
 It gets aggravated on swallowing
 Diagnosis is by transoral palpation in
tonsillar fossa
 X-ray Townes view is helpful in diagnosis
 Treatment is by excision of styloid process
by transoral or cervical approach