ENT-Throat infection-Tonsillitis

Throat infection :

TONSIL

• Tonsil is also called palatine tonsil.
• Paired structures situated in lateral wall of oropharynx between anterior and posterior pillars.
•  Consists of two surfaces (Medal and Lateral) and two poles (Upper and lower).
• There are 12-15 crypta magna or intratonsillar cleft.
• 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 absess (Quinsy).
• Tonsils are made-up of adenoids tissue that secretes lymphocytes and the main cause of tonsillitis is viral infection.
• Largest crypt is called crypta magna or intratondillar cleft.
  
  

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

Tonsillitis and Types

• Is the inflammation of the tonsils that can be acute,sub-acute and chronic due to causative factors affecting it.
•  The cause of Acute tonsillitis can either be bacterial infection or viral in origin.
• Subacute tonsillitis is caused by the bacterium actinomycin.
• Chronic tonsillitis can last for long periods  of time if not treated on time, and this is mostly caused by bacterial infection.

Acute Tonsillitis

• Mostly affected children in the age group of 5-15 years,may also affect adults 
• Organisms :Beta-hemolytic streptococci ( most common),Staphylococci,Pneumococci,  H.influenza.
• Symtoms:
• Sore throat,
• Difficulty in swallowing,
• Bad breath
• Fever,ear ache,constitutional symptoms.
• Yellow or white coating patches on the tonsils
• Enlargement of the lymp nodes.
• Malaise 
• Muffled or throaty voice.
• Difficulty while opeining of the mouth.

Types of Acute tonsillitis

• Acute catarrhal / superfical : Here tonsillitis is a part of generalized pharyngitis,mostly seen in viral infections.
• Acute follicular:    this tonsillitis occur  frequently  and 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 from membrane on the surface.

Acute catarrhal /Superficial

Aute follicular

Acute Membranous

Signs

• Halitosis
• Coated tongue
• Congestion of pillars,soft palate and uvula
• Jugulo-digastric nodes enlarged and tender
• Depending  on type of acute tonsillitis, tonsils are enlarged and congested 

Incubation Period:

• Acute tonsillitis is 72 hours.
• Sub-acute tonsillitis is 2-3 days.
• Chronic tonsillitis is 5-6 days.
• Recurrent tonsillitis is 1-2 weeks.

Diagnostic Procedures:

• Complete blood count for elevated white blood cells & Lymphocytes
• To identify streptococci and staphylococci infection buccal swab for culture and sensitivity should be done
• Clinical examination for symptoms.
• From patients history and clinical features.

Treatment

• Bed rest.
• Avoidance of the cold drinks, spicy and oily food.
• Keep hydrating the body by in take of fluids.
• Saline gargle (Mouth wash if needed)
• Analgesics
• Antipyretics & Increase fluid intake
• Antibiotic (Penicillin is drug of choice) but may use Erythromucin & Cefuroxime
• Tonsillectomy for recurrent chronic cases.

Complications

• Chronic tonsillitis
• Peritonsillar abscess
• Parapharyngeal abscess
• Cervical abscess
• Acute otitis media
• Rheumatic fever
• Acute glomerulo-nephritis
• Sub acute bacterial endocarditis.

Differential diagnosis of Membrane over the Tonsil

• Membranous tonsillitis
• Diphtheria
• Vincents,angina
• Infectious mononucleosis
• Agranulocytosis
• Leukaemia
• Traumatic ulcer
• Aphthous ulcer
• Malignancy

Chronoic Tonsillitis

• Complication of acute tonsillitis
• Sub clinical infection of tonsil
• Chronic sinusitis or dental spesis
• Mostly affects children and young adults

Types of Chronic Tonsillitis:

• Chronic follicular tonsillitis
• Chronic parenchymatous tonsillitis: 
• Chronic fibroid tonsillitis

Clinical Features

• Recurrent attacks of sore throat
• Chronic irritation in throat with cough
• Halitosis
• Dysphagia
• Odynophagia
• Thick speech

Signs

• Tonsil may show varying degree of enlargement depending on the type 
• Ir win-moore sign : Pressure on the anterior pillar express 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.

Treatment

• Conservative management
• Tonsillectomy

Complications

• Peritonsillar abscess
• Para pharyngeal abscess
• Retro pharyngeal abscess
• Intra tonsillar abscess
• Tonsillolith
• Focus of infection for RF,AGN

•