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

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