science

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ENT
Acute
Tonsillitis
Dr.Abobuker Nasser Al-kazmi

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Definition :
Acute inflammation of lymphoid tonsillar tissue.
Primary : The causative organism primarily infect the tonsil.
Secondary : may starts by viral infection then secondary bacterial infection
Pathology :
Acute infections of tonsil classified as :
1. Acute catarrhal tonsillitis.
2. Acute follicular tonsillitis.
3. Acute parenchymatous tonsillitis.
4. Acute membranous tonsillitis.
Etiology :
 Age  Often affects School-going children But also affects adults.
 Rare in Infants and Above 50 y
Causative organisms :
1. Group A betahaemolytic streptococcus are the commonest.
2. Staphyl-aureus,pneumococci and H.influenza.
Symptoms :
The symptoms vary with severity of infection.
1. Sore throat.
2. Difficulty in swallowing , odynophagia.
3. Fever 38-40 C may be +/- (chills, rigors)
4. Earache(referred pain or result of complication)
5. Constitution symptoms:-headache ,general body-ache , malaise ,anorexia
,constipation.
6. Change of voice(hot potato voice),if the tonsils are huge.

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Signs :
General :
High temperature with tachycardia proportion to fever ,patient looks ill.
Local :
1-Breath is Foetid and the tongue is coated.
2-Hyperemia and edema of pillars, soft palate and uvula.
3-Tonsils are red, congested and swollen as part of generalized pharyngitis (acute
catarrhal tonsillitis) and is mostly seen in viral infections.
 Yellowish white spots may be seen filling the Crypts(acute follicular tonsillitis).
 when exudation from crypts coalesces to form a non adherent yellowish
membrane on the surface of tonsil (acute membranous tonsillitis) .
 There is congestion and enlargement of the tonsil without pus formation (acute
Parenchymatous tonsillitis)
4-Enlarged tender upper deep cervical (juguldigastric) lymph node

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Tonsils meeting in the mid-line
 It is unusual for tonsils to meet in
the mid-line or to overlap.
 Lymphoid tissue of this bulk,
particularly during an acute
tonsillitis, may cause respiratory
obstruction and severedysphagia.
 There is an increased awareness of
theseverity of upper respiratory ract
obstruction from the bulk of
tonsillar and adenoid lymphoid
tissue.
Diagnosis :
 History.
 Examination.
 Investigation :
a. CBC - leucocytosis.
b. ESR - increase
c. ASOT -increase
d. SWAB
e. Rapid Antigen- testing
Complications :
1. Chronic tonsillitis.
2. Peritonsillar abscess(Quinsy).
3. Para pharyngeal abscess.
4. Cervical. abscess( jugulodigastric lymph nodes).
5. A cute otitis media, laryngitis and bronchitis.
6. Rheumatic fever.
7. Acute glomerulo- nephritis (rare).
8. Sub acute bacterial endocarditis (Strept-viridans)
9. Retro-Pharyngeal abscess,ludwings angina.

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Treatment :
1. Bed Rest+ Plenty of fluids.
2. Analgesics and antipyretics ( aspirin & paracetamol).
3. Antimicrobial therapy.
4. Antiseptic mouth wash.
5. Surgical (Tonsillectomy).
(( What is the indication of Tonsillectomy ?? ))