1. TONSILLITIS
-Vandana

2. The tonsils
Tonsils are subepithelial collections of
lymphoid tissue scattered in the pharynx.
Anatomically the tonsils are classified
based on their location into : palatine
(faucial), nasopharyngeal (“adenoids”),
lingual and tubal tonsils.
Generally, the palatine tonsils referred to as
“the tonsils”.

3. The Waldeyer’s ring is formed by :
1. Palatine tonsils
2. Nasopharyngeal tonsil
3. Lingual tonsils
4. Tubal tonsils
5. Lateral pharyngeal bands
6. Posterior pharyngeal nodules

4. Embryology
The tonsils develop from the
second pharyngeal pouch.
In the extraembryonic life, the
ventral part of the 2nd
pharyngeal pouch is represented
by crypta magna or intratonsillar
cleft.

5. Anatomy of tonsils
*Site: lateral walls of oropharynx, between the anterior and
posterior pillars- tonsillar fossa
*Shape: almond shape
*2 surfaces: medial, lateral
*2 poles: upper, lower
* 10-12 primary crypts,
secondary crypts
*Plica semilunaris and plica triangularis

6. Relations
Anterior: anterior pillar
Posterior: posterior pillar
Superior: soft palate
Inferior: tongue
Medial: cavity of the oropharynx
Lateral: loose areolar tissue, paratonsillar veins, superior
constrictor, buccopharyngeal fascia, glossopharyngeal nerve,
facial artery, pterygoid muscles and the mandible.

7. Transverse section showing right tonsil from above

8. Blood Supply and Venous Drainage
Blood supply
- Tonsillar branch of
facial artery
- Ascending pharyngeal
artery
- Descending lingual
artery
- Greater palatine artery
Venous drainage:
paratonsillar vein
pharyngeal plexus of
veins

9. Lymphatic drainage:
The tonsils do not
have any afferent
vessels but has
efferents which drain
into the Jugulo-
digastric nodes.
Nerve supply:
Glossopharyngeal nerve
and lesser palatine nerves.

10. Histology
- True fibrous capsule
- Fibrous septa
- Crypts lined by stratified
squamous epithelium
- Lymphoid nodules:
germinal centres – B
cells and plasma cells;
surrounded by T cells.

11. Functions of Tonsils
1. Immunity
2. Lymphocyte formation
3. Antibodies formation
4. Barrier to infections

12. What is
tonsillitis ?
Tonsillitis is inflammation of the tonsils most commonly caused
by a viral or bacterial infection.

13. Types
Acute tonsillitis Chronic tonsillitis
Tonsillitis is often labelled as acute, sub-acute, or chronic.
Acute tonsillitis tends to be bacterial or viral in nature, while
sub-acute tonsillitis is caused by the bacterium Actinomyces.
Chronic tonsillitis generally lasts for a long time and is caused
by bacteria.
Sub-acute

14. Acute Tonsillitis
- Acute infection of the tonsils involving the surface epithelium,
crypts and lymphoid tissue
Acute superficial tonsillitis
Acute follicular
tonsillitis
Acute
parenchymatous
tonsillitis
Acute membranous tonsillitis

15. Predisposing factors
Endogenous
- URTI
- Postnasal discharge due to
sinusitis
- Residual tonsillar tissue after
tonsillectomy
- Exanthemata
- Blood dyscrasias
Exogenous
- Cold drinks and foods
- Contact with infected
persons
- Crowded and ill-
ventilated environment
- Imbedded foreign body

16. Etiology
Although tonsillitis can occur at any age, school-going children
are much more likely to suffer from the condition.
In fact, tonsillitis is more common in an environment where
people are in close contact and germs can be easily spread.
*Haemolyticus streptococcus
*Staphylococci
*Pneumococci
*H.influenzae
Primary infection
Secondary infection

17. Symptoms and Signs
Symptoms:
1. Sore throat – raw sensation in the throat
2. Refusal to eat due to odynophagia
3. Earache – either referred pain from the tonsil
or due to acute otitis media
4. Voice becomes thick and muffled
5. Jugulodigastric nodes are enlarged and painful
6. Fever, may be associated with chills and rigor.
Headache, tachycardia.

18. Signs:
1.Tonsils appear congested and swollen
- Yellowish spots – follicular
- Whitish membrane – membranous
- Red and enlarged – parenchymatous
2.Hyperemia of pillars, uvula, soft palate
3.Halitosis, impeded movements of palate
and increased secretions
4.Enlarged and tender jugulodigastric
nodes

19. Acute follicular
tonsillitis
Acute
catarrhal or
superficial
tonsillitis
Acute
membranous
tonsillitis

20. Treatment
1. Bed rest, soft diet, plenty of fluids, warm
saline gargles
2. Analgesics- aspirin, paracetamol; lozenges
3. Antimicrobial therapy- penicillin,
erythromycin; for 7 to 10days

21. Complications
1. Chronic tonsillitis – incomplete resolution
of acute tonsillitis
2. Peritonsillar abscess
3. Parapharyngeal abscess
4. Acute otitis media – recurrent attacks
5. Cervical abscess due to suppuration of
jugulodigastric nodes
6. Rheumatic fever – group A B-hemolytic
streptococci
7. Subacute bacterial endocarditis (patients
with valvular heart disease) – streptococcus
viridans

22. Chronic Tonsillitis
- Characterised by recurrent acute attacks
Etiology:
1. Recurrent acute tonsillitis
2. Subclinical infection of tonsils
3. Chronic infection in sinuses or teeth

23. Pathology
1. Keratinous plug presses the adjacent
epithelium and lymphoid tissue- causing
their atrophy.
2. When many plugs are present they
produce an appearance clinically
resembling follicular tonsillitis but
inflammatory reaction is absent.
3. Histology: In chronic tonsillitis lumen
of the crypt contains bacterial colonies,
inflammatory cells including polymorphs
and lymphocytes with increased
vascularity.
4. The lymphoid tissue is hyperplastic
with germinal follicle .

25. Chronic tonsillitis
Chronic follicular
tonsillitis Chronic
parenchymatous
tonsillitis
Chronic fibroid
tonsillitis

26. Symptoms and Signs
Symptoms:
1. Recurrent throat pain
2. Cough
3. Halitosis and bad taste in the mouth
4. Quiescent phase: discomfort, irritation, pain;
asymptomatic
Signs:
1. Appearance: hypertrophied, congested – chr.
parenchymatous; small, fibrotic with cheesy debris –
chr. follicular

27. 2. Squeezing: pus oozes out – should be distinguished from
lymphatic fluid of normal tonsils
3. Retention cysts: yellowish swellings filled with yellow liquid
and debris
4. Enlarged jugulodigastric nodes

29. Treatment
1. Conservative treatment: general health care, nutritious diet,
treatment of co-existing infections of teeth, sinuses and nose
2. Surgical treatment: Tonsillectomy – when the enlarged tonsils
interfere with speech, deglutition, respiration or in case of
recurrent attacks

30. Complications
Besides those caused by acute tonsillitis, chronic tonsillitis may
also result in tonsilloliths (stones), tonsillar cysts, sleep apnoea.

31. Thankyou