Acute and chronic tonsilitis

1. 1
Acute Tonsilitis

2. 2
Etiology
Pathogen: β- Hemolytical Streptococci *.
Virus: ‘adenovirus’, ‘rhinovirus’, ‘enterovirus’**
Causes: cold, fatigue, decreasing of the
resistance to diseases, smoke and drink to excess,
stimulated by harmful gas ,etc.

3. 3
In Clinics
1. Acute Catarrhal Tonsilitis
caused by virus, the symptom is light,
inflammation located on mucosa
2. Acute Purulent Tonsilitis
caused by bacteria, the symptoms is
severe, inflammation develop in deep layer,
purulent discharge from tonsil crypt

4. 4
Clinical Appearances
◆ Symptoms:*
● General : rise of temperature, chills,
malaise, headache , a general feeling of illness,
and appetite decrease, etc.
● Local: pain, pain felt only on swallowing, or
swallowing is extremly painful, and dysphagia.

5. 5
Clinical Appearances
◆ Examinations:
● pharyngeal mucosal diffuse congestion, the
mucosal membrane of the fauces is bright red,
uvula edema, the crypt filled with debris,
desquamated epithelium and pus.
● lymph nodes: below the jaw draining the
tonsillar area are frequently enlarged and
tender

6. 6
Diagnosis and Differential Diagnosis
◆ Vincent’s angina: infected with spirillum in symbiosis
with a fusiform bacillus, poor dental hyigene,a bleeding
ulcerative gums are covered with a membrane which
spread to the tonsils. Diagnosis is bacteriological.*
◆ pharyngeal diphtheria: infected with Corynebacterium
diphtheriae, most commonly affect fauces, may be
relatively mild or very severe, a swab should be taken
and do bacteriological comfirmation.
◆ the others:

7. 7
Complications
● Local Complications: peritonsillar abscess
(most common seen), retropharyngeal abscess
(seldom seen), acute sinusitis, acute otitis media,
and acute laryngitis, etc.
● General Complications: rheumatic fever, acute
glomerulo-nephritis, acute arthritis, myocarditis,
type allergic reaction, and bacterial toxin.
Ⅲ

8. 8
Treatment
1.General therapy: in bed, diet should be light but
nourishing, encourage to intake fluid,
2. Antibiotics therapy:Penicillin should be given, or
erythromycin if the patient is allergic
3. Local treatment: soothing the affected membrane
and clearing the secretion, inhalation,etc.
4. Chinese Medicines
5. Surgery: recurrence and relapse, particularly with
complications.

9. 9
Chronic Tonsilitis

10. 10

11. 11
Chronic Tonsilitis

12. 12
Chronic Tonsilitis
Caused by repeated attacks of acute tonsilitis
or influent drainage of the crypt.
Pathogen: bacteria infection, secondary to
the acute infectious diseases or nasosinus
infections.
Pathogenesis：unknown, autoallergic
reaction

13. 13
Pathology
● Proliferation ：repeated stimulation，tissue
proliferation, gland hypertrophy, soft.
● Fibrous：degeneration, atrophy, gland is
small and stiff
● Crypt： the crypt filled with debris,
desquamated epithelium and pus or adhesion
by scar.

14. 14
Clinical Appearances
Local symptoms: simple sore throat, dry,itchy,, a
pricking or irritation as of a foreign body, fetor oris,
and cough
Pharyngeal obstructive symptoms in children：
snoring，disturbance of respiratory, swallowing
and speech resonance
General symptoms：dyspepsia, headache, tired,
low fever,etc.

15. 15
Examination
Chronic congestion of tonsils and palatoglossal arches.
Tonsil sizes are different (fairly prominent, small, or even
difficult to see.), caseation, scar, adhestion,etc.
Submandibular lymph node enlargement.

16. 16
Diagnosis and Differential Diagnosis
▲ Diagnosis: caused by repeated attacks of
acute tonsilitis*, simple sore throat, dry,itchy, a
pricking or irritation as of a foreign body, fetor
oris, and cough, caseation,scar, adhestion, and
submandibular lymph nodes enlargement.

17. 17
Diagnosis and Differential Diagnosis
▲ Differential Diagnosis:
• Tonsil Physiological Hypertrophy
• Tonsil keratosis
• Tonsil Tumor (biopsy)

18. 18
Complications
● General : rheumatic arthritis, rheumatic fever,
heart diseases, nephritis, etc.
● Tonsilitis of focal infection:
1. History: acute tonsilitis
2. Examinations: erythrocyte sedimentation
rate (ESR), anti- ‘o’, serium mucus protein,
ECG (electrocardiogram)

19. 19
Treatment
Non-surgical therapy: medicine
management, local treatment, build up
patient’s health
Surgical therapy: tonsilectomy.

20. 20
Indications for Tonsillectomy
● Repeated attacks of tonsillitis*
● Peri-tonsillar abscess (quinsy), abscess of the
lateral or retropharyngeal spaces initiated by an
episode of tonsillitis.
● Tonsils excessive hypertrophy: interfere
swallowing, respiration, or phonation.
● Focal infection tonsils.
● Diphtheria carrier, conservative therapy is
ineffective.
● Tonsil tumor.