TONSILITITS - DISORDER OF RESPIRATORY SYSTEM (AHN I).pptx

TONSILITIS - INTRODUCTION, DEFINITION, INCIDENCE IN WORLD AND INDIA, ETIOLOGY, TYPES (IN DETAIL), PHASES, PATHOPHYSIOLOGY (FLOW CHART), RISK FACTORS, CLINICAL MANIFESTATIONS, DIAGNOSTIC EVALUATIONS, MEDICAL MANAGEMENT WITH RATIONALE (IN TABLE FORM) , SURGICAL MANAGEMENT WITH RATIONALE (IN TABLE FORM), NURSING MANAGEMENT WITH RATIONALE (IN TABLE FORM), COMPLICATIONS, NANDA NURSING DIAGNOSIS

1. INTRODUCTION Tonsillitis is one of the most common upper respiratory tract infections, especially in children and adolescents. It involves inflammation of the palatine tonsils, which are lymphoid tissues located on either side of the oropharynx. The tonsils play a vital immunological role, acting as the first line of defense against inhaled or ingested pathogens. However, repeated infections can cause them to become chronically inflamed, leading to obstructive or systemic complications. Tonsillitis can be acute or chronic, bacterial or viral, and may occur as part of pharyngitis or independently. Streptococcus pyogenes (Group A β-hemolytic Streptococcus) is the most common bacterial cause. Prompt diagnosis and management are essential to prevent complications like peritonsillar abscess, rheumatic fever, or glomerulonephritis.

2. DEFINITION 1. World Health Organization (WHO, 2022): “Tonsillitis is defined as an inflammation of the palatine tonsils, usually due to infectious agents, leading to sore throat, fever, and difficulty in swallowing.” 2. Centers for Disease Control and Prevention (CDC, 2023): “Tonsillitis refers to inflammation and infection of the tonsils, most often caused by Group A Streptococcus, presenting with throat pain, erythema, and swollen tonsillar tissues.” 3. Dorland’s Illustrated Medical Dictionary: “Tonsillitis is the inflammation of the tonsils, typically the palatine tonsils, marked by pain, dysphagia, and constitutional symptoms.” 4. Oxford Concise Medical Dictionary: “Inflammation of the tonsils, usually following bacterial or viral infection of the upper respiratory tract.”

3. INCIDENCE Worldwide: o Tonsillitis accounts for 15–30% of all sore throat cases globally. o Peak incidence: ages 5–15 years. o Annual global estimate: 200–300 million cases of acute tonsillitis. o Viral causes predominate (60–70%), bacterial (30–40%). India: o Prevalence ranges between 12–18% among school-age children. o More common in humid and polluted environments. o Recurrent tonsillitis is a major indication for tonsillectomy in pediatric ENT practice.

4. ETIOLOGY A. Infectious Causes : Viral (most common): o Adenovirus o Rhinovirus o Influenza virus o Epstein-Barr virus (EBV) o Parainfluenza virus o Herpes simplex virus Bacterial: o Group A β-hemolytic Streptococcus (GABHS) — most common bacterial agent o Staphylococcus aureus o Haemophilus influenzae o Moraxella catarrhalis o Neisseria gonorrhoeae (rare)

5. ETIOLOGY B. Other Contributing Factors o Allergic reactions o Poor oral hygiene o Chronic sinus infections o Smoking or exposure to passive smoke o Environmental pollution and cold air exposure o Mouth breathing due to nasal obstruction

6. TYPES 1. Acute Tonsillitis • Sudden onset infection, lasting <10 days. • Commonly caused by GABHS or viruses. • Symptoms: sore throat, fever, dysphagia, enlarged tonsils with exudates. 2. Chronic Tonsillitis • Recurrent or persistent infection of tonsils. • Leads to fibrosis, cryptic debris, halitosis, and hypertrophy. • May cause systemic complications like rheumatic fever. 3. Recurrent Tonsillitis • ≥7 episodes in 1 year, or ≥5/year for 2 consecutive years. • Often necessitates tonsillectomy. 4. Peritonsillar Abscess (Quinsy) • A complication of acute tonsillitis causing pus accumulation beside the tonsil. • Presents with trismus, muffled voice, and uvular deviation.

7. PHASES 1. Incubation Phase •Duration: 1–3 days post-exposure. •Pathogen colonizes the tonsillar crypts. ’ 2. Catarrhal Phase •Early inflammation of tonsillar mucosa. •Symptoms: mild sore throat, malaise, slight fever. •Tonsils appear red and swollen. 3. Follicular (Suppurative) Phase •Pus formation within tonsillar crypts. •White/yellow spots visible on tonsils. •High-grade fever, odynophagia, and lymphadenopathy. 4. Resolution or Chronic Phase •Infection subsides with proper treatment. •Inadequate treatment may lead to fibrosis, scarring, and chronicity.

8. PATHOPHYSIOLOGY Pathogen (Virus/Bacteria) ↓ Entry through oral/nasal route ↓ Colonization of tonsillar crypt epithelium ↓ Immune response activated (macrophages, lymphocytes) ↓ Inflammatory changes → Edema, congestion, hyperemia ↓ Formation of exudate and pus in crypts ↓ Tonsillar enlargement → Pain, dysphagia, fever ↓ Possible outcomes: - Recovery (if treated) - Recurrent or chronic infection - Complications (abscess, rheumatic fever, glomerulonephritis)

9. RISK FACTORS • Age 5–15 years • Recurrent upper respiratory tract infections • Poor oral hygiene • Exposure to tobacco smoke or pollution • Close contact in crowded places (schools, hostels) • Allergies or chronic sinusitis • Nutritional deficiencies • Low immunity (e.g., HIV, malnutrition)

10. CLINICAL MANIFESTATIONS Local Signs: • Sore throat and pain on swallowing • Enlarged, reddened tonsils with exudates • White/yellow patches on tonsillar surface • Foul breath (halitosis) • Thick speech (“hot potato” voice) • Difficulty swallowing (dysphagia) Systemic Symptoms: • Fever and malaise • Headache • Tender cervical lymphadenopathy • Fatigue and body ache • Ear pain (referred otalgia)

11. DIAGNOSTIC EVALUATIONS 1. Throat Examination: Red, swollen tonsils with exudate and enlarged crypts. 2. Throat Swab Culture: To identify Group A Streptococcus. 3. Rapid Antigen Detection Test (RADT): Quick detection of streptococcal antigen. 4. Complete Blood Count (CBC): ↑ WBC, neutrophilia in bacterial infection. Lymphocytosis in viral infection. 5. ASO Titer (Antistreptolysin O): Indicates recent streptococcal infection. 6. Monospot Test: Detects Epstein-Barr virus infection. 7. X-ray or CT (if abscess suspected): To evaluate deep neck space infection.

12. MEDICAL MANAGEMENT Treatment Example/Intervention Rationale Antibiotics (if bacterial) Penicillin, Amoxicillin, Azithromycin To eradicate Streptococcus pyogenes and prevent complications like rheumatic fever. Analgesics/Antipyretics Paracetamol, Ibuprofen To reduce fever, inflammation, and throat pain. Antiviral therapy (if viral) Acyclovir (in HSV infection) Used only in viral causes like herpes tonsillitis. Salt water gargles Warm saline gargle every 4 hours Reduces local inflammation and bacterial load. Hydration Encourage oral fluids Prevents dehydration due to dysphagia and fever. Rest and nutrition Soft, bland diet; adequate rest Promotes healing and conserves energy. Corticosteroids (severe swelling) Prednisolone (short course) Reduces severe inflammation and tonsillar edema.

13. SURGICAL MANAGEMENT Procedure Indication Rationale Tonsillectomy Recurrent tonsillitis (≥7 episodes/year or ≥5 for 2 years), chronic tonsillitis, peritonsillar abscess, sleep apnea due to tonsillar hypertrophy Removes the chronic infection focus, relieves airway obstruction, and prevents complications. Adenotonsillectomy If adenoids are also enlarged Improves nasal breathing and reduces infection recurrence. Peritonsillar Abscess Drainage Abscess formation Prevents spread of infection and relieves pressure and pain.

14. NURSING MANAGEMENT Nursing Intervention Rationale Assess throat and vital signs regularly To monitor infection severity and systemic response. Maintain airway patency (upright position) Prevents airway obstruction due to swollen tonsils. Provide warm saline gargles Decreases discomfort and bacterial load. Encourage adequate fluid intake Prevents dehydration and maintains mucosal hydration. Administer medications as prescribed Ensures effective treatment and symptom relief. Educate on completing antibiotic course Prevents recurrence and resistance. Provide soft diet Reduces throat irritation during swallowing. Post-tonsillectomy: Observe for bleeding Early detection of hemorrhage, a major complication. Encourage oral hygiene Prevents secondary infection.

15. COMPLICATIONS Local: • Peritonsillar abscess (Quinsy) • Parapharyngeal abscess • Airway obstruction • Otitis media or sinusitis Systemic: • Rheumatic fever • Acute glomerulonephritis • Septicemia • Post-streptococcal arthritis • Scarlet fever

16. NANDA NURSING DIAGNOSES Actual Nursing Diagnoses 1. Acute pain related to inflammation of tonsillar tissue. 2. Impaired swallowing related to throat edema and pain. 3. Hyperthermia related to infectious process. 4. Imbalanced nutrition: less than body requirements related to painful swallowing. 5. Deficient knowledge related to disease process and home care. Potential (Risk) Nursing Diagnoses 1. Risk for airway obstruction related to tonsillar hypertrophy and edema. 2. Risk for dehydration related to decreased oral intake. 3. Risk for infection spread related to poor oral hygiene. 4. Risk for bleeding (post-tonsillectomy) related to surgical incision. 5. Risk for impaired tissue integrity related to infection and inflammation.