Tonsillitis

1. TONSILLITISTONSILLITIS
DEPT OF OTORHINOLARYNGOLOGYDEPT OF OTORHINOLARYNGOLOGY
J J M M CJ J M M C
DAVANAGEREDAVANAGERE

2. ANATOMY OF PALATINE TONSILANATOMY OF PALATINE TONSIL
Paired structures situated in lateral wall of Paired structures situated in lateral wall of
oropharynx between anterior and posterior oropharynx between anterior and posterior
pillarspillars
Consists of two surfaces (medial and lateral) and Consists of two surfaces (medial and lateral) and
two poles (upper and lower)two poles (upper and lower)
Medial surface is covered by non keratinizing Medial surface is covered by non keratinizing
stratified squamous epitheliumstratified squamous epithelium
There are 12-15 crypts on the medial surfaceThere are 12-15 crypts on the medial surface
Largest crypt is called crypta magna or Largest crypt is called crypta magna or
intratonsillar cleft intratonsillar cleft

3. ANATOMY OF PALATINE TONSILANATOMY OF PALATINE TONSIL
Lateral surface of tonsil presents a well defined Lateral surface of tonsil presents a well defined
fibrous capsule fibrous capsule
Loose areolar tissue lies between the tonsillar Loose areolar tissue lies between the tonsillar
bed and the capsule, it is the site for collection of bed and the capsule, it is the site for collection of
pus in peritonsillar abscess (Quinsy) pus in peritonsillar abscess (Quinsy)
Upper pole of tonsil extends into soft palate, its Upper pole of tonsil extends into soft palate, its
medial surface is covered by semilunar foldmedial surface is covered by semilunar fold
plica semilunaris plica semilunaris
Lower pole of tonsil is attached to the tongue, Lower pole of tonsil is attached to the tongue,
triangular fold of mucous membrane extends triangular fold of mucous membrane extends
from anterior pillar to antero-inferior part of tonsil from anterior pillar to antero-inferior part of tonsil
enclosing plica triangularisenclosing plica triangularis
Tonsil is seperated from the tongue by tonsilo-Tonsil is seperated from the tongue by tonsilo-
lingual sulcus lingual sulcus

4. ANATOMY OF PALATINE TONSILANATOMY OF PALATINE TONSIL

5. TONSILLAR BEDTONSILLAR BED
Formed byFormed by
Loose areolar tissue containing paratonsillar Loose areolar tissue containing paratonsillar
veinvein
Pharyngo-basilar fasciaPharyngo-basilar fascia
Superior constrictor muscleSuperior constrictor muscle
Bucco-pharyngeal fasciaBucco-pharyngeal fascia
StyloglossusStyloglossus
Medial pterygoid muscleMedial pterygoid muscle
Glossopharyngeal nerveGlossopharyngeal nerve
Facial arteryFacial artery
Submandibular salivary glandSubmandibular salivary gland

6. BLOOD SUPPLY OF TONSILBLOOD SUPPLY OF TONSIL

7. LYMPHATIC DRAINAGELYMPHATIC DRAINAGE
Lymphatics pierce the superior constrictor Lymphatics pierce the superior constrictor
and drain into upper deep cervical (jugulo-and drain into upper deep cervical (jugulo-
digastric) nodedigastric) node

8. FUNCTIONS OF TONSILFUNCTIONS OF TONSIL
It is the component of inner waldeyer’s It is the component of inner waldeyer’s
ringring
It has a protective role and acts as a It has a protective role and acts as a
sentinal at portal of air and food passagesentinal at portal of air and food passage
Crypts increase the surface area for Crypts increase the surface area for
contact with foreign substances contact with foreign substances

9. ACUTE TONSILLITISACUTE TONSILLITIS
Mostly affects children in the age group of Mostly affects children in the age group of
5-15 years, may also affect adults5-15 years, may also affect adults
Organisms Organisms  beta-hemolytic streptococci beta-hemolytic streptococci
(most common), staphylococci, (most common), staphylococci,
pneumococci, H.influenzaepneumococci, H.influenzae
Symptoms: sore throat, difficulty in Symptoms: sore throat, difficulty in
swallowing, fever, ear ache, constitutional swallowing, fever, ear ache, constitutional
symptomssymptoms

10. ACUTE TONSILLITIS-TYPESACUTE TONSILLITIS-TYPES
Acute catarrhal/superficial  here tonsillitis is a here tonsillitis is a
part of generalized pharyngitis, mostly seen in part of generalized pharyngitis, mostly seen in
viral infectionsviral infections
Acute follicular Acute follicular  infection spread into the crypts infection spread into the crypts
with purulent material, presenting at the opening with purulent material, presenting at the opening
of crypts as yellow spotsof crypts as yellow spots
Acute parenchymatousAcute parenchymatous  tonsil in uniformly tonsil in uniformly
enlarged and congestedenlarged and congested
Acute membranousAcute membranous  follows stage of acute follows stage of acute
follicular tonsillitis where exudates coalesce to follicular tonsillitis where exudates coalesce to
form membrane on the surfaceform membrane on the surface

11. Acute catarrhal/superficial

12. Acute follicularAcute follicular

13. Acute membranousAcute membranous

14. SIGNS SIGNS
Halitosis Halitosis
Coated tongueCoated tongue
Congestion of pillars, soft palate and uvulaCongestion of pillars, soft palate and uvula
Jugulo-digastric nodes enlarged and Jugulo-digastric nodes enlarged and
tendertender
Tonsils are congested and enlarged Tonsils are congested and enlarged
depending on type of acute tonsillitisdepending on type of acute tonsillitis

15. TREATMENTTREATMENT
Bed restBed rest
Plenty of oral fluidsPlenty of oral fluids
AnalgesicsAnalgesics
Antimicrobial therapyAntimicrobial therapy penicillin penicillin
In case of penicillin sensitivity macrolides In case of penicillin sensitivity macrolides
are givenare given

16. COMPLICATIONSCOMPLICATIONS
chronic tonsillitischronic tonsillitis
peritonsillar abscessperitonsillar abscess
parapharyngeal abscessparapharyngeal abscess
cervical abscesscervical abscess
acute otitis mediaacute otitis media
rheumatic feverrheumatic fever
acute glomerulo nephritisacute glomerulo nephritis
sub acute bacterial endocarditis sub acute bacterial endocarditis

17. DIFFERENTIAL DIAGNOSIS OF DIFFERENTIAL DIAGNOSIS OF
MEMBRANE OVER THE TONSILMEMBRANE OVER THE TONSIL
Membranous tonsillitisMembranous tonsillitis
DiphtheriaDiphtheria
Vincents anginaVincents angina
Infectious mononucleosisInfectious mononucleosis
AgranulocytosisAgranulocytosis
LeukaemiaLeukaemia
Traumatic ulcerTraumatic ulcer
Aphthous ulcerAphthous ulcer
malignancymalignancy

18. CHRONIC TONSILLITISCHRONIC TONSILLITIS
Aetiology: Aetiology:
Complication of acute tonsillitisComplication of acute tonsillitis
Sub clinical infection of tonsilSub clinical infection of tonsil
Chronic sinusitis or dental sepsisChronic sinusitis or dental sepsis
Mostly affects children and young adultsMostly affects children and young adults

19. TYPES OF CHRONIC TYPES OF CHRONIC
TONSILLITISTONSILLITIS
Chronic follicular tonsillitisChronic follicular tonsillitis
Chronic parenchymatous tonsillitis : tonsils Chronic parenchymatous tonsillitis : tonsils
are very much enlarged uniformly and are very much enlarged uniformly and
may interfere with speech, deglutition and may interfere with speech, deglutition and
respiration, long standing cases may respiration, long standing cases may
develop pulmonary hypertensiondevelop pulmonary hypertension
Chronic fibroid tonsillitisChronic fibroid tonsillitis

20. CLINICAL FEATURESCLINICAL FEATURES
recurrent attacks of sore throatrecurrent attacks of sore throat
chronic irritation in throat with coughchronic irritation in throat with cough
halitosishalitosis
dysphagiadysphagia
odynophagiaodynophagia
thick speech thick speech

21. SIGNSSIGNS
Tonsil may show varying degree of Tonsil may show varying degree of
enlargement depending on the typeenlargement depending on the type
Irwin-moore signIrwin-moore sign pressure on the pressure on the
anterior pillar expresses frank pus or anterior pillar expresses frank pus or
cheesy material cheesy material  mainly seen in fibroid mainly seen in fibroid
typetype
Flushing of the anterior pillar compared to Flushing of the anterior pillar compared to
rest of the pharyngeal mucosarest of the pharyngeal mucosa
Enlargement of the jugulo-digastric node Enlargement of the jugulo-digastric node
 soft non tender soft non tender

22. TREATMENTTREATMENT
conservative managementconservative management
tonsillectomytonsillectomy

23. COMPLICATIONSCOMPLICATIONS
Peritonsillar abscessPeritonsillar abscess
Parapharyngeal abscessParapharyngeal abscess
Retro pharyngeal abscessRetro pharyngeal abscess
Intra tonsillar abscessIntra tonsillar abscess
Tonsillar cystTonsillar cyst
TonsillolithTonsillolith
Focus of infection for RF, AGNFocus of infection for RF, AGN

24. Peritonsillar abscessPeritonsillar abscess

25. STYALGIA (EAGLE’S STYALGIA (EAGLE’S
SYNDROME)SYNDROME)
Due to elongated styloid process or Due to elongated styloid process or
calcification of stylohyoid ligamentcalcification of stylohyoid ligament
Patient complains of pain in tonsillar fossa Patient complains of pain in tonsillar fossa
and upper neck which radiates to and upper neck which radiates to
ipsilateral earipsilateral ear
It gets aggravated on swallowingIt gets aggravated on swallowing
Diagnosis is by transoral palpation in Diagnosis is by transoral palpation in
tonsillar fossatonsillar fossa
X-ray Townes view is helpful in diagnosisX-ray Townes view is helpful in diagnosis
Treatment is by excision of styloid process Treatment is by excision of styloid process
by transoral or cervical approachby transoral or cervical approach