ACUTE TONSILLITIS
Tonsils-act as sentinels to guard against foreign intruders like viruses, bacteria and other antigens coming into contact through inhalation and ingestion.
Forms of tonsillitis: Acute and chonic
Acute Tonsillitis: most common form in children
Causes:
- Group A beta hemolytic streptococcal infection (most common)
- Pneumococci
- H. influenzae
- Viruses (EBV, respiratory syncytial virus)
Types of acute tonsilitis:
- Acute catarrhal/ Superficial tonsilitis: involves surface epithelium, is a part of generalized pharyngitis.
- Acute follicular: Infection spreads into tonsillar crypts and they are filled with purulent material. The. openings of crypts exhibit yellow spots.
- Acute parenchymatous: involves tonsil substance/ parenchyma, tonsils are enlarged and red.
- Acute membranous: The exudation (of acute follicular stage) coalesce to form a membrane on tonsil surface
Chronic tonsillitis: exist as a complication of acute forms
Cause: Chronic infections in sinuses/teeth and recurrent acute attacks
Types :
- Chronic follicular tonsillitis: Resembling acute follicular forms with cheesy exudate material filling the crypts
- Chronic parenchymatous tonsillitis: Enlarged, hyperplastic tonsils which might lead to dysphagia and sleep apnea
- Chronic fibroid: Small infected tonsils with history of repeated sore throats
Symptoms:
- Sore throat
- fever(38-40C)
- Dysphagia
- Earache (referred pain from tonsils or due to otitis media as a complication)
- Constitutional symptoms: malaise, headache, abdominal pain due to mesenteric lymphadenitis; (resembling clinical picture of acute appendicitis)
Signs:
- Foetid breath and coasted tongue
- red swollen tonsils with hyperemia of tonsillar pillars, soft palate and uvula
Examination:
- Check for enlargement of tonsils, sometimes they may meet in midline
- yellowish beads of pus on medial surface of tonsils
- Tonsils are small but pressure on the anterior pillar expresses frank pus or cheesy material (chronic fibroid type)
Complications:
- Chronic tonsillitis(due to recurrent attacks)
- Peritonsillar abscess
- parapharyngeal and cervical abscesses
- acute Otitis media
- rheumatic fever and glomerulonephritis(rare)
- SABE
General management:
- bed rest and plenty of fluid intake
- Pain management : analgesics (aspirin or PCM)
- Indications for antibiotics (penicillin most preferred)
👉Tonsillectomy: A surgical approach
Recurrent pharyngitis and chronic tonsillitis are the most common reasons for tonsillectomy in adults. However, majority of operations are found to be conducted in children.
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