Chronic Tonsillitis

Chronic Tonsillitis
Recurrent infections of the tonsils and the
peritonsillar tissue lead to permanent
inflammation in the tonsillar crypts and
scarring of the tonsillar tissue.
Mostly affects children and young adults.
Rarely occurs after 50 years.

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 Aetiology
It may be a complication of acute
tonsillitis.
Subclinical infections of tonsils without an
acute attack.
Chronic infection in sinuses or teeth may
be a predisposing factor.

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• The organisms responsible for chronic
tonsillitis are similar to those which cause
acute infection, with a predominance of
β-haemolytic streptococci.
• Chronic infected tonsils are considered as
a “focus” which may activate other chronic
inflammatory diseases in the body by
spreading bacteria and mediators

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 Pathology
Three types:
Chronic follicular tonsillitis
Chronic parenchymatous tonsillitis
Chronic fibroid tonsillitis

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 Pathology
Chronic follicular tonsillitis
Tonsillar crypts are full of infected cheesy
material which shows on the surface as
yellowish spots.

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 Pathology
Chronic parenchymatous tonsillitis
• There is hyperplasia of lymphoid tissue.
Tonsils are very much enlarged and may
interfere with speech, swallowing and
respiration.
• Attacks of sleep apnoea may occur.
• Long-standing cases develop pulmonary
heart disease.
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 Pathology
Chronic parenchymatous tonsillitis

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 Pathology
Chronic fibroid tonsillitis
Tonsils are small but infected, with history
of repeated sore throats.

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 Clinical Features
Recurrent attacks of sore throat or acute
tonsillitis.
Chronic irritation in throat with cough.
Bad taste in mouth and foul breath
(halitosis) due to pus in crypts.
Thick speech, difficulty in swallowing and
choking spells at night.

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 Examination
– Tonsils may be show varying degree of
enlargement.

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Which degree?

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 Examination
Tonsils may be covered
with debris or there may
be purulent material in the
tonsillar crypts.
Tonsils appear atrophic
and scar, often with
surrounding peritonsillar
erythematous tissue.

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 Examination
Enlargement of Jugulodigastric lymph nodes
is a reliable sign of chronic tonsillitis. During
acute attacks, the nodes enlarge further and
become tender
Tonsillar smears are found to contain group A
β-hemolytic streptococci

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 Diagnosis
Medical history
repeated episodes of acute tonsillitis

Local examination of signs

varying degree of enlargement
debris or purulent material
enlarged lymph nodes

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 Differential Diagnosis
Physiological hypertrophy of tonsil

• Usually seen in children and adolescents

• The surface of the tonsil is smooth and the
crypts is clean
• Have no history of inflammatory attacks

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 Differential Diagnosis
keratosis of tonsil
• The small white sand-like masses, which
are difficult to remove by swabbing.
• Remove the masses leaves a bleeding
surface

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 Differential Diagnosis
Tumor of tonsil
• One side tonsil is enlarged and have
ulcers.
• Often accompanied by swelling of the
same lateral cervical lymph node.
• Pathologic evidence is the final diagnosis

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 Complications
Rheumatic arthritis
Rheumatic fever
Nephrosis
Cardiac disease

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 Treatment
Conservative treatment：attention to general
health, diet, treatment of coexistent infection
of teeth, nose and sinuses.
Operation—tonsillectomy: indicated when
tonsils interfere with speech, swallowing and
respiration or cause recurrent attacks

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Tonsillectomy

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 History

Tonsillectomy has been one of the most

commonly performed procedures in the
history of surgery.

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Tonsillectomy represents one of the
earliest surgical techniques taught to the
otolaryngology resident.
It is often the arena for the early testing
and training of surgical skills valuable
throughout the practice of
otolaryngology-head and neck surgery.

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 Tonsillectomy
Indication
• Recurrent acute tonsillitis,
• Peritonsillar abscess,
• Tonsils interfere with speech, swallowing or
respiration,
• Cause cardiac, kidney or joint complications,
• Carrier of diphtheria, when conservative
treatment is ineffective,
• Benign tumor of the tonsil
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 Tonsillectomy
Contraindication
• bleeding disorders(such as leukemia,
aplastic anemia)
• Recent acute infection.
• Children under the age of 3 years

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 Tonsillectomy
Anesthesia
Usually done under general anesthesia
with endotracheal intubation.
In adults, it can be done under local
anesthesia.

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 Tonsillectomy
a variety of methods that may be used：

“hot”：laser, electrotome,
low temperature plasma

“cold”：traditional instruments

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 Traditional instruments
Drafton rods (1);
Bipolar orceps (2);
Silk ties (3);
Blades for Boyle Davis gag
(4);
Boyle Davis gag (5);
Knot pusher (6);
Pillar retractor (7);
Tonsil dissector (8);
Burkitt straight forceps (9);
Curved Negus Forceps (10);
Luc’s tonsil holding forceps
(11)

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electrotome

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low temperature plasma

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 Post-operative Care
Immediate general care:
• Keep the patient in coma position until fully
recovered from anesthesia.
• Keep a watch on bleeding from the nose
and mouth.
• Keep check on vital signs, e.g. pulse,
respiration and blood pressure.

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 Post-operative Care
Diet
• Take liquids, e.g. cold milk or ice cream.
• Diet is gradually built from soft to solid food.
• Plenty of fluids should be encouraged.
• Patient can resume his normal duties within
2 weeks.

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 Post-operative Care
Oral hygiene
• Patient is given Condy’s or salt water
gargles 3-4 times a day.
• A mouth wash with plain water after every
feed helps to keep the mouth clean.

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 Post-operative Care
Analgesics
• Pain, locally in the throat and referred to
ear, can be relieved by analgesics like
paracetamol.
• An analgesic can be given half on hour
before meals.

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 Post-operative Care
Antibiotics
• Postoperative antibiotics are administered
by most surgeons.
• A suitable antibiotic can be given orally or
by injection.

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 Complications
Bleeding
Primary bleeding and secondary bleeding
Infection
Pulmonary complications
Tonsillar remnants

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 Review
The classification of chronic tonsillitis according
Pathology?
Chronic follicular tonsillitis;
Chronic parenchymatous tonsillitis;
Chronic fibroid tonsillitis.
How to diagnose chronic tonsillitis?
Medical history and Local examination of signs

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 Review
The indications for tonsillectomy?
Recurrent acute tonsillitis,
Peritonsillar abscess,
Tonsils interfere with speech, swallowing or
respiration,
Cause cardiac, kidney or joint complications,
Carrier of diphtheria, when conservative
treatment is ineffective,
Benign tumor of the tonsil

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