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PRESEPTOR : DR. JACKY MUNILSON, SP.

THT-KL

OLEH :
PANDE BAGUS TUA SIAHAAN 07923072
M. NURMAN ARIEFIANSYAH 0910312002
• Tonsillitis is an
inflammation of the
palatine tonsils that are
part of Waldeyer’s ring
DEFINITION
RSUP Dr. Kariadi
Semarang 23,36%
RSUP dr. Hasan
Sadikin Bandung
1024 patients
RSUP dr M.
Djamil Padang
tonsillitis 465
from 1110 patients

Bacteria
• Haemofilus influenza
• Corrynebacterium diphteriae
• Streptococcus hemolyticus
Virus


Waldeyer’s ring
a ring of lymphoid tissue located in
the nasopharynx and oropharynx
1. palatine tonsils (also called the
faucial tonsils)
2. adenoids (nasopharyngeal tonsils)
3. the lateral bands on the lateral wall
of the oropharynx
4. lingual tonsils at the base of the
tongue

Tonsil
10-30
crypts
Crypts are
getting
longer and
wider +
detritus
Swelling of
tonsils
Chronic
inflamatian
Obstruction
of crypts
• A. phariygeal ascenden
• A. Descending palatine
Upper
pole
• Anterior : A. Dorsal
lingual
• Posterior : A. Ascending
palatine
• A. tonsillar
Lower
pole
F
u
n
c
t
i
o
n

Capture and
effectively
collect foreign
objects
F
u
n
c
t
i
o
n

As a place for
the
production of
antibodies
produced by
plasma cells
derived from B
lymphocyte
differentiation
B-lymphocytes
50-65%

T-lymphocytes
40%
Acute inflammation of the upper
respiratory tract
Antigen both inhalant and
ingestan easily fit into the tonsillar
Focus of infection
Obstruction of crypts in tonsils
Acute
tonsillitis
• Viral
• Bacterial
Membranous
tonsillitis
• Diphtheria
• Vincent Angina
Plaut (ulsero
membranous
stomatitis)
Chronic
tonsillitis


Medication
Surgery

Tonsilitis Terapi
1. Tonsilitis akut
a. Tonsilitis viral Istirahat, minum yang cukup, analgetika, dan antivirus
diberikan jika gejala berat.
a. Tonsilitis bakterial Antibiotik spektrum lebar, misalnya penisilin dan eritromisin.
Antipiretik dan obat kumur yang mengandung desinfektan.
1. Tonsilitis membranosa
a. Tonsilitis difteri Anti Difteri Serum (ADS) diberikan segera tanpa
menunggu hasil kultur, dengan dosis 20.000 - 100.000
unit tergantung dari umur dan beratnya penyakit.
Antibiotik penisilin atau eritromisin 25-50 mg/kgBB
dibagi dalam 3 dosis selama 14 hari.
Kortikosteroid 1,2 mg/kgBB per hari.
Antipiretik untuk simtomatis.
Pasien harus diisolasi. Perawatan harus istirahat di
tempat tidur selama 2-3 minggu.
a. Angina Plaut Vincent (stomatitis ulsero membranosa) Antibiotik spektrum lebar selama 1 minggu. Memperbaiki
higiene mulut. Vitamin B kompleks dan vitamin C.
1. Tonsilitis kronis Terapi lokal ditujukan pada higiene mulut dengan
berkumur atau obat hisap
Antibiotik spektrum luas
Tonsilektomi
Surgery Tonsillectomy
Acute otitis media, sinusitis, abscess
peritonsil (Quincy throat), parafaring
abscess, bronchitis, acute
glomerulonephritis, myocarditis,
arthritis and septicemia
Myocarditis, laryngitis diphtheria
paralysis of the soft palate muscles, eye
muscles for accommodation, the muscles
of the pharynx and larynx muscles
causing difficulty swallowing,
hoarseness, and paralysis of respiratory
muscles, albuminuria may occur due to
complications to the kidney
Chronic rhinitis, sinusitis or otitis media
perkontinuitatum, endocarditis,
arthritis, myositis, nephritis, uveitis,
iridoksiklitis, dermatitis, pruritus,
urticaria, and furunculosis.
IDENTITY of the PATIENT
Name : Mrs. M
MR : 872291
Age : 35 years
Gender : Female
Address : Pariaman
Ethnic groups : Minangkabau

Anamnesis :
Main complaints : Pain in swallowing since 1 week ago
Anamnese
Medical history:
 Swallowing pain since 1 week ago.
 Intermittent swallowing pain has been felt since 5
years ago.
 Pain is felt when swallowing occurs in approximately
3-4 times in the last 1 year accompanied with cough
and colds.
 Patients often go to the clinic ENT Hospital Dr. Djamil
Padang with swallowing pain, after treatment, pain
swallowing missing.

 Cough and cold with a stuffy nose since 1 week ago,
phlegm, clear colored, viscous, and does not bleed
 Sense of a lump in throat with pain since last 2 days,
not accompanied by difficulty to swallowing water and
solid foods.
 Both ears pain since 1 week ago, pain is felt when the
patient swallows. No discharge from the ear, no
hearing impairment, no tinitus.
 The patient had a history of sneezing more than 5
times in one time with a stuffy nose sneezing when
exposed to dust
 Patient’s doughter had a history of asthma


Physical Examination
General Examination
 Geneal condition : not look sick
 Heart rate : 81 x/ min
 Respiration rate : 20x/ min
 Temperature : 36,8°C
 Blood pressure : 110/70 mmHg


ENT Examination
Ear : Right : ear canal was wide, TM intact,
cone of light +
Left : ear canal was wide, Tm intact,
cone of light +
Nose :
 Right nasal cavity : wide, vibrase (+), inferior concha
livid, septum deviation (-), Spina (-), Krista (-),
secretion was clear
 Left nasal cavity : wide, vibrase (+), inferior concha
livid, septum deviation (-), Spina (-), Krista (-),
secretion was clear


Throat : Pharyngeal arch symmetric, uvula in the
middle, pharyngeal wall not hiperemis, tonsil T3-T2,
crypt open out, detritus (+)

Diagnose : Chronic tonsilitis
Theraphy : - Tonsilectomy
- IVFD RL 8 hour/kolf
- Ceftriaxone 2 x 1 gram (iv)

Follow up
June 25th, 2014
S/ No febrile, odinophagy, no breathless
o/ general condition : was moderate illness
consciousness : composmentis
blood pressure : 110/70 mmHg
temperature : 36,8°C


ENT Examination
Ear : Right : ear canal was wide, TM intact,
cone of light +
Left : ear canal was wide, Tm intact,
cone of light +
Nose :
 Right nasal cavity : wide, vibrase (+), inferior concha
livid, septum deviation (-), Spina (-), Krista (-),
secretion was clear
 Left nasal cavity : wide, vibrase (+), inferior concha
livid, septum deviation (-), Spina (-), Krista (-),
secretion was clear

Throat : Pharyngeal arch symmetric, uvula in the
middle, pharyngeal wall not hiperemis, tonsil T3-T2,
crypt open out, detritus (+), irregular surface
Haematology :
Hb : 11,5 g%
Ht : 36%
Leukosit : 10.900/mm3
Trombosit : 393.000/mm3
PT : 11,8 s
APTT : 37 s
A/ Chronic tonsillitis pro tonsilectomy with general
anesthesia
P/ - Tonsilectomy today
- IVFD RL 8 hour/kolf
- Ceftriaxone 2x 1 gram (iv)

June 26th, 2014
S/ Patient post tonsilectomy 1 day ago, No febrile,
odinophagy, no breathless, no nausea and vomit, no
bleeding from mouth and nose, no swallowed sense
behind throat, change of sound
O/ general condition : was moderate illness
consciousness : composmentis
blood pressure : 120/80 mmHg
temperature : 36,8°C

ENT Examination
Ear : Right : ear canal was wide, TM intact,
cone of light +
Left : ear canal was wide, Tm intact,
cone of light +
Nose :
 Right nasal cavity : wide, vibrase (+), inferior concha
livid, septum deviation (-), Spina (-), Krista (-),
secretion was clear
 Left nasal cavity : wide, vibrase (+), inferior concha
livid, septum deviation (-), Spina (-), Krista (-),
secretion was clear

Throat : Pharyngeal arch symmetric, uvula in the middle
and hiperemis, pharyngeal wall not hiperemis, tonsil
T0-T0, bleeding (-), Blood clot (-), fibrin (+)
A/ Post tonsillectomy with indication Chronic tonsillitis
day I
P/ - Sloping bed
- Gradually eating, start from liquid food
- Drip Tramadol in IVFD RL 8 hour/kolf
- Ceftriaxone 2x 1 gram (iv)
- Aff. Infuse if RL with Tramadol is empty

June 27th, 2014
S/ Patient post tonsilectomy 1 day ago, No febrile,
odinophagy, no breathless, no nausea and vomit, no
bleeding from mouth and nose, no swallowed sense
behind throat, change of sound
O/ general condition : was moderate illness
consciousness : composmentis
blood pressure : 110/80 mmHg
temperature : 36,8°C

ENT Examination
Ear : Right : ear canal was wide, TM intact,
cone of light +
Left : ear canal was wide, Tm intact,
cone of light +
Nose :
 Right nasal cavity : wide, vibrase (+), inferior concha
livid, septum deviation (-), Spina (-), Krista (-),
secretion was clear
 Left nasal cavity : wide, vibrase (+), inferior concha
livid, septum deviation (-), Spina (-), Krista (-),
secretion was clear

Throat : Pharyngeal arch symmetric, uvula in the middle
and hiperemis, pharyngeal wall not hiperemis, tonsil
T0-T0, bleeding (-), Blood clot (-), fibrin (+)
A/ Post tonsillectomy with indication Chronic tonsillitis
day II
P/ - outpatient
- Gradually eating, start from liquid food
- Ciprofloxacine 2x 250 mgs (po)
- Paracetamol 3x 500 mgs (po)
Discussion
 Have treated a 35-year-old patient in the ward ENT
Hospital Dr. M. Djamil Padang with a chief complaint
of pain swallowing since 1 week ago. Intermittent
swallowing pain has been felt since 5 years ago. Pain is
felt when swallowing occurs in approximately 3-4
times in the last 1 year accompanied with cough and
colds. Patients experiencing a cold with a cough and
nasal congestion since 1 week ago, phlegm, clear
colored, viscous, and does not bleed.
 Sense of a lump in the throat with sore from 2 days
ago, was not accompanied by difficulty swallowing
liquid or solid food. Both ear pain since 1 week ang ago,
felt especially when the patient swallows, discharge
from the ear does not exist. The patient had a history
of sneezing more than 5 times in 1 time with a stuffy
nose sneezing when exposed to dust
 On physical examination found vital signs within
normal limits. Checking the status of localist ENT, ear
found no abnormality, nasal turbinate hypertrophy are
inferior, color Livid. Examination throat hyperemia
obtained tonsils, kripti widened, there detritus.
Patients diagnosed with chronic tonsillitis. Patients
planned tonsillectomy tonsillectomy because there are
indications according to The American Academy of
Otolaryngology-Head and Neck Surgery ie tonsillitis
attack 3-4 times in 1 year despite often go to the clinic
 After tonsillectomy patients no fever, painful
swallowing are still there but the pain is felt less than
before swallowing. Patients are given education to
gradually start eating liquid foods, soft foods, and
regular food, not hot.
Thank You