Objective

• Anatomy.

• Acute Tonsillitis.

• Chronic Tonsillitis.

• Adenoiditis
Types:

• Acute.

• Chronic.
 Acute Tonsillitis

Acute inflammation of the tonsil

occur commonly in children and
transmitted by droplet infection
The causative organisms in children

Viral: Bacterial:

• Adenovirus. • B hemolytic Streptococci

• E.P. virus • Strep. Pneumoniae.

• Herpes virus. • Haemophlus Influenzae.

• Anaerobic organisms.
The causative organisms in Adults

Viral: Bacterial:

• Infuenza & Parainfuenza • B hemolytic Streptococci

virus.
• Other Streptococci.
• Adenovirus.

• Enterovirus. • Homophiles.

• Rhinovirus. • Anaerobes.
 Clinical Features
Symptoms :

• Pyrexia , Malaise & Headache.

• Sore Throat & Odenophagia.
• Abdominal pain & Vomiting
• Change of voice.
• Otalgia.
• Neck Pain.
Signs:

• Hyperemic tonsils.

• Pus in the tonsillar crypts

 Differential Diagnosis

• Acute diphtheria.
• Infectious mononucleosis.
• Scarlet fever.
• Acute leukemia.
• Agranulocytosis.
 Treatment

• Antibiotics:
Penicillin.
Erythromycin.
• Analgesics.

• Gargles.
 Complications 1
• Local:
– Respiratory obstruction.

– Peritonsillar abscess.

– Parapharyngeal abscess

– Mediastinitis.

– Otitis media.
 Complications 2

• General:

– Septicemia.

– Acute rheumatic fever & glomerulonephritis.

 Chronic Tonsillitis

Chronic inflammation of the tonsil it is either

atrophic or hypetrophic caused by
repeated attacks of acute tonsillitis.
 Clinical Picture 1
• Local Symptoms:

– History of repeated attacks.

– Sense of irritation in the throat.

– Foeter and bad taste.

– Difficulty in swallowing.

– Difficulty in breathing.
 Clinical Picture 2

• General Symptoms:

– Anemia.

– Poor appetite.

– Fatigue.
 Signs:
• Inequality in the size of the tonsil.

• Congestion of the anterior pillars.

• Intra-consular abscess, calcification or scarring.

• Pus oozing from the tonsillar crypts on pressure.

• Enlarged cervical glands.

 Treatment

When the symptoms are persistent

Tonsillectomy is indicated.
 Indications of Tonsillectomy 1

• Local:

– Recurrent attacks of acute tonsillitis.

– One attack of quinsy.
– Huge tonsil.
– Persistent jugulo-diagastric L.N. Enlargement.
– F.B of the tonsil.
– Tumor of the tonsil.
Indications of Tonsillectomy 2

• General:

Tonsillitis acting as septic focus.

 Contraindications

• Blood diseases.
• During acute attack.
• During U.R.T.I .
• During an epidemic of poliomyelitis.
• During active systemic disease
eg.diabetes, T.B , anemia.
• Cleft palate an bifid uvula.
 Adenoiditis
Inflammation of the sub epithelial lymphoid
tissues in the roof and posterior wall of the of
the nasopharynx, usually occurring in children.
 Clinical Picture

• Nasal Symptoms:
– Nasal obstruction.
– Nasal discharge.
• Aural Symptoms:
– Rec. A.O.M .
– Chronic otitis media.
• General Symptoms:
– Mental dullness .
 Treatment

Adenoidectomy in cases of marked symptoms.