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ACUTE TONSILLITIS.
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Quick Review on Tonsils Anatomy. Palatine tonsils are a pair of soft tissue masses located at the lateral wall of oro pharynx (Right & Left). Adenoid are found in nasopharynx which can only be seen through nasal endoscopy . Lingual tonsil is located at the base of the tongue . Tonsils are collections of lymphoid tissue covered by pink mucosa. They are part of the Waldeyer ring and play an important role in immune system..
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Acute Tonsillitis. I nflammation of palatine tonsils located at lateral wall of oro pharynx between anterior & posterior pillars..
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SYMPTOMS. Sore throat Odynophagia or dysphagia High grade fever with chills and rigors Referred otalgia Muffled voice Halitosis.
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SIGNS. Enlarged & inflamed tonsils Follicular / exudative tonsillitis Parenchymatous tonsillitis Membranous tonsilitis Dehydration.
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Grading of enlarged tonsil. Surgically removed tonsils 1 Tonsils hidden within tonsil pillars 2 Tonsils extending to the pillars 3 Tonsils are beyond the pillars 4 Tonsils extend to midline.
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3 . Enlarged upper jugulodigastric lymph nodes. Change the photo.
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Causes of Acute Tonsillitis. 1.Viral infection rhinoviruses – which cause the common cold the influenza virus parainfluenza virus – which causes laryngitis and croup enteroviruses – which cause hand, foot and mouth disease adenovirus – which is a common cause of diarrhoea the rubeola virus – which causes measles 2.Bacterial infection - Group A streptococcus bacteria Haemophilus Influenzae, Staphylococci.
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Complication of Acute T onsillitis. Local 1. Chronic Tonsillitis with r ecurrent acute attacks due to incomplete resolution of acute attacks. 2.Peritonsillar abscess 3.Parapharyngeal abscess 4.Cervical abscess due to suppuration of the jugulodigastric lymph nodes 5.Severe swelling lead to upper respiratory airway obstruction 6.Acute otitis media Systemic 1.Rheumatic fever due to Group A beta-haemolytic Streptococci 2.Acute poststreptococcal glomerulonephritis (due to body produces extra immunoglobulin that can settle in the glomeruli and causing inflammation ) 3.Subacute bacterial endocarditis (in patient with valvular heart disease).
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Investigation. Throat swab and culture - to identify cause of throat infection (virus or bacteria) Full blood count - increase in total white blood cell count.
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Management. Adequate hydration . Patient is put to bed and encouraged to take plenty of fluids - patient easily become dehydrated . Administer intravenous fluid if patient has poor oral intake and dehydrated. Analgesic medication ( aspirin or paracetamol) are given according to the age of the patient - to relieve local pain and as antipyretic Topical anti-inflammatory and analgesic eg Difflam throat spray Antimicrobial therapy -Most of the infections are due to Streptococcus -Penicillin based antibiotic is the drug of choice. Eg. Penicillin, ampicillin, amoxycillin, Amoxycillin/Calvulanic acid, Ampicillin/clavulanic acid -Patients allergic to penicillin can be treated with erythromycin -Antibiotics should be continued for 7 –10 days..