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Tonsillitis An Overview

Tonsillitis An Overview

Tonsils are collections of lymphoid tissue facing into the aero digestive tract. The set of lymphatic tissue known as waldeyer’s tonsillar ring includes the adenoid tonsil, two palatine tonsils, two tubal tonsils and the lingual tonsils.

Tonsillitis

Palatine tonsils, commonly called the tonsils and occasionally called the faucial tonsils are two in number. Each tonsil is an ovoid mass of lymphoid tissue situated in the lateral wall of oropharynx between the anterior & posterior pillars.

Structure

Primarily, the tonsil consists of

  1. Surface epithelium which is continuous with the oropharyngeal lining.
  2. Crypts which are tube like invaginations from the surface epithelium.
  3. And the lymphoid tissue.

Functions of tonsils

Like other lymphoid masses of waldeyer’s ring, palatine tonsils have a protective role and act as a sentinals at the portal of air and food passage. The crypts in tonsils increase the surface area for contact with foreign substances. Tonsils are larger in childhood and gradually diminish near puberty. They are removed when they themselves become the seat of disease.

Acute tonsillitis:

Acute Tonsillitis

Acute tonsillitis often affects school going children, but also affects adults. Hemolytic streptococcus is the most commonly infecting organism. Other Causes of infection may be staphylococci, pneumococci or H.influenzae. These bacteria may primarily infect the tonsils or may be secondary to viral infection. Acute tonsillitis is classified as

  • Acute catarrhal or superficial tonsillitis: Here tonsillitis is a part of generalised pharyngitis and is mostly seen in viral infections.
  • Acute follicular tonsillitis: Infection spreads into the crypts which become filled with purulent material , presenting at the openings of crypts as yellowish spots
  • Acute parenchymatous tonsillitis: Here tonsil substance is affected. Tonsil is uniformly enlarged and red.
  • Acute membranous tonsillitis: It is a stage ahead of acute follicular tonsillitis when exudation from the crypts coalesces to from a membrane on the surface of tonsil.

Symptoms:

  • Sore throat
  • Difficulty in swallowing or dysphagia
  • Fever
  • Constitutional symptoms like head ache, malaise, body aches and constipation.
  • Earache

Treatment: 

  • Patient is put to bed and encouraged to take plenty of fluids.
  • Analgesics are given according to the age of the patient to relieve local pain and bring down the fever.
  • Anti microbial therapy- Most of the infections are due to streptococcus and penicillin is the drug of choice. Antibiotics should be continued for 7-10 days.

Chronic tonsillitis:

Chronic Tonsillitis

Chronic tonsillitis with recurrent acute attacks. This is due to incomplete resolution of acute infection. Chronic infection may persist in lymphoid follicles of the tonsil in the form of microabscessses.

Mostly affects children and young adults.

Chronic tonsillitis is classified as

  • Chronic follicular tonsillitis
  • Chronic parenchymatous tonsillitis
  • Chronic fibroid tonsillitis

Clinical features:

  • Recurrent attacks of sore throat
  • Chronic irritation in throat with cough
  • Bad taste in mouth and foul breath
  • Thick speech, difficulty in swallowing and choking spells at night.

Treatment:

Conservative treatment

Tonsillectomy

Tonsillectomy:

Tonsillectomy is indicated in

  • Chronic tonsillitis with bad taste or halitosis which is unresponsive to medical treatment
  • Peritonsillar abscess
  • Tonsillitis causing febrile seizures
  • Hypertrophy of tonsils causing airway obstruction, difficulty in deglutition and interference with speech
  • Suspicion of malignancy

Coblation assisted tonsillectomy which is recent advance is available in Sankhya hospitals.

 

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