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.
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.
Primarily, the tonsil consists of
Surface epithelium which is continuous with the oropharyngeal lining.
Crypts which are tube like invaginations from the surface epithelium.
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 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: Infectionspreads 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.
Difficulty in swallowing or dysphagia
Constitutional symptoms like head ache, malaise, body aches and constipation.
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 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
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.
Tonsillectomy is indicated in
Chronic tonsillitis with bad taste or halitosis which is unresponsive to medical treatment
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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