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Diseases Of Tonsil

  1. Acute Tonsillitis:
    1. Types:
      1. Acute catarrhal or Superficial tonsillitis – seen in viral infections
      2. Acute follicular tonsillitis – Purulent material seen in crypts as yellowish spots
      3. Acute parenchymatous - tonsillar substance is affected causing uniform enlargement and redness
      4. Acute membrane tonsillitis – exudation coalesce to form a membrane
    2. Organisms:
      Most common : b hemolytic streptococcus (may be secondary to primary viral infections)
      Others:
      1. Staphylococcus
      2. Hemophilus influenzae
      3. pneumococcus
        Viral causes:
        Adenovirus> Ebstein Barr> Influenza
    3. Symptoms:
      1. Fever                      
      2. Headache                        
      3. Malaise             
      4. Body ache                     
      5. Soar throat                              
      6. Dysphagia                      
      7. Earache
    4. Signs:
      1. Inflamed tonsils, pillars, soft palate, uvula
      2. B/l jugulodigastric lymph nodes are enlarged and tender
      3. Halitosis
    5. Treatment:
      1. Antibiotics: penicillin group 7 –10 days / erythromycin
      2. Analgesics
      3. Bed rest
    6. Complications:
      1. Chronic tonsillitis                                          
      2. Peritonsillar abscess
      3. Parapharyngeal abscess                                              
      4. Cervical abscess
      5. Acute otitis media                                       
      6. Rheumatic fever
      7. Acute glomerulonephritis                          
      8. ​Subacute bacterial endocarditis
    7. D/D of Membrane over the tonsils:
      1. Membranous tonsillitis
      2. Diphtheria: membrane is dirty Grey, removal causes bleeding
      3. Vincent’s angina
      4. Infectious mononucleosis
      5. Agranulocytosis
      6. Leukemia
      7. Aphthous ulcer                            
      8. Malignancy tonsil
      9. Traumatic ulcer                             
      10. Candidiasis
  2. Chronic Tonsillitis:
    1. Types:
      1. Chronic Follicular Tonsillitis
      2. Chronic Parenchymatous Tonsillitis
      3. Chronic Fibrotic/Fibroid Tonsillitis
    2. Clinical Features:
      1. Recurrent acute tonsillitis
      2. Chronic irritation in throat
      3. Halitosis
      4. Thick speech. Choking at night when tonsils v. large
    3. Treatment
      Treatment of predisposing cause
      Tonsillectomy
  3. Tonsillectomy:
    1. Indications:
Absolute Relative As a part of an operative procedure
Large tonsils causing sleep apnea responding to antibiotics Diphtheria carriers not As part of Uvulopalatopharyngoplasty
Recurrent tonsillitis (3-4 documented attacks of acute tonsillitis for a period of 2-3 yrs) maintained Rheumatic fever where anti streptococcus prophylaxis cannot be As an approach to IX nerve and styloid process
U/L enlarge d tonsil (suspicion of malignancy)    
Recurrent quinsy (recurrence: 20%)    
  1. Contraindications:
    1. Hb<10g%
    2. Age < 3 yrs
    3. Acute infection
    4. In epidemics of polio
    5. Bleeding disorders (laser tonsillectomy)
    6. Uncontrollable systemic disease (diabetes, hypertension)
  2. Laser tonsillectomy:
    Is performed with KTP-532
    1. Advantage:
    2. Decreased blood loss
  3. Disadvantage:
    1. Increase cost                          
    2. Increased operating time              
    3. ​Delayed healing
  4. Complications of Tonsillectomy:
    1. Perioperative:
      1. Primary Hemorrhage:
        Hypertension                    
        Acute infection
        Bleeding disorder                            
        Intratonsillar dissection
        Presence of an aberrant internal carotid artery in the tonsillar fossa
      2. Trauma:
        To the pillars, uvula, soft palate
      3. Temporomandibular Joint dislocation
  1. Postoperative:
  2. Immediate Complications:
    Reactionary haemorrhage (venous bleed)  (occurs within 24 hrs of surgery)
    Causes:  - Reflex rise in Blood Pressure - Slippage of ligature - Vasodilatation
  3. Treatment:
    1. Blood- Grouping & cross- matching                            
    2. Tonsillar fossa: any clot removed
    3. Pressure with 1:1000 adrenaline                               
    4. Bleeder ligated ¯ G.A.
  4. B. Intermediate Complications:
    Secondary haemorrhage (bleeding after 24 h post op) (not as severe as primary haemorrhage)
    1. Occurs at: 6-8 days                        
    2. Cause: Infection
  5. Treatment:                                                
    1. Systemic antibiotics                                         
    2. Any blood clot removed                                   
    3. Pressure pack with 1: 1000 adrenaline
    4. The tonsillar fossa would be friable it would be difficult to locate the bleeders
    5. Suturing of the pillars with gauze piece in the tonsillar fossa triad
      1. Hematoma &. Odema of the uvula
      2. Infection:
      3. Features:
        - Pyrexia will increase pain                    
        - Secondary haemorrhage
      4. Pulmonary complications:
        Pulmonary atelectasis (due to inhalation of blood or fragments of tonsillar tissues)
      5. Subacute bacterial endocarditis:
        Tonsillectomy  Transient bacteremia Patient with septal defect or an abnormal heart valve
      6. Pain: With or without referred otalgia
      7. Earache: Referred otalgia or ASOM
  6. Late Complications
    1. Post operative Scarring
    2. Tonsillar remnants: Large remnants: Can cause acute tonsillitis and peritonsillar abscess
    3. Hypertrophy of lingual tonsils




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