TONSILS:


Tonsillitis - causes, symptoms, treatment
Tonsillitis


Definition:

Inflammation or infection of tonsils or lymph nodes

Tonsils are lymph nodes present in pharynx and oral cavity.

Classification of tonsils:

Based on location
On the basis of location tonsils may be of three types;
Palatine tonsils
Pharyngeal tonsils
Lingual tonsils

Palatine tonsils:

Inflammation of palatine tonsils are called palatine tonsils. Palatine tonsils are located in parterior and lateral wall of oropharynx.
Pharyngeal tonsils:
Inflammation of the pharyngeal tonsils are called pharyngeal tonsils. They are located in the posterior wall of the nasopharynx.


Lingual tonsils:

Lingual tonsils are located at the base of the tongue. It infection is called lingual tonsillitis. Pharynx is the tubular structure that connects the naal cavity and oral cavity with esophagus. Pharynx is also called throat.

Based on severity:

On the basis of severity, tonsils are classified as;


  • Acute tonsillitis 
  • Sub-acute tonsillitis 
  • Chronic tonsillitis 


Acute tonsillitis:

Onset is rapid and self-limiting and after 3 or 4 days it gradually subside as;
Causative agents are Group “A” abrororor and streptococus pyrogenous bacteria are involved.
Viruses like epatain per virus are also involved.
 require treatment after 3 to 4 days.

Sub-acute tonsillitis:

It is mostly bacterial in origin and causative agents are streptococcus pyrogene and epstain bar virus.
It is bothersome and require therapy i.e. sore throat, fever, pain.
It untreated, sub-acute tonsillitis progress towards chronic tonsillitis.

Chronic tonsillitis:

It is very much complicated and ranges from days to months and streptococcus pyrogene are involved.
It is mostly bacterial in origin and require immediate therapy.

Sign and symptoms:

Following are the sign and symptoms of tonsillitis;

  • Pain in throat.
  • Dyrophgia (difficulty is swallowing)
  • Chills 
  • High grade fever
  • Cough 
  • Head ache
  • Tonsil exudote\
  • Complications of tonsillitis:
  • It includes;
  • Sinusitis (due to bacterial movement into sinusitis)
  • Otitis media (middle ear infection)
  • Peritonsiller absess (serious one)
  • Reiro pharyngeal absess/infection
  • Glamerula nephritis
  • Sleep ophea (disturbed sleep)
  • Septic phlebitis
  • Shirring

Sinusitis:

Inflammation of the sinus
Sinuses are cavities air spaces present in cranium and it reduces the weight of the cranium.

Otitis media:

Middle or external ear infection. In this condition yellowish exudate formation occur which causes the severe pain of ear.

Peritonsiller Abcess:

Chronic inflammation of tonsils characterized by exudate formation. In this case tonsils are covered by white exudate and tonsils are dislocated come forward, move forward, move toward downward and to the midline of the oral cavity and tonsils become hypertophia.

Retropharyngeal abcess:


Infection of area behind the pharynx;

Sign and symptoms:


  • Severe neck pain
  • High grade fever
  • Lymph aderopathy
  • Hypertrophy of pharynx
  • Dyshpagia’
  • In retropharyngeal abcess bacteria gain acess to the cerrical vertebra and cause meningitis.
  • Bacteria also gain acess to the jugular vein and can result in septic phlebitis.


Glomerulonephritis:

Mostly arises from viral tonsillitis. Due to Ig antibody formation, which form immune complex and this complex is then deposited in the nephron.

Snoring:

Hypertrophy of tonsils leads to snoring.

Apner/disturbed sleep:

Nasal cavities are blacked due to hypertrophy of tonsils. Patients is on mouth breathing, blood level of oxygen decrease because of closed nasal cavity and leds to apnea.

Prevertebral infection:

If bacteria gain access to prevertebral space i.e. spinal cord, there are chances of spinal cord infection and damage,
While if bacteria gain access to the neck muscles and jugular vein ( internal jugular vein or external jugular vein) it causes septic phobitor.

Diagnosis:

Based on physical examination i.e.
Swallowed tonsils
Physical signs and symptoms
Take exudation of the tonsils by swab and check for bacterial infection.


Treatment:


Symptomatic treatment:


To relieve the pain, head ache and to prevent the spread of infection or the complication of the tonsillitis.

Causative treatment:


First line drugs:

Penicillin’s are the first line therapy (Augmentin may also be given in severe condition)
Second line drugs:
Macrolides like azithromycin is a drug of choice due to short duration of time i.e. 3 days.
Dose=250mg bid for 3 days.
Pain killer:
Ibuprofen
Antipyretic:
Paractemol
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Haseenullah Shah

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