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Acute Tonsilitis

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Etiology

Pathogen: β- Hemolytical Streptococci *.

Virus: ‘adenovirus’, ‘rhinovirus’, ‘enterovirus’**

Causes: cold, fatigue, decreasing of the

resistance to diseases, smoke and drink to excess,

stimulated by harmful gas ,etc.

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In Clinics

1. Acute Catarrhal Tonsilitis

caused by virus, the symptom is light,

inflammation located on mucosa

2. Acute Purulent Tonsilitis

caused by bacteria, the symptoms is severe, inflammation develop in deep layer, purulent discharge from tonsil crypt

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Clinical Appearances

◆ Symptoms:*

● General : rise of temperature, chills, malaise,

headache , a general feeling of illness, and

appetite decrease, etc.

● Local: pain, pain felt only on swallowing, or

swallowing is extremly painful, and dysphagia.

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Clinical Appearances◆ Examinations:

● pharyngeal mucosal diffuse congestion, the

mucosal membrane of the fauces is bright red,

uvula edema, the crypt filled with debris,

desquamated epithelium and pus.

● lymph nodes: below the jaw draining the

tonsillar area are frequently enlarged and

tender

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Diagnosis and Differential Diagnosis

◆ Vincent’s angina: infected with spirillum in symbiosis

with a fusiform bacillus, poor dental hyigene,a bleeding

ulcerative gums are covered with a membrane which

spread to the tonsils. Diagnosis is bacteriological.*

◆ pharyngeal diphtheria: infected with Corynebacterium

diphtheriae, most commonly affect fauces, may be

relatively mild or very severe, a swab should be taken

and do bacteriological comfirmation.

◆ the others:

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Complications

● Local Complications: peritonsillar abscess (most

common seen), retropharyngeal abscess (seldom

seen), acute sinusitis, acute otitis media, and acute

laryngitis, etc.

● General Complications: rheumatic fever, acute

glomerulo-nephritis, acute arthritis, myocarditis,

type allergic reaction, and bacterial toxin.Ⅲ

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Treatment 1.General therapy: in bed, diet should be light but

nourishing, encourage to intake fluid,

2. Antibiotics therapy:Penicillin should be given, or erythromycin if the patient is allergic

3. Local treatment: soothing the affected membrane and clearing the secretion, inhalation,etc.

4. Chinese Medicines

5. Surgery: recurrence and relapse, particularly with complications.

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Chronic Tonsilitis

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Chronic Tonsilitis

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Chronic Tonsilitis

Caused by repeated attacks of acute tonsilitis

or influent drainage of the crypt.

Pathogen: bacteria infection, secondary to

the acute infectious diseases or nasosinus

infections.

Pathogenesis ： unknown, autoallergic

reaction

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Pathology

● Proliferation ： repeated stimulation ， tissue

proliferation, gland hypertrophy, soft.

● Fibrous ： degeneration, atrophy, gland is

small and stiff

● Crypt ： the crypt filled with debris,

desquamated epithelium and pus or adhesion

by scar.

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Clinical Appearances Local symptoms: simple sore throat, dry,itchy,, a

pricking or irritation as of a foreign body, fetor oris,

and cough

Pharyngeal obstructive symptoms in children ：snoring ， disturbance of respiratory, swallowing

and speech resonance

General symptoms ： dyspepsia, headache, tired,

low fever,etc.

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Examination

Chronic congestion of tonsils and palatoglossal arches. Tonsil sizes are different (fairly prominent, small, or even

difficult to see.), caseation, scar, adhestion,etc. Submandibular lymph node enlargement.

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Diagnosis and Differential Diagnosis

▲ Diagnosis: caused by repeated attacks of

acute tonsilitis*, simple sore throat, dry,itchy, a

pricking or irritation as of a foreign body, fetor

oris, and cough, caseation,scar, adhestion, and

submandibular lymph nodes enlargement.

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Diagnosis and Differential Diagnosis

▲ Differential Diagnosis:

• Tonsil Physiological Hypertrophy

• Tonsil keratosis

• Tonsil Tumor (biopsy)

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Complications

● General : rheumatic arthritis, rheumatic fever,

heart diseases, nephritis, etc.

● Tonsilitis of focal infection:

1. History: acute tonsilitis

2. Examinations: erythrocyte sedimentation

rate (ESR), anti- ‘o’, serium mucus protein,

ECG (electrocardiogram)

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Treatment

Non-surgical therapy: medicine

management, local treatment, build up

patient’s health

Surgical therapy: tonsilectomy.

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Indications for Tonsillectomy

● Repeated attacks of tonsillitis*

● Peri-tonsillar abscess (quinsy), abscess of the lateral or retropharyngeal spaces initiated by an episode of tonsillitis.

● Tonsils excessive hypertrophy: interfere swallowing, respiration, or phonation.

● Focal infection tonsils.

● Diphtheria carrier, conservative therapy is ineffective.

● Tonsil tumor.