Acute and chronic tonsilitis

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Transcript of Acute and chronic tonsilitis

  • 1.Acute Tonsilitis

2. Etiology

  • Pathogen: -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.

3. 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

4. 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.

5. 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

6. Diagnosis and Differential Diagnosis

  • Vincents 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 withCorynebacterium diphtheriae, most commonly affect fauces, may be relatively mild or very severe, a swab should be taken and do bacteriological comfirmation.
  • the others:

7. Complications

  • LocalComplications: 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.

8. 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.


  • Chronic Tonsilitis

10. 11. Chronic Tonsilitis 12. 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

13. 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.

14. 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.

15. 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.

16. 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.

17. Diagnosis and Differential Diagnosis

  • Differential Diagnosis:
  • Tonsil Physiological Hypertrophy
  • Tonsil keratosis
  • Tonsil Tumor ( biopsy )

18. 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)

19. Treatment

  • Non-surgical therapy:medicine management, local treatment, build up patients health
  • Surgical therapy: tonsilectomy.

20. Indications for Tonsillectomy

  • Repeated attacks of tonsillitis*
  • P eri-tonsillar abscess (quinsy), abscess of thelateral 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.