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.

9.

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.