CHRONIC TONSILLITIS

HASRIYANTO

Normal Tonsils

Tonsillitis
Tonsillitis

is inflammation of the pharyngeal

tonsils.
The inflammation usually extends to the
adenoid and the lingual tonsils; therefore, the
term pharyngitis may also be used.
Lingual tonsillitis refers to isolated
inflammation of the lymphoid tissue at the
tongue base.
3

Classification
Infection/inflammation
Acute tonsilitis
Recurrent tonsilitis
Chronic(persistent) tonsilitis
Tonsiliolithiasis
4

CHRONIC TONSILLITIS
Aetiology:
Complication

of acute tonsillitis
Sub clinical infection of tonsil
Chronic sinusitis or dental sepsis
Mostly affects children and young
adults

CLINICAL FEATURES
recurrent

attacks of sore throat

chronic irritation in throat with cough
halitosis
dysphagia
odynophagia
thick speech

SIGNS
Tonsil

may show varying degree of

enlargement depending on the type
Irwin-moore sign pressure on the anterior
pillar expresses frank pus or cheesy material
mainly seen in fibroid type
Flushing of the anterior pillar compared to
rest of the pharyngeal mucosa
Enlargement of the jugulo-digastric node
soft non tender

TREATMENT
conservative

management
tonsillectomy

COMPLICATIONS
Peritonsillar

abscess
Parapharyngeal abscess
Retro pharyngeal abscess
Intra tonsillar abscess
Tonsillar cyst
Tonsillolith
Focus of infection for RF, AGN

Clinical presentation
1.HISTORY
Individuals with acute tonsillitis present with fever, sore
throat, foul breath, dysphagia, odynophagia and tender
cervical lymph nodes.
Airway obstruction may manifest as mouth breathing,
snoring, sleep-disordered breathing, nocturnal breathing
pauses, or sleep apnea.
Lethargy and malaise are common.
Symptoms usually resolve in 3-4 days but may last up to 2
weeks despite adequate therapy.
11

Individuals

with peritonsillar
abscess (PTA) present with severe
throat pain, fever, drooling, foul
breath, trismus (difficulty opening
the mouth), and altered voice
quality (the hot-potato voice).
12

2.PHYSICAL EXAM..
Should

begin by determining the degree of distress

regarding airways and swallowing.
Examination of pharynx may be facilitated by mouth
opening without tongue protrusion, followed by
gentle central depression of the tongue.
Full assessment of oral mucosa, dentation, and
salivary ducts may then be performed by gently
walking a tongue depressor about the lateral oral
cavity.
13

14

Flexible fiberoptic nasopharyngoscopy may be useful in

selected cases.
Acute tonsilitis reveals fever and enlarged inflammed
tonsil that may have exudates.
Open mouth breathing and voice changes result from
obstructive tonsilar enlargement.
Voice change in acute tonsilitis is not as severe as that
assc with peritonsilar abscess.

15

In PTA , pharyngeal edema and trismus cause a hot

potato voice.
Tender cervical nodes and neck stiffness observed in
acute tonsilitis.
Examine skine and mucosa for sign of dehydration.
Chronic tonsilitis,express pus on squeezing the tonsil and
excess tonsilar debris(tonsiliolith)
Hypertrophic inflammed tonsil for childrens and atrophic
tonsil in adult.

16

Tonsil in this pt were so swollen that

they caused resp distress
necessitating tonsillectomy

17

Palatine tonsil which are bright

red,swollen and coated

18

19

Peritonsilar abscess

20

INVESTIGATIONS
Tonsillitis and peritonsillar abscess (PTA) are clinical diagnoses.
Testing is indicated when group A beta-hemolytic
Streptococcus pyogenes (GABHS) infection is suspected.
Throat cultures (sensitivity 90-95%) are the criterion standard
for detecting GABHS.
For patients in whom acute tonsillitis is suspected to have
spread to deep neck structures radiologic imaging using plain
films of the lateral neck or CT scans with contrast is warranted.
In cases of PTA, CT scanning with contrast is indicated

21

Lab Studies
Throat

cultures are the criterion standard for

detecting group A beta-hemolytic Streptococcus
pyogenes (GABHS).
GABHS is the principal organism for which antibiotic
therapy (sensitivity 90-95%) is definitely indicated.
Relying only on clinical criteria, such as the presence
of exudate, erythema, fever, and lymphadenopathy,
is not an accurate method for distinguishing GABHS
from viral tonsillitis.
22

Peritonsilar

abscess CT scan with

contrast is indicated in general for
unusual presentation(e.g. inferior pole
abscess) and for pts at high risk of
drainage procedures.
CTscan may be used to guide needle
aspiration for draining PTA.
23

INDICATIONS FOR TONSILLECTOMY

The

American Academy of Otolaryngology

Head and Neck Surgery (AAO-HNS):
Enlarged

tonsils that cause upper airway

obstruction, severe dysphagia, sleep disorders
Recurrent peritonsillar abscess
Unilateral tonsil hypertrophy that is presumed to
be neoplastic (tumour tonsillectomy)
Chronic or recurrent tonsillitis, Cor pulmonale
24

contraindications
Bleeding

disorders

Anemia
Acute

infection
Uncontrolled medical illness
25

ROSE POSITION

26

..

Variations in dissection methods include the following

- cold steel (eg, scissors, curettes)
- monopolar cautery
- bipolar cautery
- radiofrequency ablation/coblation (can be used to shrink tonsils)
- harmonic scalpel with vibrating titanium blades
- microdebrider - for an intracapsular technique

27

..

Variations in haemostasis methods include the following:

- pressure with sponge for several minutes
- bismuth subgallate
- ties
- cautery

28

TONSILLECTOMY

29

Complications
Haemorrhage
- the most common complication
- intraoperative/primary (occurring within the first 24hrs)
- secondary (occurring between 24hrs and 10 days)
Pain (sore throat, otalgia)
Dehydration (children - do not eat because of pain)
Fever (not common, usually related to local infection)
Postoperative airway obstruction (uvular oedema,
haematoma, aspirated material)

30

..
Local

trauma to oral tissues

Temporomandibular joint dislocation
Psychological trauma, night terrors, or depression
Nasopharyngeal stenosis
Death
- uncommon
- bleeding
- or anaesthetic complications
31

Selamat HUT Enrekang

yang Ke-55

32