Tonsilitis

Definition
• Tonsillitis is inflammation of the palatine tonsil
which is part of Waldeyer's ring
• The Waldeyer ring consists of a gland arrangement
lymph in the oral cavity 1. pharyngeal
tonsils (adenoid) 2. palatine tonsils
(tonsil faucial) 3. lingual tonsils (base
tonsils tongue) 4. Eustachian tube tonsils
(lateral band I Gerlach's canine tonsils)
Acute Tonsilitis
A. Viral Tonsilitis
• Etiologi : Epstein barr virus (EBV), Hemophilus influenzae, Coxschakie virus.
• Diagnose: on inspection looked small ilitis on the palate and tonsils, pain felt by the patient
• Therapy:
1. Rest
2. Drink enough
3. Analgetics
4. Antivirus if symptoms are severe.
B. Bacterial Tonsilitis
• Etiologi : Streptococcus B hemoliticus, Pneumococcus, Streptococcus viridans, Streptococcus piogenes.
• Pathogenesis:
1. Bacterial infiltration of the epithelial of tonsillar tissue will cause an inflammatory reaction in the
form of discharge
2. Polymorphonuclear leukocytes are formed detritus. This detritus is a collection of leukocytes, dead
bacteria and epithelial free. Clinically detritus fills the crypts tonsils and appear as yellow spots
• Symtomp: sore throat, odinophagia, fever, lethargy, joint pain, no
appetite, otalgia
• Diagnose: on inspection it appears tonsil swollen, hyperemic and
there is follicular detritus, lacuna or covered by a pseudo membrane,
Subgland mandible swollen and tenderness.
• Therapy:
1. Wide-spectrum antibiotics (penicillin, erythromycin)
2. Antipyretic
3. Mouthwash containing disinfectant
• Complication: acute otitis media, sinusitis, peritonsillary abscess
(Quincy thorat), parafaring abscess, bronchitis, acute
glomerulonephritis, myocarditis, arthritis as well septicemia due to
infection v. Internal jugular (Lemierre syndrome).
Membranous tonsillitis
A. Diphtheria tonsillitis
• Etiologi: Corynebacterium diphteria
• Phatogenesis: Infection depends on the anti-toxin titers in a person's blood.
Titer anti toxin is 0.03 units per cc of blood can be considered able to
provide a basis for immunity. This is what is used in the Schick test.
• Symtomp:
1. Common symptoms: increasing body temperature (usually subfebris),
headache, no lust eating, weak body, slow pulse, pain swallowing.
2. Local symptoms: pseudo membrane (if lifted it will bleed)
3. Exotoxin-induced symptoms: heart (endocarditis,decompensatio cordis),
cranial nerves (palatal and respiratory muscle paralysis), kidney
(albuminuria)
• Diagnose: culture
• Therapy:
1. Anti Diphtheria Serum (ADS) is given immediately without
waiting for the results of the culture, with a dose 20,000 -
100,000 units depending on age and the severity of the
disease.
2. Penicillin antibiotics or Erythromycin 25-50 mg per kg body
weight divided into 3 doses for 14 days.
3. Corticosteroids 1.2 mg per kg body weight per day.
4. Antipyretic for symptomatic.
5. The patient must be isolated.
6. Rest in bed for 2-3 weeks.
• Complication:
1. Diphtheria laryngitis
2. Myocarditis
3. Albuminuria
B. Septic tonsillitis
• Etiologi: Streptococcus Hemolytic that is found in
milk
• In Indonesia cow's milk is cooked first by
pasturization before drinking then this disease is
rarely found.
C. Angina Plaut Vincent (ulsero stomatitis
membranous)
• Etiologi:
1. bacteria spirochaeta or triponema
2. bad oral hygiene
3. vitamin C deficiency
• Symtomp: fever to 39 C, headache, body weak and
sometimes there is interference digestion. Pain in the
mouth, hypersalivation, teeth and gums bleed easily.
• Diagnose: on inspection, the oral mucosa and
pharyngeal hyperemia, appearing grayish white
membrane above the tonsils, uvula, wall of pharynx,
gums and process of alveolans, smelly mouth (foetor
ex ore) and sub gland the mandible enlarges.
• Therapy:
1. Wide-spectrum antibiotics for 1 week
2. Improve oral hygiene
3. Vitamin C and vitamin B complex
Chronic tonsillitis
• Etiologi: the bacteria is the same as acute tonsillitis but
sometimes turned into a Gram negative group.
• Predisposing factors:
1. stimulus from cigarettes or certain types of food
2. bad oral hygiene
3. the influence of the weather
4. treatment of acute tonsillitis that is not adequate
• Pathogenesis: because the repetitive inflammation process arises
then the mucosal epithelium and tissue lymphoid eroded, so that
in the healing process lymphoid tissue is replaced by lightly the
scar will experience shrinkage so crypts widen. In this crypt clinic
looks filled by detritus
• Symtomp:disphagia, dry throat, smelly mouth
• Diagnose: on inspection, uneven tonsil surface, crypts
widens and some crypts are filled with detritus
• Therapy: Local therapy (oral hygiene), antibiotics
• Complications:
1. the surrounding area (rihinitish chronic, sinusitis or
otitis media)
2. hematogenous or lymphogen (endocarditis, arthritis,
myosilis, nephritis, uveitis, iridocyclitis, dermatitis,
pruritus, urticaria and furunculosis)