CHRONIC TONSILITIS

FATIMA AHMED
.Def •
Chronic inflammation of lymphoid tissue of •
tonsil
Types •
Atrophic.1 •
Hypertrophic .2 •
HYPERTOPHIC vs atrophic
ETIOLOGY
Recurrent acute attack.1
Persistance predisposing factor.2
Chronic inf. Sinuses &teetn.3
Common in school going children & adult less.4
than 50y
Pathogenesis •
chronic follicular tonsilitis.1 •
a)tonsillar crypts full infected cheesy •
material •
b)yellowish spot on surface •
chronic parenchymatous tonsilitis.2 •
hyperplasia of lymphoid tissue and the tonsil is •
very much enlarged ,there will be difficulty in
speech ,swallowing and respiration
.Cont
chronic fibroid tonsilitis.3 •
Tonsils are small •
Symptoms
General-
Local-

: General
Manifestation of low grade inf (septic
focus:chronic toxemia caused by chronic
inflammation e.g tonsilitis & sinusitis )
.Cont
Clinical pic. Of septic focus
glomerulonephritis-
low grade fever-
anemia-
myalgia & arthralgia-
rheumatic fever-
bronchiectesis-
dermatitis and iridocyclitis-
: Local
Recurrent acute attack i.e dysphagia and-
sore throat
Otalgia (referred pain through jackbson nerve-
of glossopharyngial)
Foetor tonsils (obstructive) lead to- :
a- dysphagia
b-snoring and sleep apnea
c-hot potato voice
Signs
Congested ant. pillars)1
Asymmetrical enlargement)2
Shape : irregular)3
Squeezing oozing pus )4
Lymph node enlarged & firm)5
O/E
Invx
Elevated ESR -

Increased ASO titer up to 200 tods units

Treatment
Surgical tonsillectomy
:Indications=
Recurrent acute attack (more than 3 time/1
/year )
One attack of quinsy (once quinsy always/2
quinsy ,it is an old concept , recently in
recurrent quinsy)
: Chronic tonsilitis causing/3
QUINSY
.cont
snoring and sleep apnea-

septic focus-

rheumatic fever or glomerulonepht-

dyphagia due to hypertrophy-

Diphtheria carrier :resistant to medical ttt/4
Tumour of tonsil either/5
benign :papilloma=
malignant :carcinoma or lymphoma=
Containdications=
: Absolute)a(
Bleeding disorders as haemophilia , purpura or leukaemia
Bleeding : should be relieved before operation)b(
i)Acute tonsilitis
ii)Active systemic disease e.g DM
iii)Active rheumatic fever
iv)Menstruation :during menses
v)Active URTI as common cold
Post operative complications
Haemorrhage ]1[
Respiratory either ]2[
a)Resp. obstruction by
laryngeal spasm after extubation due inhalation of=
blood or vomitus
ttt :by suction of boold and Oxygen inhalation*
:Falling of tongue backwards=
ttt :pulling the tongue and insertion of plastic airway*
b)Resp. infection :bronchitis, pneumonia or lung abscess
.Cont
: Anaesthesia complications]3[
Anaphylactic shock
Apnea (succinyl apnea)
Arrest (cardiac arrest)
Incomplete removal : causes hge or]4[
compensatory hypertrophy of remenants
Injury to: palate ,tongue or teeth]5[
: Infection ]6[
MUCHA GRACIAS