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.
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Classification
Infection/inflammation
Acute tonsilitis
Recurrent tonsilitis
Chronic(persistent) tonsilitis
Tonsiliolithiasis
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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
[Link]
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.
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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).
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[Link] 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.
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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.
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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.
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Tonsil in this pt were so swollen that
they caused resp distress
necessitating tonsillectomy
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Palatine tonsil which are bright
red,swollen and coated
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Peritonsilar abscess
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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
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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.
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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.
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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
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contraindications
Bleeding
disorders
Anemia
Acute
infection
Uncontrolled medical illness
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ROSE POSITION
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..
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
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..
Variations in haemostasis methods include the following:
- pressure with sponge for several minutes
- bismuth subgallate
- ties
- cautery
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TONSILLECTOMY
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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)
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..
Local
trauma to oral tissues
Temporomandibular joint dislocation
Psychological trauma, night terrors, or depression
Nasopharyngeal stenosis
Death
- uncommon
- bleeding
- or anaesthetic complications
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Selamat HUT Enrekang
yang Ke-55
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