TONSILS AND ADENOID
PROBLEM
TONSILS
• Waldeyers ring: Is a ring of lymphoid tissues in the pharynx
STRUCTURE AND FUNCTIONS
PALATINE TONSILS
• Palatine tonsils are paired structures located b/w anterior
(palatoglossus) and posterior (palatopharyngeus) faucial pillars.
• Consist of aggregates of lymphocytes embedded in a stroma of
connective tissue
• Epithelial lining is stratified squamous epithelium which invaginates
into the parenchyma forming crypts
• Function: Immunity. Both T- & B-Lymphocytes are present. Has both
cell mediated and humoral immune function. B-lymphocytes
synthesize specific antibodies – IgG, IgA.
DISORDERS OF PALATINE TONSILS
INFLAMMATORY BLOOD DISORDERS
Acute tonsilitis Agranulocytosis
Diphtheria Leukaemia
Infectious mononucleosis
Vincent angina OTHER CAUSES
Aphthous ulceration
NEOPLASM Behcets syndrome
Squamous cell carcinoma AIDS
Lymphoma
Salivary gland tumous
ACUTE TONSILLITIS
• Most frequent in childhood
• Aetiology is poorly understood
• Aetiology:
Viruses (eg influenza, parainfluenza, adenovirus, enterovirus &
rhinovirus account for up to 50%
Initial viral infection predisposes to superinfection by bacteria
(haemolytic Streptococcus, Streptococcus pneumonia, H influenza &
anaerobic organism)
CLINICAL FEATURES
Symptoms
• Prodromal illness with pyrexia, malaise and headache
• Throat pain radiating to the ear: may occur in the neck (lymphadenopathy)
• Muffled voice
• Trismus and dribbling
• Abd pain & occasionally vomiting in children
Signs
• Hyperaemia with pus or debris in the crypts
• Tender cervical lymphadenopathy (particularly jugulodigastric)
TYPES OF ACUTE
TONSILLITIS
ACUTE TONSILLITIS
DIFFERENTIAL DIAGNOSIS OF MEMBRANOUS TONSILLITIS
• Diphtheria
• Candidiasis
• Infectious mononucleosis
• Agranulocytosis
DIAGNOSIS
• Clinical features
• In more serious cases
Paul-Bunnell test
WBC
Throat swab
TREATMENT
• Antibiotics (Penicillin): erythromycin for allergy to penicillin.
Ampicillin to be avoided
• Analgesics
• Fluid replacement
• Bed rest
• Tonsillectomy
COMPLICATIONS
LOCAL
• Respiratory obstruction
• Abscesses ( peritonsillar, parapharyngeal, Retropharyngeal
• Acute otitis media
• Recurrnt acute tonsillitis (chronic tonsillitis)
GENERAL
• Septicaemia
• Meningitis
• Acute glomerulonephritis
• Acute rheumatic fever
ADENOID
• Lymphoid tissues found at the junction of the roof & posterior wall of
the nasopharynx.
• Sizes varies: maximum between 3 – 8yrs and then regress
• Structure & functions: same as palatine tonsil
PATHOLOGY OF ADENOID
• Viral & bacterial infection leads to hyperplasia with enlargement &
multiplication of lymphoid follicles
• Pathological effect is due to increase in size
• Symptoms results from relative disproportion in size between the
adenoid and cavity of the nasopharynx.
CLINICAL FEATURES OF ADENOID
SYMPTOMS
• Nasal obstruction
• Mouth breathing, snoring, hyponasal speech
• Refusal of feed (or sucking of breast)
• Nasal discharge
• Postnasal drip
• Sleep apnoea, Corpulmonalae
• Adenoid facies (open lip posture, prominent upper incisors, short upper
lip, a thin nose, hypoplastic maxilla with a high arched palate) rarely seen.
CLINICAL FEATURES CONTD
Eustachian tube
• Ear ache & deafness (from acute otitis media & otitis media with
effusion)
EXAMINATION
• Via postnasal mirror (difficult in children)
• Fibreoptic endoscopy
• Otoscopy (dull/retracted tympanic membrane)
• Tympanometry
ADENOID
INVESTIGATION
• EUA is most reliable
• Lateral soft tissue x-ray of the nasopharynx
• Preoperative investigation
TREATMENT:
• Watchful waiting
• Adenoidectomy: (has indications, contraindications and complications)
• Treatment of complications of obstructive adenoid (otologic, cardiac)
X-RAY POSTNASAL SPACE
