Understanding Tonsillitis Types and Causes

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Questions and Answers

What are the potential predisposing factors for chronic tonsillitis?

Chronic infection of sinuses or teeth may predispose individuals to chronic tonsillitis.

Define tonsillectomy in your own words.

Tonsillectomy is the surgical removal of the palatine tonsils.

List one absolute and one relative indication for tonsillectomy.

An absolute indication is obstructive sleep apnea; a relative indication is recurrent acute tonsillitis.

What constitutes a genuine attack of acute tonsillitis?

A genuine attack includes severe sore throat, fever, dysphagia, and general systemic upset. Signup and view all the answers

Describe one technique used for tonsillectomy.

Diathermy dissection uses an electrically heated instrument to cut or coagulate tissues. Signup and view all the answers

What are the clinical features of chronic tonsillitis?

Chronic tonsillitis is characterized by recurrent attacks of acute tonsillitis, chronic throat irritation, and halitosis. Signup and view all the answers

What are the indications for tonsillectomy regarding peritonsillar abscess?

Tonsillectomy is indicated due to the high risk of recurrence after the second peritonsillar abscess. Signup and view all the answers

Explain the significance of pediatric septic tonsils in the context of surgical intervention.

Pediatric septic tonsils are characterized by anterior faucial pillar congestion and pus in the tonsillar crypts, requiring surgical evaluation. Signup and view all the answers

What is the primary difference between acute catarrhal tonsillitis and acute follicular tonsillitis?

Acute catarrhal tonsillitis involves generalized pharyngitis and is associated with viral infections, while acute follicular tonsillitis features tonsillar crypts filled with purulent materials. Signup and view all the answers

List three main causative organisms associated with acute tonsillitis.

Group A beta hemolytic streptococci, Haemophilus influenzae, and Streptococcus pneumoniae. Signup and view all the answers

Identify two symptoms of acute tonsillitis that indicate possible infection.

Sore throat and difficulty swallowing. Signup and view all the answers

Describe the appearance of tonsils in acute membranous tonsillitis.

The tonsils show whitish membranes formed by coalesced exudates on their medial surface. Signup and view all the answers

What types of chronic tonsillitis exist, and what is a characteristic feature of chronic fibroid tonsillitis?

The types include chronic follicular, chronic parenchymatous, and chronic fibroid tonsillitis, with the latter having small infected tonsils and a history of repeated sore throats. Signup and view all the answers

What signs might indicate the presence of acute parenchymatous tonsillitis?

Enlarged and congestive tonsils with a swollen uvula, along with hyperaemia of the pillars and soft palate. Signup and view all the answers

What differential diagnoses should be considered in a patient with suspected acute tonsillitis?

Diphtheria, infectious mononucleosis, and malignancies such as lymphoma or leukemia. Signup and view all the answers

What general treatment measures are recommended for acute tonsillitis?

Bed rest, plenty of fluids, analgesia, and antimicrobial therapy. Signup and view all the answers

What are two contraindications for performing an intracapsular partial tonsillectomy?

Bleeding disorders and recent infections. Signup and view all the answers

Describe the primary technique for achieving haemostasis during dissection in tonsillectomy.

Haemostasis can be achieved through ligation, electro cautery, or both. Signup and view all the answers

What immediate postoperative complication requires careful monitoring due to the risk of shock?

Bleeding (reactionary) is the immediate complication to monitor. Signup and view all the answers

Which analgesic is recommended over aspirin for postoperative pain management in tonsillectomy patients?

Paracetamol is recommended over aspirin. Signup and view all the answers

What specific dietary recommendations are advised for a patient on the day of tonsillectomy?

An ice diet is recommended on day zero post-surgery. Signup and view all the answers

What should be monitored closely to detect early bleeding after a tonsillectomy?

Pulse rate and signs of excessive swallowing or vomiting of blood. Signup and view all the answers

Identify one late postoperative complication that may occur after tonsillectomy.

Scarring is a potential late complication. Signup and view all the answers

Why is performing a tonsillectomy during an epidemic of infectious illness risky?

It poses a risk of spreading the virus and causing bulbar palsy. Signup and view all the answers

Study Notes

Tonsillitis

Inflammation of the tonsils.
Types:
- Acute Tonsillitis:
  - Acute catarrhal/superficial tonsillitis: Part of generalized pharyngitis, seen in viral infections.
  - Acute parenchymatous tonsillitis: Tonsils become enlarged and red.
  - Acute follicular tonsillitis: Tonsillar crypts fill with purulent material.
  - Acute membranous tonsillitis: Coalesced exudates form membranes on the tonsil surface.
- Chronic tonsillitis:
  - Chronic follicular tonsillitis
  - Chronic parenchymatous tonsillitis
  - Chronic fibroid tonsillitis: Tonsils are small but infected, with a history of repeated sore throats.

Acute Tonsillitis

Affects school-age children but adults can be affected. Rare in infants (<1 year) and individuals older than 50 years.
Causative organisms:
- Group A beta hemolytic streptococci
- Haemophilus influenzae
- Streptococcus pneumoniae
- Staphylococci
- Tuberculosis (in immunocompromised individuals)
- Viruses: adenovirus, Epstein-Bar virus, and herpes simplex virus.

Acute Tonsillitis: Symptoms

Sore throat
Difficulty swallowing and pain
Fever (can be accompanied by rigors and chills)
Earache
Headache
Generalized body fatigue

Acute Tonsillitis: Signs

Foetid breath and coated tongue
Hyperaemia of the pillars, soft palate, and uvula
Enlarged and congestive tonsils with swollen uvula (acute parenchymatous tonsillitis)
Red and swollen tonsils with yellowish spots in the crypts (follicular tonsillitis)
Whitish membrane on the medial surface of the tonsils (membranous tonsillitis)
Enlarged and tender jugulodigastric lymph nodes

Acute Tonsillitis: Differential Diagnosis

Diphtheria
Infectious mononucleosis
Malignancy (lymphoma, leukemia)

Acute Tonsillitis: Treatment

Bed rest and plenty of fluids
Analgesia
Antimicrobial therapy

Chronic Tonsillitis: Etiology

Can be a complication of acute tonsillitis.
Subclinical infection of tonsils without acute attacks.
Chronic infection of sinuses or teeth can be a predisposing factor.

Chronic Tonsillitis: Clinical Features

Recurrent attacks of acute tonsillitis.
Chronic throat irritation and cough.
Bad taste in the mouth and foul breath (halitosis).

Chronic Tonsillitis: Treatment

Conservative treatment: Attention to diet, general health, and treatment of coexisting infections of teeth, sinuses, and nose.
Tonsillectomy: Surgical removal of the tonsils

Tonsillectomy: Definition

Surgical excision of the palatine tonsils.

Tonsillectomy: Indications

Absolute indications:
- Enlarged tonsils causing obstructive sleep apnea, especially in pediatric patients.
- Peritonsillar abscess (quinsy) (high risk of recurrence after the second abscess).
- Tonsils requiring biopsy to define tissue pathology (Biopsy tonsillectomy).
Relative indications:
- Recurrent genuine attacks of acute tonsillitis (more than 6-7 episodes in one year, 5 episodes per year for two years, or 3 episodes per year for three years).
- As part of uvulopalatopharyngoplasty (U3P) in the treatment of snoring and OSA in adult patients.
- As an approach to other procedures such as glossopharyngeal neuralgia or Eagle’s syndrome (elongation of the styloid process).
- Chronic tonsillitis.
- Pediatric septic tonsils (2 out of 3: Congestion of the anterior faucial pillar, pus expressed from tonsillar crypts, persistent jugulodiagastric lymph node enlargement without other obvious causes).

Tonsillectomy: Techniques

Dissection techniques:
- Cold dissection techniques.
- Diathermy or electrocautery dissection.
- Radio frequency/electrosurgery tonsillectomy.
- Harmonic scalpel (ultrasound) tonsillectomy.
- Laser dissection tonsillectomy: CO2 laser, potassium titanyl phosphate (KTP), and Nd-YAG laser.
Nondissection Techniques:
- Guillotine tonsillectomy.
- Intracapsular partial tonsillectomy.

Tonsillectomy: Dissection technique

Anesthesia: General anesthesia (GA).
Endotracheal tube.
Position: Supine with neck extension.
Mostly dissection method.
Incise mucosa of the anterior pillar.
Dissect between the capsule and superior constrictor muscle.
Haemostasis (crucial step) through ligation, electrocautery, or both.

Tonsillectomy: Contraindications

Bleeding disorders:
- History of bleeding tendency.
- Family history of bleeding disorders.
Recent infection:
- Potential risk of bleeding.
- Operate when fever subsides.
- Operate when tonsils are not obviously acutely infected.
- Risk of pulmonary complications.
Oral contraceptives:
- Risk of deep vein thrombosis (DVT).
During epidemics of infectious illnesses:
- (Poliomyelitis) because tonsils expose nerves ending through which the virus may spread and cause bulbar palsy.

Tonsillectomy: Postoperative care

Early detection of bleeding:
- Pulse rate (tonsils have 5 sources of blood supply, increasing the risk of bleeding).
- Excessive swallowing.
- Vomiting of blood.
Analgesia:
- Be careful with aspirin.
- Paracetamol is preferred.
Diet:
- Day zero: Ice diet.
- After that, a usual diet.
Discharge: The patient can be discharged on the day of surgery or not.

Tonsillectomy: Complications

Perioperative:
- Bleeding (primary):
  - Recent infection.
  - Previous quinsy.
- Trauma:
  - Teeth.
  - Soft palate and uvula.
  - Temporomandibular joint (TMJ).
  - Posterior pharyngeal wall.
Immediate postoperative:
- Bleeding (reactionary):
  - Up to 24 hours.
  - Dangerous because the patient is still unconscious and can result in shock.
  - Caused by slipped ligature, increased post-operative BP.
  - Always taken seriously.
- Complications of anesthesia:
  - Asphyxia.
Intermediate complications:
- Bleeding (secondary):
  - More than 24 hours.
  - Mostly due to infection.
  - In most cases, responds to antibiotics and blood transfusion.
- Haematoma and edema of the uvula.
- Infection.
- Pulmonary complications.
- Subacute bacterial endocarditis (SBE) (due to transient bacteremia).
- Pain and otalgia.
- Change in voice (removal of pillars and palatine tonsils may cause primary rhinolalia aperta).
Late postoperative complications:
- Scarring.
- Remnants and reinfection.

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Description

This quiz explores the various types of tonsillitis, including acute and chronic forms, and their characteristics. Learn about the causative organisms and how tonsillitis typically presents in different age groups. Test your knowledge on this common condition affecting many individuals.