Approach to Tonsillitis PDF

AN APPROACH TO TONSILLITIS DR KM RATALE Edited Dr S Maharaj  DEFINITION AND ANATOMY Anatomy Waldeyer’s Ring: the oral cavity is considered the gateway for disease and infection therefore there’s a ring of lymphoid tissue surrounding the oropharynx as a form of l...

AN APPROACH TO TONSILLITIS DR KM RATALE Edited Dr S Maharaj  DEFINITION AND ANATOMY Anatomy Waldeyer’s Ring: the oral cavity is considered the gateway for disease and infection therefore there’s a ring of lymphoid tissue surrounding the oropharynx as a form of local defence Consists of palatine tonsils of the left and right lateral walls, lingual tonsils inferiorly, nasopharyngeal tonsils(adenoids) as the major components and tubal tonsils (lateral pharyngeal bands) as the lesser components. Produce B an T lymphocytes Definition of Tonsillitis Inflammation/infection of the tonsils. Majority of infections occur in the palatine tonsils located bilaterally in the lateral walls of the oropharynx in the tonsillar recess. Anterior wall is the palatoglossal fold and posterior wall is the palatopharyngeal fold. ETIOLOGY AND PATHOPHYSIOLOGY Tonsillitis mainly affects children between the ages of 5 to 10 and young adults 15- 25. 30%- 40% due to Group A beta-haemolytic Streptococcus 60% other… viral S. Pyogenes Staphylococci Pneumococci Haemophilus influenza Most cases start off as a viral infection which then develop a super imposed bacterial infection. CLINICAL PRESENTATION dysphagia / odynophagia Fever (>38,3 oC) trismus halitosis cervical lymphadenopathy (often tender) tonsillar enlargement Stages of Tonsillitis: erythema exudative phase Follicular phase (yellow lymphatic spots) Cryptic phase (chronic tonsillitis) SUBTYPES Superficial/Catarrhal Mostly viral Generalised infection of the oropharyngeal mucosa. Follicular Spreads into the tonsillar crypts with purulent material Yellowish exudates  Membranous Follows the follicular stage Exudate coalesce and form a membranous sheath on the surface of the tonsils Parenchymatous Uniform swelling/congestion and erythaema Ulcerative Ulcerations which can be deep or superficial May be indicative of Diptheria or Syphilis (Vincent’s angina) MANAGEMENT Investigations Bloods ( FBC, U&E, CRP) Blood cultures- rarely taken Throat smear/ pus swab Rapid immune assay – can identify Group A beta- haemolytic Streptomycin Medical management Antibiotics ( streptococcal infections require 7-14 days of either oral or intravenous penicillin + B lactamase inhibitors) Patients with penicillin allergies microlides or cephalosporins can be used Analgesia Bed rest, fluids, oral hygiene  Surgical management - Tonsillectomy Indications suspected tumour Relieve airway obstruction Halitosis Sleep apnoea Recurrrent infections (acute tonsillitis) - paradise score 7x in 1 year 5x in 2 consecutive years 3x in 3 consecutive years COMPLICATIONS Local Recurrent tonsillitis Chronic tonsillitis – constant sore throat with tonsillar hypertrophy – usually indication of TB, syphilis, malignancy Peritonsillar abscess (Quinsy) – infection spreads past the tonsillar capsule and collection is usually found medial to the superior constrictor muscle. Requires aspiration +/- incision and drainage Can spread using the superior constrictor muscle to form abscess in the parapharyngeal space +/- retropharyngeal spaces. Systemic – REQUIRE intense medical treatment intra hospital Septacaemia In the case of Group A beta-haemolytic strep: Acute rheumatic fever ( 1-4 wks) Infective endocarditis Acute glomerulonephritis ( 1-2 wks post infection) THANK YOU