Tonsil and Adenoid Senin

8/13/2019 Tonsil and Adenoid Senin

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TONSILS AND ADENOID

ASKAROELLAH ABOET


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The word tonsil- derives from latin, a mooring post

- it part of waldeyers ring of the lymphoid tissue

encircling the entrance from the mouth and nasalpassages to the pharynx


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Ring of waldeyer consist of:

Palatine (faicial) tonsil situated, one oneach side between the folds of thepalatopharyngeans and palato glossus

muscle Lingual tonsil one each side between base

of tongue and vallecula

A single nasopharyngealtonsil (adenoid:Greek aden, gland; eidos, form) in theroof of the nasopharynx (epipharynx)


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Tonsil and adenoids are the major immunologicorgans of the upper aerodigestive tract. Tonsilhas 10 to 30 cryptlike invagination that branch

deep into the tonsil parenchyma and are linedby the specialized antigen processing squamousepithelium

This epithelium serves as the immune systems

acces route for both inhaled and ingestedantigens


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The lymphatic drainage from the tonsil isprimarily into the superior deep cervicaland jugular lymph node

Sensory innervation of the tonsil is fromthe glassopharyngeal nerve and somebranches of the lessen palative nerve via

the sphenopalatine ganglion


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Diseases of the tonsil and adenoid are some of themost common problems seen in children.

Adenotonsillar disease can be broadly classified as

infectious, obstructive and miscellaneous.

The miscellaneous group includes unilateral tonsillar

hypertrophy and tonsilloliths.


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TONSILLITIS

Acute tonsillitis is defined as an acuteinfection of the tonsil with symptoms ofsore throat, fever, odynophagia, and

general malaise.

Physical findings include tonsillarhypertrophy and erythema and exudates

on the tonsillar surfaces.


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Tonsillitis may be associated with cervicallymphadenopathy, skin rashes, and fever.

The disease is usually self-limited, lastingfrom 7 to 14 days, but during this periodthere may be significant loss of time from

school or work.


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Acute tonsillitis may progress to recurrentacute tonsillitis, repeated episodes ofacute tonsillitis followed by periods inwhich the patient is asymptomatic.

The patient may develop symptoms of

acute tonsillitis, during each acute episode


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Recurrent acute tonsillitis patientsdeveloped enlarged tonsillar crypts thataccumulate debris, persistent erythema of

the tonsils, and dilated blood vessels onthe surface of the tonsils.


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Many pathogens may be cultured from thesurface and the core of the tonsils andmay cause acute tonsillitis.

The greatest concern is group A beta-hemolytic streptococcus because it maylead to the development of rheumatic

cardiac disease and glomerulonephritis.


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Group A beta-hemolytic streptococcusmaybe isolated on the tonsil surface

Up to 60% cases were found deep within

the tonsillar crypts Cultures of the tonsil surface may not

detect group A beta-hemolytic

streptococcus as the cause of acutetonsillitis


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Treatment of acute tonsillitis should bebased on clinical judgement

Consideration the entire clinical picturerather than just cultures of the tonsilsurface


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Antimicrobial theraphy may be startedeven in the absence of a positive culturefor group A beta-hemolytic streptococcus

In most cases, penicillin and amoxicillinare the initial drugs of choise


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The responsible pathogens are likely to be-lactamase-producing bacteria forpatients with history of treated reccurent

acute tonsillitis

Should be used -lactamase-stableantibiotic such as amoxicillin clavulanate


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Some patients may be carriers of group Abeta-hemolytic streptococcus

No treatment is necessary forasymptomatics patients

Patients who experience frequent episodesof acute tonsillitis, infect other patients ordevelop complications should be treated.


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An initial course of antibiotics may

eradicate the bacteria dan carrier stateAdenotonsillectomy is indicated for

treatment failure


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Children who continue to experience reccurentacute tonsillitis:

- Adequate antibiotic theraphy

- Considered for tonsillectomy and adenoidectomyOver 70% cases, core tonsil and core adenoid tissue

harbor the same pathogens

Both tonsillectomy and adenoidectomy lead to their

eradication


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Candidates for tonsillectomy and

adenoidectomy are patients with > 3episodes of acute tonsillitis within a year

It is important to document:

- dates of the two last infections- degree of fever

- severity of disease

- results of any throat cultures- response antibiotics


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CHRONIC TONSILLITIS


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Defined as persistent tonsillar infectionoccur in all age groups but more often nadolescents and young adults

Patient complains:

- constant throat pain

- halitosis

- fatique


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Examination of tonsil reveals hypertrophy,erythema, and enlarged crypts filled withdebris

Patient is treated with tonsillectomy if thesymptoms are severe or the persistentinfections interferes with normal activity


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PERITONSILLAR INFECTION


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Defined as persistent tonsillar infectionoccur in all age groups but more often inadolescents and young adults

Most frequent head and neck spaceinfection

Most common complication of acute

tonsillitis


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Infections of the tonsillar capsule toinvolve the peritonsillar space

Most infection occur in the superior pole of

the tonsil, but some involve themidtonsillar area and inferior pole

The infection begins as a cellulitis and

progresses to an abscess


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Classic signs include:

- a muffled voice

- drooling, unilateral swelling, an erythema of the

superior tonsillar pole

- deviation of the uvula to the opposite side

- bulging of the posterolateral part of the soft palate


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The oral airway may be compromised.

The diagnosis of a peritonsillar spaceinfection is usually made clinically, but itmay be difficult to distinguish betweencellulitis and an early abscess


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There is no consensus regardding the besttechnique for drainage of the abscess

Options include needle aspiration, incisionand drainage, and immediatetonsillectomy

Needle aspiration and incision anddrainage have success rates greater than

90%, but there is 10 to 15% risk ofabscess reccurent


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ADENOIDITIS


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Examination with a mirror or telescopemay demonstrate inflamed, swollen

adenoid covered with exudates


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Treatment is with antibiotics

Antibiotics with activity against -lactamase-producing microorganism arerecommended for patient with reccurentcondition


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The relationship between adenoidinfections and sinusitis has not beenclearly established

Adenoitis may be misdiagnosed assinusitis since the presentation ot thesetwo conditions is similiar


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Tonsil and Adenoid Senin