TONSILITIS*

ANATOMY*

*Acute Tonsilitis

*Etiology Pathogen: - Hemolytical Streptococci *. Virus: adenovirus, rhinovirus, enterovirus** Causes: cold, fatigue, decreasing of the resistance to diseases, smoke and drink to excess, stimulated by harmful gas ,etc.

*In Clinics 1. Acute Catarrhal Tonsilitis caused by virus, the symptom is light, inflammation located on mucosa 2. Acute Purulent Tonsilitis caused by bacteria, the symptoms is severe, inflammation develop in deep layer, purulent discharge from tonsil crypt

* Clinical Appearances Symptoms:* General : rise of temperature, chills, malaise, headache , a general feeling of illness, and appetite decrease, etc. Local: pain, pain felt only on swallowing, or swallowing is extremly painful, and dysphagia.

*Clinical Appearances Examinations: pharyngeal mucosal diffuse congestion, the mucosal membrane of the fauces is bright red, uvula edema, the crypt filled with debris, desquamated epithelium and pus. lymph nodes: below the jaw draining the tonsillar area are frequently enlarged and tender

*Diagnosis and Differential Diagnosis Vincents angina: infected with spirillum in symbiosis with a fusiform bacillus, poor dental hyigene,a bleeding ulcerative gums are covered with a membrane which spread to the tonsils. Diagnosis is bacteriological.* pharyngeal diphtheria: infected with Corynebacterium diphtheriae, most commonly affect fauces, may be relatively mild or very severe, a swab should be taken and do bacteriological comfirmation. the others:

*Complications Local Complications: peritonsillar abscess (most common seen), retropharyngeal abscess (seldom seen), acute sinusitis, acute otitis media, and acute laryngitis, etc. General Complications: rheumatic fever, acute glomerulo-nephritis, acute arthritis, myocarditis, type allergic reaction, and bacterial toxin.

* Treatment 1.General therapy: in bed, diet should be light but nourishing, encourage to intake fluid, 2. Antibiotics therapy:Penicillin should be given, or erythromycin if the patient is allergic 3. Local treatment: soothing the affected membrane and clearing the secretion, inhalation,etc. 4. Chinese Medicines 5. Surgery: recurrence and relapse, particularly with complications.

*Chronic Tonsilitis

*Chronic Tonsilitis

*Chronic TonsilitisCaused by repeated attacks of acute tonsilitis or influent drainage of the crypt.Pathogen: bacteria infection, secondary to the acute infectious diseases or nasosinus infections.Pathogenesisunknown, autoallergic reaction

*Pathology Proliferation repeated stimulationtissue proliferation, gland hypertrophy, soft. Fibrousdegeneration, atrophy, gland is small and stiff Crypt the crypt filled with debris, desquamated epithelium and pus or adhesion by scar.

*Clinical AppearancesLocal symptoms: simple sore throat, dry,itchy,, a pricking or irritation as of a foreign body, fetor oris, and coughPharyngeal obstructive symptoms in childrensnoringdisturbance of respiratory, swallowing and speech resonanceGeneral symptomsdyspepsia, headache, tired, low fever,etc.

*Examination

Chronic congestion of tonsils and palatoglossal arches.Tonsil sizes are different (fairly prominent, small, or even difficult to see.), caseation, scar, adhestion,etc.Submandibular lymph node enlargement.

*Diagnosis and Differential Diagnosis Diagnosis: caused by repeated attacks of acute tonsilitis*, simple sore throat, dry,itchy, a pricking or irritation as of a foreign body, fetor oris, and cough, caseation,scar, adhestion, and submandibular lymph nodes enlargement.

*Diagnosis and Differential Diagnosis Differential Diagnosis: Tonsil Physiological Hypertrophy Tonsil keratosis Tonsil Tumor (biopsy)

* Complications General : rheumatic arthritis, rheumatic fever, heart diseases, nephritis, etc. Tonsilitis of focal infection: 1. History: acute tonsilitis 2. Examinations: erythrocyte sedimentation rate (ESR), anti- o, serium mucus protein, ECG (electrocardiogram)

*TreatmentNon-surgical therapy: medicine management, local treatment, build up patients healthSurgical therapy: tonsilectomy.

*Indications for Tonsillectomy Repeated attacks of tonsillitis* Peri-tonsillar abscess (quinsy), abscess of the lateral or retropharyngeal spaces initiated by an episode of tonsillitis. Tonsils excessive hypertrophy: interfere swallowing, respiration, or phonation. Focal infection tonsils. Diphtheria carrier, conservative therapy is ineffective. Tonsil tumor.

**The bacteria infections are caused by streptococci,staphylococci ,pneumococci ,and Heamophilus influenza. The - Hemolytical Streptococci is important because it may be responsible for rheumatic and renal complications.** these virus groups are probably responsible for about 50%of acute adenotonsilitis. ** If the attack is severe, the patient can be quite ill. The young child even can be delirious** Treatment consists of peroxide mouth washes and gargles and penicillin by injection. Metronidazole is given intravenously. Dental treatment is essential to avoid recurrence, and tonsillectomy may be needed for similar reasons.** In which permanent damage has been done to the tonsil, or it can occur when resolution has been incomplete.*