Chronic tonsillitis

CHRONIC TONSILLITIS

Aetiology

Complication of acute sinusitisSubclinical infection of tonsilsChronic infection of sinuses or teeth

Mostly affects children and young adults , rarely occurs after 50yrs

TYPES1.Chronic follicular tonsillitis – Tonsillar crypts are full of infected cheesy material, shows yellowish spots on surface

2.Chronic parenchymatous tonsillitis Hyperplasia of lymphoid tissue Tonsils are very much enlarged,may interfere with speech,deglutition and respiration Long standing cases develop features of cor pulmonale

3.Chronic fibroid tonsillitis Tonsils are small but infected,with history of repeated sore throats

CLINICAL FEATURES

• Recurrent attack of sore throat or acute tonsillitis

• Chronic irritation in throat with cough• Bad taste in mouth and foul breath(halitosis)• Difficulty in swallowing and choking spells at

night

EXAMINATION

• Tonsils may show varying degree of enlargement

• There may be yellowish beads of pus on medial surface of tonsil

• Tonsils are small but pressure on anterior pillar expresses frank pus or cheesy material

• Flushing of anterior pillars compared to rest of the pharyngeal mucosa

• Enlargement of jugulodigastric lymphnodes

TREATMENT

• Conservative treatment - attention to general health,diet,treatment of coexistent inefction of teeth,nose and sinuses

• Tonsillectomy - tonsils interfere with speech,

deglutition and respiration

COMPLICATIONS

1.Peritonsillar abscess2.Parapharyngeal abscess3.Intratonsillar abscess4.Tonsilloliths5.Tonsillar cysts

TONSILLOLITHS(calculus of the tonsil)

• Seen in c/c tonsillitis • when crypt is blocked with retention of

debris• Inorganic salts of Ca and Mg are then

deposited stone formation• Gradually and then ulcerate through tonsil

• It give rise to local discomfort or foreignbody sensation

• Diagnosed by palpation or gritty feeling on probbing

• Treatment- simple removal of stone or tonsillectomy

INTRATONSILLAR ABSCESS• Accumulation of pus within the substance of tonsil• It usually follows blocking of crypt opening in Acute follicular tonsillitis• There is marked local pain and dysphagia• Treatment – Antibiotics,drainage of abscess

TONSILLAR CYST

• It is due to blockage of tonsillar crypt and appraer as a yellowish swelling over the tonsil

• Usally symptomless

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