Tonsillitis and Adenoiditis DHQG 2023

TONSILLITIS AND ADENOIDITIS
A/Prof. TRAN PHAN CHUNG THUY

CONTENT
 overview
 clinical
 Diagnose
 Symptoms
 Medical treatment
 Indications for tonsillectomy and
adenoidectomy
Introduction
Your tonsils and adenoids are part of your lymphatic system. Your tonsils are in the back of
your throat and your adenoids are higher up, behind your nose. They help protect you from
infection by trapping germs coming in through your mouth and nose.
Sometimes your tonsils and adenoids become infected themselves.
Tonsillitis makes your tonsils sore and swollen.
Enlarged adenoids can be sore, make it hard to breathe and cause ear problems.
History
 Celsus 50 A.D.
 Caque of Rheims
 Philip Syng
 Wilhelm Meyer 1867
 Samuel Crowe
Embryology
 8 weeks: Tonsillar fossa and palatine tonsils
develop from the dorsal wing of the 1st
pharyngeal pouch and the ventral wing of
the 2nd pouch; tonsillar pillars originate
from 2nd/3rd arches
 Crypts 3-6 months; capsule 5th month;
germinal centers after birth
 16 weeks: Adenoids develop as a
subepithelial infiltration of lymphocytes
Anatomy 6
Tonsils
 Plica triangularis
 Gerlach’s tonsil
Adenoids
 Fossaof
Rosenmüller
 Passavant’s ridge
ANATOMY OF PALATINE TONSIL
Lateral surface of tonsil presents a well defined fibrous capsule
Loose areolar tissue lies between the tonsillar bed and the
capsule, it is the site for collection of pus in peritonsillar abscess
(Quinsy)
Upper pole of tonsil extends into soft palate, its medial surface
is covered by semilunar fold plica semilunaris
Lower pole of tonsil is attached to the tongue, triangular fold of
mucous membrane extends from anterior pillar to antero-inferior
part of tonsil enclosing plica triangularis
Tonsil is seperated from the tongue by tonsilo- lingual sulcus
• Paired structures situated in lateral wall of oropharynx between
anterior and posterior pillars
• Consists of two surfaces (medial and

lateral) two poles (upper and lower)
• Medial surface is covered by non keratinizing stratified
squamous epithelium
• There are 12-15 crypts on the medial
surface
• Largest crypt is called crypta magna or
intratonsillar cleft
Loose areolar tissue containing vein
Pharyngo-basilar fascia
Superior constrictor
muscle Bucco-pharyngeal
fascia Styloglossus
Medial pterygoid muscle
Glossopharyngeal nerve
Facial artery
Blood Supply
Tonsils
 Ascending and
descending palatine
arteries
 Tonsillar artery
 1% aberrant ICA just
deep to superior
constrictor
Adenoids
 Ascending pharyngeal,
sphenopalatine arteries
LYMPHATIC DRAINAGE
Lymphatics pierce the superior constrictor

and drain into upper deep cervical (jugulo- digastric)
node
FUNCTIONS OF TONSIL
AND ADENOID
It is the component of inner waldeyer’s ring
Tonsils are made –up of adenoids tissue that
 secretes lymphocytes that help in fighting against systemic
infection of the body.
Tonsils It has a protective role and acts as a sentinal at portal
of air and food passage

Tonsils Crypts increase the surface area for contact with
foreign substances
ETIOLOGY
 Viral or bacterial infection along with
immune agents that cause tonsillitis
and its complications. The cramped
Acute tonsillitis can either environment and poor nutrition
be bacterial or viral in origin. facilitate tonsillitis. Most acute
Subacute tonsillitis is episodes of tonsillitis and
caused by the bacterium Acti pharyngitis are caused by viruses,
nomyces. such as:
Chronic tonsillitis, which can
 Herpes simplex virus
last for long periods if not
 Epstein-Barr virus (EBV)
treated, is mostly caused by
bacterial infection.  Cytomegalovirus
 Adenovirus
 Measles virus
Common Diseases of the
Tonsils and Adenoids
Acute adenoiditis/tonsillitis
Recurrent/chronic
adenoiditis/tonsillitis
Obstructive hyperplasia
Malignancy
Acute Adenotonsillitis
Etiology
 5-30% bacterial; of these
39% are beta-lactamase-
producing (BLPO)
 Anaerobic BLPO
GABHS most important
pathogen because of
potential sequelae
 Throat culture
 Treatment
Microbiology of
Adenotonsillitis
Most common organisms cultured from patients
with chronic tonsillar disease (recurrent/chronic
infection, hyperplasia):
 Streptococcus pyogenes (Group A beta-
hemolytic streptococcus)
 H.influenza
 S. aureus
 Streptococcus pneumoniae
Tonsil weight is directly proportional to bacterial
load.
Acute Adenotonsillitis
Differential diagnosis
Infectious mononucleosis
Malignancy: lymphoma, leukemia, carcinoma
Diptheria
Scarlet fever
Agranulocytosis
Medical Management
 PCN is first line, even if throat culture is negative
for GABHS
 For acute UAO: NP airway, steroids, IV abx, and
immediate tonsillectomy for poor response
 Recurrent tonsillitis: PCN injection if concerned
about noncompliance or antibiotics aimed against
BLPO and anaerobes
 For chronic tonsillitis or obstruction, antibiotics
directed against BLPO and anaerobes for 3-6 weeks
will eliminate need for surgery in 17%
 Co-amoxiclav or clindamycin or PCN+Rifampin
Obstructive Hyperplasia
 Adenotonsillar hypertrophy most common cause of

SDB in children
 Diagnosis: snoring, restless sleep, FTT, daytime
symptoms… poor mentation, decreased attn span,
poor scholastic performance, dysphagia, nocturnal
enuresis, chronic mouth breathing
 Indications for polysomnography
 Interpretation of polysomnography
 Perioperative considerations
Unilateral Tonsillar
Enlargement
Apparent enlargement vs true
enlargement
Non-neoplastic:
 Acute infective
 Chronic infective
 Hypertrophy
 Congenital
Neoplastic
Waldeyer (1884) 26
Heinrich Wilhelm Gottfried von Waldeyer (1836 - 1921).

ADENOIDITIS 27
 Viêm VA khá phổ biến ở trẻ em 2-6 tuổi.
 Tỷ lệ Viêm VA:
 Việt Nam: 30%

 Pháp: 25%
 Tiệp Khắc: 12%
 Đức: 17%
28
Incubation period of Tonsillitis
Acute Tonsillitis is 72 hours.

Sub-acute tonsillitis is 2-3 days.
 Chronic Tonsillitis is 4-6 days.
 Recurrent Tonsillitis is 1-2 weeks.
Is the inflammation of the tonsils that can be acute,
sub-acute, and chronic due to causative factors affecting it.
Acute Tonsillitis 30
 The most common form of upper respiratory infection in children

 Appears usually until the age of 15
 The same in 2 sexes
 Virus agents: HSV, EBV, CMV, Adenovirus, measles.
 VK agents: anaerobic, group A beta hemolytic strepto pyogens,
mycoplasma, chlamydia, N. gonorrhea.
ACUTE TONSILLITIS
Mostly affects children in the age group of5-15 years, may also affect adults
Organisms  beta-hemolytic streptococci (most
common), staphylococci, pneumococci, H.influenzae
Symptoms: sore throat, difficulty in swallowing, fever, ear
ache, constitutional symptoms
ETIOLOGY
 Bacterial agents account for 15-30% of cases of sore throat - tonsillitis
 Anaerobic bacteria play an important role in tonsillitis
 Most cases of bacterial tonsillitis are caused by group A streptococcus pyogenes beta
hemolytic A (GABHS).
 S.pyogenes binds to receptors that attach to the tonsil epithelium
 The causative agent globulin may have an initial role in bacterial tonsillitis
 Mycoplasma pneumoniae, Corynebacterium diphtheriae, and Chlamydia pneumoniae rarely
cause acute tonsillitis.
 Arcanobacterium haemolyticum is an important agent of sore throat in England and
Scandinavia.
 Neisseria gonorrhea can cause sore throat - tonsillitis in people having sex
 Hemolytic tonsillitis caused by Streptococcus may form a rash resembling typhus
Enters the nose and mouth causing
inflammation to the tonsils.
Acut follicul
e ar
Acut catarrhal/
e superficial
Acut membrano
e us
38
39
40
Brodsky’s Clasfication
FRIEDMAN STAGE
Modified Mallanpotti Score
 Tongue is relaxed inside the
mouth
Score
1 Tonsils visible
2 Uvula visible
3 Soft palate visible
4 Hard palate visible
FRIEDMAN STAGE
Độ lớn của Amidan
Độ lớn
0 không thấy
1< 25%
225 - 50%
350 - 75%
4> 75%
SIGNS
 Halitosis
 Coated tongue
 Congestion of pillars, soft palate uvul
 and and a
Jugulo-digastric nodes enlarged
tender

Tonsils are congested and
enlarged
depending on type of acute
NASAL ENDOSCOPIC OF VA 46
 I: VA<25%
 II: 25%≤VA<50%
 III: 50% ≤ VA < 75%
 IV: VA ≥75%
47
48
VA
Signs and symptoms
Sore throat as referred pain to the ears

Painful or difficult swallowing (Dysphagia)
Crouch coughing
Headache, fever, chills
Red swollen tonsils with pus
Swelling and tenderness of the submandibular glands
odynophagia
Diagnostic
Buccal swab for Culture & sensitivity test to identify

Streptococci and Staphylococci infections
Complete blood count for elevated white blood cells &
lymphocytes
Treatment
1.Saline gargle (Mouthwash if needed)
2.Analgesics (Ponstan, Brufen)
3.Antipyretics & Increase fluid intake
4.Soothing Lozenges (Orofar-L, Strepsils)
5.Antibiotics (Penicillin is drug of choice)
but may use erythromycin & cefuroxime
6.Tonsillectomy for recurrent chronic cases
Complications
1.Peritonsillar
abscess (tonsils with pus)
2.Lemierres syndrome (septicemia)
 3.Hypertrophy of tonsils (snoring, mouth disturbed sleep and obstructive
sleep apnea)
4.Rheumatic heart disease
5.Glomerulonephritis
6.Tonsillolith (tonsil debris in whitish color)
7.Halitosis (bad breath)
Peritonsill absces
ar s
Acute Infection Guideline Summary ADULT 2016-17
VA Treatment 63
 ADENOIDECTOMY
64
Sluder's guillotine used for tonsillectomy
Tonsillotomy ( partial tonsil removal )
70
Laser tonsillectomy Laser tonsillotomy
THANK YOU!

Tonsillitis and Adenoiditis DHQG 2023

Uploaded by

Copyright:

Available Formats

Tonsillitis and Adenoiditis DHQG 2023

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Tonsillitis and Adenoiditis DHQG 2023

Uploaded by

Copyright:

Available Formats

TONSILLITIS AND ADENOIDITIS

A/Prof. TRAN PHAN CHUNG THUY

infection by trapping germs coming in through your mouth and nose.

Sometimes your tonsils and adenoids become infected themselves.

Tonsillitis makes your tonsils sore and swollen.

• Consists of two surfaces (medial and

• There are 12-15 crypts on the medial

Lymphatics pierce the superior constrictor

of air and food passage

 Adenotonsillar hypertrophy most common cause of

Heinrich Wilhelm Gottfried von Waldeyer (1836 - 1921).

 Viêm VA khá phổ biến ở trẻ em 2-6 tuổi.

 Việt Nam: 30%

Acute Tonsillitis is 72 hours.

 The most common form of upper respiratory infection in children

 III: 50% ≤ VA < 75%

Sore throat as referred pain to the ears

Buccal swab for Culture & sensitivity test to identify

You might also like