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    9 - Chronic Tonsillitis & Pharyngitis

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    Fajar Agung Prayogo
    Chronic tonsillitis and pharyngitis are common conditions caused by viral or bacterial infections of the tonsils and throat. Chronic tonsillitis can cause bad breath, sleep issues, and recurrent infections. Tonsillectomy is the surgical removal of the tonsils and is one of the most common procedures in children, though there is debate around its indications. Pharyngitis, or a sore throat, is usually viral but can be bacterial and needs to be treated to prevent complications like rheumatic fever.

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    9 - Chronic Tonsillitis & Pharyngitis

    Uploaded by

    Fajar Agung Prayogo
    374 views31 pages
    Chronic tonsillitis and pharyngitis are common conditions caused by viral or bacterial infections of the tonsils and throat. Chronic tonsillitis can cause bad breath, sleep issues, and recurrent infections. Tonsillectomy is the surgical removal of the tonsils and is one of the most common procedures in children, though there is debate around its indications. Pharyngitis, or a sore throat, is usually viral but can be bacterial and needs to be treated to prevent complications like rheumatic fever.

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    Chronic tonsillitis and pharyngitis are common conditions caused by viral or bacterial infections of the tonsils and throat. Chronic tonsillitis can cause bad breath, sleep issues, and recurrent infections. Tonsillectomy is the surgical removal of the tonsils and is one of the most common procedures in children, though there is debate around its indications. Pharyngitis, or a sore throat, is usually viral but can be bacterial and needs to be treated to prevent complications like rheumatic fever.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    374 views31 pages

    9 - Chronic Tonsillitis & Pharyngitis

    Uploaded by

    Fajar Agung Prayogo
    Chronic tonsillitis and pharyngitis are common conditions caused by viral or bacterial infections of the tonsils and throat. Chronic tonsillitis can cause bad breath, sleep issues, and recurrent infections. Tonsillectomy is the surgical removal of the tonsils and is one of the most common procedures in children, though there is debate around its indications. Pharyngitis, or a sore throat, is usually viral but can be bacterial and needs to be treated to prevent complications like rheumatic fever.

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    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 31

    Chronic Tonsillitis & Pharyngitis

    By Adnan AL-Maaitah

    Chronic Tonsillitis

    Chronic Tonsillitis
    Halitosis due to crushing of tonsilloliths More resistant to antibiotics Obstruction to breathing snoring, sleep apnea Blockage of Eustachian Canal Dysphagia Constants feeling of fullness and pain in the throat Accompany multiple infections May be with peritonsilar abscess Persistent tender cervical nodes

    Tonsillolith

    Enlarged tonsils in child with obstructive sleep apnea.

    Tonsillectomy

    Tonsillectomy
    Surgical removal of tonsils or a tonsil One of the most common surgical procedures among children Controversy regarding indications for surgery

    Tonsillectomy / Indications
    The American Academy of OtolaryngologyHead and Neck Surgery (AAO-HNS) publishes clinical indicators for surgical procedures: Absolute indications
    Enlarged tonsils that cause upper airway obstruction, severe dysphagia, sleep disorders, or cardiopulmonary complications Peritonsillar abscess that is unresponsive to medical management and drainage documented by surgeon, unless surgery is performed during acute stage Tonsillitis resulting in febrile convulsions Tonsils requiring biopsy to define tissue pathology Three or more tonsil infections per year despite adequate medical therapy Persistent foul taste or breath due to chronic tonsillitis that is not responsive to medical therapy Chronic or recurrent tonsillitis in a streptococcal carrier not responding to betalactamase-resistant antibiotics Unilateral tonsil hypertrophy that is presumed to be neoplastic

    Relative indications

    Tonsillectomy/Contraindications
    Bleeding diathesis Poor anesthetic risk or uncontrolled medical illness Anemia Acute infection (tonsillitis: wait 3 weeks) Peritonsillar abscess

    Tonsillectomy/Procedure
    Patient lying flat on their backs, with the shoulders elevated on a small pillow so that the neck is hyperextended the so-called 'Rose' position. Tonsil is held by forceps and removed by blunt scalpel or electrocautery Bleeding is stopped with electrocautery

    Tonsillectomy/Postop.
    Painful give adequate analgesia Hydration Tonsil beds maybe covered with white or yellowish exudate (up to 2 weeks) normal, not pus

    Complications:
    Bleeding: primary, reactionary (first 24Hr), secondary (3-7 days) Sepsis Chest complications Otitis media Peritonsillar abcess

    Normal appearance after tonsillectomy

    Pharyngitis

    Pharynx/Anatomy
    The musculomembranous cavity behind the nasal cavities, mouth and larynx communicating with them and with the esophagus. Composed of skeletal muscles lined by mucous membrane. Respiratory and digestive function Divided into:
    Nasopharynx Oropharynx Hypopharynx (Laryngopharynx)

    Pharynx/Anatomy

    Pharyngitis
    Inflammation of the mucous membrane and underlying part of the pharynx One of the most common causes of absence from school or work Vast majority due to viruses More common in children (peak 4 7 yrs) Affects all races and both sexes equally Usually associated with URTI

    Pharyngitis
    Causes:
    Viral: rhinovirus, adenovirus, EBV, HSV, influenza virus Bacterial: GABHS Other: allergy, trauma, toxins, neoplasia

    Predisposing factors:
    Smoking (including passive) Mouth breathing Rhinosinusitis Periodontal disease

    Pharyngitis
    Pathophysiology: Viral and bacterial directly invades the mucosa causing local inflammatory response. Some viruses causes inflammation to the mucosa secondary to nasal secretion

    Pharyngitis
    Symptoms:
    Sore throat is the main CCx Fever, headache Acute: rapid onset, short duration, with dysphagia and malaise Chronic: persistent, mild soreness, dryness. Eliminate underlying cause.

    Signs:
    Edema and erythema of the pharynx Exudate can be present

    Pharyngitis
    Bacterial Exposure to known carrier High fever, chills, headache, abdominal pain Painful cervical adenopathy Rare pathogen < 2 yrs Viral Involvement of other mucous membrane With sneezing, rhinorrhea and cough

    An acute inflammation of the part of the throat between the tonsils and the larynx (the pharynx)

    Beefy redness of posterior pharynx, which is the result of infection.

    Phryngitis/Complications
    Usually self limiting Primary concern in children (3 18 yrs) is that untreated GABHS may cause rheumatic fever Adjacent organs: otitis media, sinusitis, peritonsillar abscess Acute respiratory inflammation Acute glomerulonephritis Toxic shock syndrome Mortality due to airway obstruction (rare)

    Streptococcus pyogenes at 100X magnification.

    Pharyngitis/DDx

    Streptococcal pharyngitis Non-infectious pharyngitis Peritonsilar abscess Pharyngeal candidia Diphtheria

    Pharyngitis/RRx
    Symptomatic Rest, oral-fluids, and salt-water gargling are the main supportive measures Paracetamol (Acetaminophen) is the DOC in high pain and fever Antibiotics are indicated for clinically suspected and culture or antigen verified GAS infection. Prevent rheumatic fever if given 9 days from onset

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