Tonsillitis and Adenoids - ahmad：扁桃体和腺样体-艾哈迈德

TonsillitisandAdenoids

Presentedby:

Dr.MonaAhmedA/RahimAssistantProfessorFacultyofMedicine&HealthSciencesAlneelainUniversityWaldeyer’sRingTonsillitis

Definition:

Isaninflammationofthetonsils.

Types:AcutetonsillitisChronictonsillitis

Acutetonsillitis

Classification:acutecatarrhalorsuperficialtonsillitis:Heretonsillitisisapartofgeneralizedpharyngitisandseeninviralinfections

acutefolliculartonsillitis:Inwhichtonsillarcryptsbecomefilledwithpurulentmaterials

acuteparenchymatoustonsillitis:Heretonsilsareuniformlyenlargedandredacutemembranoustonsillitis:TheexudatesinthecryptscoalescestoformmembraneonthesurfaceAcuteMembranousTonselitisAcuteFolliculerTonselitisAcuteParenchymatousTonselitisAcutecatarhaltonselitisEtiology:

Affectsschool-agechildrenbutadultscanalsobeaffected.Itisrareininfants(<1yearage)andpersonsabove50years.Causativeorganisms:

GroupAbetahemolyticstreptococciHaemophilusinfluenzaeStreptococcuspneumoniaeStaphylococciTuberculosis(inimmunocompromised)Viruses:adenovirus,Epstein-Barvirusandherpessimplexvirus

Symptoms:

sorethroatdifficultyinswallowing+painfever(canbeaccompaniedbyrigorsandchills)earacheheadachegeneralizedbodyfatigueSigns:

breathisfoetidandtongueiscoatedhyperaemiaofthepillars,softpalateanduvularedandswollentonsilswithyellowishspotsinthecrypts(folliculartonsillitis),whitishmembraneonthemedialsurfaceofthetonsils(membranoustonsillitis)orenlargedandcongestivetonsilswithswollenuvula(acuteparenchymatoustonsillitis)enlargedandtenderjugulodigastriclymphnodesTreatment:

bedrest+plentyoffluidsanalgesia(AspirinorParacetamol)antimicrobial(Penicillinisthedrugofchoice)shouldbecontinuedfor7-10daysComplications:

chronictonsillitiswithrecurrentacuteattacksperitonsillarabscess(quinsy)parapharyngealabscesscervicalabscessacuteotitismediarheumaticfeveracutegolomerulonephritissubacutebacterialendocarditisDifferentialdiagnosis:

DiphtheriaInfectiousmononucleosismalignancy(lymphoma,leukemia)Indicationsfortonsillectomy:

recurrentinfections(>6timesperyear)peritonsilarabscesspossibilityofmalignancysleepapnoeafebrileconvulsionsChronictonsillitisTypes:chronicfolliculartonsillitischronicparenchymatoustonsillitischronicfibroidtonsillitisEtiology:

maybeacomplicationofacutetonsillitissubclinicalinfectionoftonsilswithoutacuteattackchronicinfectionofsinusesorteethmaybeapredisposingfactorClinicalfeatures:recurrentattacksofacutetonsillitischronicirritationinthroatandcoughbadtasteinmouthandfoulbreath(halitosis)

Treatment:

conservativetreatment:attentiontodiet,generalhealthandtreatmentofcoexistinginfectionsofteeth,sinusesandnose.tonsillectomy:iftonsilsinterferewithdeglutition,speech,respirationorthereisrecurrentattacksoftonsillitisAdenoids

(Nasopharyngealtonsil)

situatedatthejunctionoftheposteriorwallandroofofthenasopharynxcomposedoflymphoidtissuescoveredbycolumnarepitheliumitispresentatbirthphysiologicallyenlargedupto6yearsthenregressandcompletelydisappearsbytheageof20AdenoidEnlargedAdenoidEtiology:

Recurrentattacksofrhinitis,tonsillitisandsinusitiscauseadenoidinfectionandhyperplasia

Symptoms:

nasalobstructionmouthbreathingnasaldischargeadenoidface:elongatedface,dullexpression,nasaldischarge,openmouth,hitched-upupperlip,prominentandovercrowdedupperteeth,high-archedpalatepulmonaryhypertensionAdenoidFace1AdenoidFace2Diagnosis:

nasopharyngoscop