1. TONSILITTIS
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2. The tonsils
Tonsils are subepithelial collections of lymphoid tissue scattered in the pharynx. Anatomically the tonsils are classified based on their location into : palatine (faucial), nasopharyngeal (“adenoids”), lingual and tubal tonsils.
Generally, the palatine tonsils referred to as “the tonsils”.
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3. Waldeyer's tonsillar ring
Waldeyer's tonsillar ring (pharyngeal lymphoid ring orWaldeyer's lymphatic ring) is an anatomical term collectively describing the annular arrangement of lymphoid tissue in the pharynx.
The Waldeyer’s ring is formed by :
Palatine tonsils
Nasopharyngeal tonsil
Lingual tonsils
Tubal tonsils
Lateral pharyngeal bands
Posterior pharyngeal nodules
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4. Anatomy of tonsils
*Site: lateral walls of oropharynx, between the anterior and posterior pillars- tonsillar fossa
*Shape: almond shape
*2 surfaces: medial, lateral
*2 poles: upper, lower
* primary crypts,
secondary crypts
*Plica semilunaris and plica triangularis
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5. Functions of Tonsils Immunity Lymphocyte formation
Antibodies formation
Barrier to infections
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6. Tonsillitis
Tonsillitis is inflammation of the tonsils most commonly caused by a viral or bacterial infection.
Tonsillitis is divided into acute, sub-acute and chronic. Acute tonsillitis tends to be bacterial or viral in nature, while sub-acute tonsillitis is caused by the bacterium Actinomyces. Chronic tonsillitis generally lasts for a long time and is caused by bacteria.
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7. Acute tonsillitis
- Acute infection of the tonsils involving the surface epithelium, crypts and lymphoid tissue
Mostly affects children in the age group of 5-15 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
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8. Predisposing factors Endogenous URTI
Postnasal discharge due to sinusitis
Residual tonsillar tissue after tonsillectomy
Exanthemata
Blood dyscrasias
Exogenous
Cold drinks and foods
Contact with infected persons
Crowded and ill-ventilated environment
Imbedded foreign body
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9. Types of Acute Tonsillitis
Acute superficial tonsillitis
Acute parenchymatous tonsillitis
Acute follicular tonsillitis
Acute membranous tonsillitis
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10. Acute catarrhal/superficial
Here tonsillitis is a part of generalized pharyngitis, mostly seen in viral infections

11. Acute follicular
infection spread into the crypts with purulent material, presenting at the opening of crypts as yellow spots.

12. Acute membranous
follows stage of acute follicular tonsillitis where exudates coalesce to form membrane on the surface

13. Acute parenchymatous
tonsil is uniformly enlarged and congested

14. Clinical Manifestation of Acute Tonsillitis
Symptoms:
1. Sore throat – raw sensation in the throat
2. Refusal to eat due to odynophagia
3. Earache – either referred pain from the tonsil or due to acute otitis media
4. Voice becomes thick and muffled
5. Jugulodigastric nodes are enlarged and painful
6. Fever, may be associated with chills and rigor. Headache, tachycardia.
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15. Clinical Manifestation of Acute Tonsillitis
Signs:
1.Tonsils appear congested and swollen
Yellowish spots – follicular
Whitish membrane – membranous
Red and enlarged – parenchymatous
2.Hyperemia of pillars, uvula, soft palate
3.Halitosis, impeded movements of palate and increased secretions
4.Enlarged and tender jugulodigastric nodes
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16. Differential Diagnosis of Membranous tonsillitis
Diphtheria
Vincents angina
Infectious mononucleosis
Agranulocytosis
Leukaemia
Traumatic ulcer
Aphthous ulcer
malignancy
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17. TREATMENT Bed rest Plenty of oral fluids Analgesics
Antimicrobial therapy penicillin
In case of penicillin sensitivity erythromycin are given.
Antibiotics should be continued for 7_10 days
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18. COMPLICATIONS chronic tonsillitis peritonsillar abscess
parapharyngeal abscess
cervical abscess
acute otitis media
rheumatic fever
acute glomerulo nephritis
sub acute bacterial endocarditis
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19. Chronic follicular tonsillitis Chronic parenchymatous tonsillitis
CHRONIC TONSILLITIS
Characterised by recurrent acute attacks
Aetiology:
Complication of acute tonsillitis
Sub clinical infection of tonsil
Chronic sinusitis or dental sepsis
Mostly affects children and young adults
Types
Chronic follicular tonsillitis
Chronic parenchymatous tonsillitis
Chronis Fibroid tonsillitis
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20. Types of chronic tonsillitis
1). Chronic follicular tonsillitis
tonsillar crypts are full of cheesy material resulting in yellow spots on the surface.
2). Chronic parenchymatous tonsillitis
tonsils are very much enlarged almost touching each other and may interfere with speech, deglutition and respiration, long standing cases may develop pulmonary hypertension
3).Chronic fibroid tonsillitis
Tonsils are small but infected , with history of repeated sore throat.
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21. CLINICAL FEATURES recurrent attacks of sore throat
chronic irritation in throat with cough
halitosis
dysphagia
odynophagia
thick speech
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22. Examination
Tonsil may show varying degree of enlargement depending on the type
Irwin-moore sign tonsils are small but pressure on the anterior pillar expresses pus or cheesy material ,mainly seen in fibroid type
There may be yellowish beads of pus on the medial surface of tonsils chronic follicular tonsillitis
Flushing of the anterior pillar compared to rest of the pharyngeal mucosa
Enlargement of the jugulo-digastric node, soft non tender

23. TREATMENT Conservative management
Pay attention to the general health ,diet,and treatment of co- existent infections of teeth , nose , and sinuses.
Tonsillectomy
when recurrent attacks ,interference with speech , deglutination & respiration.

24. COMPLICATIONS Peritonsillar abscess Parapharyngeal abscess
Retro pharyngeal abscess
Intra tonsillar abscess
Tonsillar cyst
Tonsillolith
Focus of infection for RF, AGN
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