tonsolitis

Tonsils

   Tonsils are the aggregations of lymphoid tissues that are present beneath but in contact with epithelium of digestive tract.

tonsillitis

membrane over the tonsils BECOMES enlarged and sore lymph glands CAUSING sore throat and temperature

general symptoms:

The main symptoms of tonsillitis are inflammation and swelling of the tonsils, sometimes severe enough to block the airways. Other symptoms include:

• Throat pain or tenderness
• Redness of the tonsils
• A white or yellow coating on the tonsils
• Painful blisters or ulcers on the throat
• Hoarseness or loss of voice
• Headache
• Loss of appetite
• Ear pain
• Difficulty swallowing or breathing through the mouth
• Swollen glands in the neck or jaw area
• Fever, chills
• Bad breath

In children, symptoms may also include:

• Nausea
• Vomiting
• Abdominal pain
• cough and rhinitis are evidence against group A streptococcal  infection

            TYPES

Depending on their localisation we distinguish between 

• Palatine tonsils
• Lingual tonsils
• pharyngeal tonsils  

Palatine tonsils: (THE tonsils), which are located in the lateral wall of the oropharynx and covered by a stratified squamous epithelium,The palatine tonsils (what the term tonsils generally refer to) are two lymphatic tissue masses. There is one located on each side of the oral pharynx, in the back of the throat. The function of palatine tonsils has yet to be discovered, however they are part of the immune system and are thought to assist in defending the body from respiratory infections.

lingual tonsils: which are situated in the lamina propria at the root of the tongue and also covered by a stratified squamous epithelium, and

Pharyngeal tonsils (also called nasopharyngeal tonsils or adenoids) which are located in the upper posterior part of the throat (nasopharynx) and covered by a pseudostratified ciliated epithelium with goblet cells.

significant causative agents:

• beta-haemolytic streptococci (groups A, C and G)
• adenoviruses
• Epstein-Barr virus
• Influenza virus
• Parainfluenza viruses
• Enteroviruses
• Herpes simplex virus

other causative agents:

various bacteria and viruses which are rare and with little significance on treatment

Diagnosis of tonsillitis

The aim is to:

reliably identify group A streptococcal infections

during epidemics testing is also done for group C and G streptococci

Diagnosis of tonsillitis 2

group A streptococcal infection cannot be reliably diagnosed on clinical symptoms and findings (A)

antibiotic treatment should be based on isolation of beta-haemolytic streptococci from the throat (A)

the main bacteriological investigation is a throat swab (the only acceptable one during an epidemic) (A)

use of “on the spot” testing methods is justifiable only if results are available whilst the patient waits

a positive “on the spot” test result is reliable – a negative one should be counterchecked by bacterial culture

Antimicrobial therapy of tonsillitis

First choice:

                Penicillin V 1-1.5 mega units twice daily for 10 days (more relapses with shorter treatment period (A))

Second choice:

first generation cephalosporins (cefalexin 750 mg twice daily or cefadroxil 1g daily) or

procaine penicillin 1.2 – 1.5 mega units daily

                for 10 days

macrolides – with caution (if local resistance patterns accept their use or they are indicated by sensitivity testing)

                 

Treatment of tonsillitis 2

about 90% of patients with pharyngitis are asymptomatic within a few days of symptom onset whether they received antibiotics or not

Antibiotic treatment aims at:

relieving patient’s symptoms sooner (A) and

preventing both complications (A) and epidemics

Symptomatic pain relief should also be remembered.  Painkillers have a significant effect on pain, including pain on swallowing. (A)

Recurrent episodes of tonsillitis

                4 or more episodes of group A streptococcal infections per year

90-96% carry beta-lactamase producing bacteria in the normal flora of their throat

Other reasons:

poor compliance with treatment

new infection from a close contact

frequent episodes of viral infections in carriers

Treatment:

1. cefalexin or cefadroxil or

2. clindamycin 300mg twice daily  for 10 days
3.cephradin 500mg twice for 5 days
4.ciprofloxacin 250mg 7days ,500mg 5 days
5.ofloxacin dose same as ciprofloxacin.

Quality criteria for the treatment of tonsillitis

antibiotic therapy based on microbiological confirmation

the majority of patients treated with narrow spectrum antibiotics

treatment decision made within 24 hours

patient informed also about symptomatic pain relief

                 Tonsil Tests

• Throat (pharynx) swab: A doctor rubs a cotton swab on the tonsils and throat and sends the swab for tests. Usually this is done to check for bacteria such as Streptococcus.
• Monospot test: A blood test can detect certain antibodies, which can help confirm that a person’s symptoms are due to mononucleosis.
• Epstein-Barr virus antibodies: If a monospot test is negative, antibodies in the blood against EBV might help diagnose mononucleosis.
• Tonsil Conditions
• Acute tonsillitis: A bacteria or virus infects the tonsils, causing swelling and a sore throat. The tonsil may develop a gray or white coating (exudate).
• Chronic tonsillitis: Persistent infection of the tonsils, sometimes as a result of repeated episodes of acute tonsillitis.
• Peritonsillar abscess: An infection creates a pocket of pus next to the tonsil, pushing it toward the opposite side. Peritonsillar abscesses must be drained urgently.
• Acute mononucleosis: Usually caused by the Epstein-Barr virus, “mono” causes severe swelling in the tonsils, fever, sore throat, rash, and fatigue.
• Strep throat: Streptococcus, a bacterium, infects the tonsils and throat. Fever and neck pain often accompany the sore throat.
• Enlarged (hypertrophic) tonsils: Large tonsils reduce the size of the airway, making snoring or sleep apnea more likely.
• Tonsilloliths (tonsil stones): Tonsil stones, or tonsilloliths, are formed when this trapped debris hardens, or calcifies

 FOR MORE INFORMATION YOU CAN READ ITS ANATOMY AND HISTOLOGY

Anatomy

The tonsils consist of two glandular tissues similar to hundreds of other lymph glands in the human body, present on either side of the back side of the throat. They are normal body organs just like lungs, skin and eyes. They are visible just behind the tongue, when the mouth is opened with slight force. They may vary in size. They are soft to touch and may either be bright red or pink-grayish in color.

Physiology

Tonsils, like any other body organ, have a specific role to play. Rather, tonsils have been allotted the vital task of checking if there are certain intruders such as bacteria, virus, allergens, etc attempting to attack the human body. Tonsils being lymphoid tissues, they produce the special cells called Lymphocytes. The Lymphocytes are similar to the white blood cells (Leukocytes) with which they form an immunological network of self-defense.

Growth

Tonsils tend to reach their largest size near puberty, and they gradually undergo atrophy thereafter. However, they are largest relative to the diameter of the throat in young children.

Tonsils can become enlarged or inflamed (tonsillitis) and may be surgically removed in tonsillectomy. This may be indicated if they obstruct the airway or interfere with swallowing. In older patients, asymmetric tonsils (also known as ) may be an indicator of virally infected tonsils, or tumors such as lymphoma or squamous cell carcinoma.

Some doctors who are not ear, nose and throat (ENT) specialists are conservative on recommending the removal of tonsils , because the tissue cannot be put back, and some claim that removal decreases the power of the immune system. ENT specialists generally recommend removal if there are frequent recurrent tonsillitis, adenotonsillar hyperplasia causing symptomatic partial upper airway obstruction or asymmetry.

Tonsil enlargement can affect speech, making it hypernasal and giving it the sound of velopharyngeal incompetence.

 HISTOLOGICALY

                The tonsils are accumulations of lymphoid tissue surrounding the openings of the digestive and respiratory tracts. The tonsils and smaller accumulations of lymphoid tissue, which may be found between them, are also called Waldeyer's ring.