Tonsillitis is the inflammation of the flesh areas located on both sides at the back of the throat. This causes symptoms such as difficult and uncomfortable swallowing, malaise (headache, shivers and generalised aches), as well as pain. The tonsils are swollen, red and covered with white-yellowish spots or streaks. Temperature and pulse frequency rise. Lymph nodes are felt under the jaw. Another possible cause is laryngitis, whose main symptom is a HOARSE VOICE.
ACUTE TONSILLITIS:
This is generalized inflammation of the faucial tonsils and is usually caused by hemolytic streptococci,virus, staph. & pneumococcus.. It can occur at any age, but more common in children and adolescents.
"The importance in differentiating patients with tonsillitis from those with glandular fever [mononucleosis] is the prevention of spontaneous rupture of the spleen and acute intra-abdominal hemorrhage," potential complications of mononucleosis.Currently, distinguishing between them requires an expensive mononucleosis spot test.But measuring a patient's ratio of white blood cell types may help physicians accurately distinguish between the similar conditions infectious mononucleosis and bacterial tonsillitis, potentially guiding treatment decisions;according to a new study.
Arcanobacterium haemolyticum is a rarely diagnosed cause of acute pharyngitis and tonsillitis that tends to occur in adolescents and young adults. The symptoms of infection with this organism closely mimic those of acute streptococcal pharyngitis, including a scarlatiniform rash in many patients. A. haemolyticum infection should be suspected in patients with these findings in whom the throat culture is negative for group A streptococci.
Group A streptococcus is a common bacterial pathogen that causes tonsillitis and skin infections, such as erysipelas and impetigo, as well as serious, life-threatening septic infections and suppurative and nonsuppurative complications. The macrolide antibiotics, such as erythromycin, azithromycin, clarithromycin, and roxithromycin, are usually effective against these streptococci and are commonly used in the treatment of respiratory tract infections.
Of the prescriptions analysed, Acute respiratory infections (ARIs) accounted for more than one-third of diagnoses (36.1%), with approximately two-thirds of these affecting the upper, and one-third affecting the lower respiratory tract. Pharyngitis/tonsillitis and acute bronchitis were the most frequently diagnosed ARIs (41.3% and 31.9% respectively). Pneumonia, the most fatal, accounted for less than 1% of ARI diagnoses.
Pathological types:
1. Acute parenchymatous type: where tonsils are inflamed and enlarged.
2. Acute follicular type : where tonsils are inflamed with multiple follicles on its medial surface
Symptoms:
1. Sore throat, difficulty in swallowing, Younger children do not complain of much sore throat, but refuse to eat food .
2. Fever, cold cough, pain in the throat & ear.
3. Malaise, headache, constipation etc. Earache is quite common. Patients usually take to bed and children go off school.
Signs :
(1) The temperature is often 103°-104°F. and the child is flushed.
(2) The tonsils are enlarged and congested. In cases of follicular variety, the tonsils are studded with yellowish spots over the crypts. The follicles often coalesce forming patch on tonsils.
(3) The surrounding area of the pharynx is often inflammed. Tongue is furred and breath is foetid.
(4) Whitish membrane on the tonsil,pus on sneezing, foul smelling, cervical lymphnodes are enlarged, and tender.
(5) The tonsillar lymph nodes are enlarged and tender on both sides.
Complications :
1. Peritonsillar abscess.
2. Parapharyngeal & retro-pharyngeal abscess.
3. Oedema of the larynx.
4. Acute otitis media
5. Septicaemia.
6. Acute rheumatism, acute nephritis, etc.
Treatment :
(1) Patient is put to bed.
(2) Temperature is controlled by giving aspirin or paracetamol group of drugs which also act as analgesics. Aspirin 500 mg. every 6 hours or paracetamol 500 mg. T. D. should be given.
(3) In milder form, antibiotic is not given to allow the body to develop resistance, but in severe cases Penicillin is the drug of choice to be given either orally or systemically. It should be continued for a full period of 5 to 7 days—orally Penicillin 'V (250 mg) 1 tab 6 hourly or systemically Inj. (Cryst) Penicillin 5 lakhs. I. M. twice daily. Broad spectrum penicillin (ampicillin or amoxycillin) or erythromycin is administered more often in recent years.
(4) Bowel is opened up. Fluid and soft solid foods should be allowed.
(5) Mild warm antiseptic gargle is soothing ,mouth wash with saline water or NaHCO3
(6) For constipation-Milk of Magnesia 1 teaspoonful thrice daily.
(7) Soft diet and Vit. C is helpful.
CHRONIC TONSILLITIS:
Pathological types:
This is or two varieties :
(1) Chronic parcnchymatous tonsillitis: seen in children and adolescents.
(2) Chronic fibrotic tonsillitis : common in adults. Usually follows acute or subacute recurrent attacks of tonsillitis.
Signs, symptoms and complications:
There is history of recurrent sore throat, difficulty in swallowing, and rise of temperature. There may be occasional malaise, pain in the limbs, and feverishness. Hawking is common and also choking. Adults often complain of unpleasant taste and smell from cheesy material from the crypts.
Tonsils are often enlarged in children but in adult it is fibrotic, ant. pillars are congested.On
pressing the ant. pillars pus comes out of the
tonsillar crypts.
On examination, tonsils are usually enlarged in children and adolescents, but in adult the tonsils are often fibrotic from recurrent attacks. There is flushing of anterior pillars of the tonsils. On pressing the anterior pillars, pus comes out of the tonsillar crypts which indicates persistent tonsillar sepsis.
The tonsillar glands are persistently enlarged and tender, located ˝ inch below and behind the angle of the mandible
(Jugulo-digastric node).In chronic fibrotic variety, occasionally, there may be some follicles, over the crypts (chronic follicular type).
Treatment :
1. Treatment is conservative at first with attention to general health, nutritious diet, well ventilated room, like that of acute tonsillitis.
2. If trouble persists & recurrent i.e. at least 3/4 attacks a year then tonsillectomy is advised.
Recurrent tonsillitis is managed by ENT surgeons quite frequently. Thirty five such patients underwent tonsillectomty and samples were taken from the surface and core of tonsillar tissue and sent for aerobic and anaerobic culture. Results revealed a marked discrepency between surface and core organisms. It was concluded that superficial throat swab has little role to identify all bacteria responsible. Therapeutic recommendations need to be reconsidered on these grounds.
Tonsillectomy is a useful therapy for treating children with recurrent strep throat infections.Children with recurrent strep throat whose tonsils have not been removed are over three times more likely to develop subsequent episodes of strep throat than children who undergo tonsillectomy;reasearchers found.
A small study of adults from Finland, published recently on bmj.com, showed that tonsillectomy significantly reduced the likelihood of further infection after 90 days, compared with watchful waiting.
Warning:
One of the best-selling herbal medicines in the United States and worldwide is ginkgo biloba, which is used to treat tinnitus, asthma and tonsillitis among other things. Fraunfelder found two cases of hemorrhaging in the anterior chamber of the eye as well as reports of retinal hemorrhages in patients taking this agent.
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