DISEASES OF OROPHARYNX-TOPICS
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Pharyngitis
Tonsillitis
Acute
Recurrent (Chronic)
Complication and
Management
Tonsillectomy
ANATOMY OF TONSILS
Main lymphoid tissues present in the lateral wall of oropharynx between
ant. and post. Pillars
Free surface is lined by St. sq. epithelium
It has 12-15 crypts
Mucous glands open into crypts
Core consists of Lymphoid tissues arranged in follicles
Has only efferent lymphatics. No afferent channels
Deep surface has capsule which separates it from tonsillar bed i.e. Sup.
Constrictor muscle
PHARYNGITIS
Etiology
Viral:
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50 - 85% are viral
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Most viral cases are self limiting.
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Some lead to secondary bacterial infections.
PHARYNGITIS
Etiology
Viral:
– 50 - 85% are viral
– Most viral cases are self limiting.
– Some lead to secondary bacterial infections
Bacterial:
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Streptococcus (most common) or GABHS
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Staphlococci
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Pneumococci
PHARYNGITIS CLINICAL FEATURES
Mild cases: (local symptoms)
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Slight sense of irritation in throat.
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Feeling of being unwell.
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Slight cough dry or irritating
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Feeling of something sticking in throat.
PHARYNGITIS CLINICAL FEATURES
Severe cases:
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Fever
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Rapid pulse
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Anorexia (loss of appetite)
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Insomnia (loss of sleep)
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Severe pain in throat
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Difficulty in swallowing.
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Adenopathy(Lymph node involvement)
PHARYNGITIS ETIOLOGY
Pre-disposing factors:
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Diet
e.g. sour, cold, hot
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Profession e.g. singer, teachers
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Disease
e.g. diabetes mellitus
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Climate
e.g. cold wet climate
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Trauma
e.g. impaction of foreign bodies
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PHARYNGITIS DIAGNOSIS
Tonsillar exudate (white secretions on the surface of tonsils)
Adenopathy (enlarged lymph nodes of the neck)
High white blood cell count (Raised TLC)
Culture/Sensitivity (c/s)
PHARYNGITIS
COMPLICATIONS
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Peritonsillar abscess
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Bacteremia (Infection spreads in the blood)
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Acute rheumatic fever (With inflammation of the joints)
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Glomerulonephritis (Involvement of the structures of the kidneys)
PHARYNGITIS TREATMENT
General:
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Bed rest
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Semi - solid or liquid diet
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Analgesics for pain
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Antibiotics
Local:
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Saline gargles
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BLOOD SUPPLY OF TONSILS
Tonsillar branch of Facial A.
(Main)
Greater Palatine A.
Dorsal Lingual A.
Ascending Pharyngeal A.
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TONSILLITIS
Acute inflammation of the palatine or faucial tonsils
TYPES
ACUTE PARENCHYMATOUS TONSILLITIS:
Whole tonsil is infected, with generalized swelling of whole tonsil
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TYPES
ACUTE FOLLICULAR TONSILLITIS:
Tonsillar crypts are filled with infected debris, containing pus,
fibrin etc.
TYPES
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ACUTE MEMBRANOUS TONSILLITIS:
Thick muco-purulent secretions are deposited over tonsillar surface in
the form of membrane
CAUSATIVE ORGANISMS
B-Haemolytic Streptococcus
Streptococcus pneumoniae
Staph. Aureus
Haemophillus influenzae
Anaerobic Bacteria
Viruses (Influenza, parainfluenza, adenovirus, enterovirus,
rhinovirus)
CLINICAL FEATURES: (SYMPTOMS)
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Sore throat
Pain on swallowing
Fever
Malaise
Earache
CLINICAL FEATURES: (SIGNS)
Raised temperature
Tachycardia
Redness & congestion of Tonsils especially over pillars
Pus in Tonsillar crypts
Tender Jugulo-diagastric lymph nodes
DIFFERENTIAL DIAGNOSIS
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Acute Pharyngitis
Diphtheria
Infectious Mononucleosis
Vincent’s Angina
Oral Thrush
Agranulocytosis
Acute Leukemia
Scarlet fever
D/D of WHITE PATCH on TONSIL
Diphtheria
Infectious Mononucleosis
Oral Thrush
Agranulocytosis
TONSILLITIS COMPLICATIONS
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General
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Loss of appetite
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Fever high grade
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Chills
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Lethargy
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Weakness
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Loss of sleep
Specific
• Peritonsillar abscess
(quinsy)
• Acute rheumatic fever
• Acute laryngitis
• Acute nephritis
REMOTE COMPLICATIONS
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Rheumatic Fever
Glumerulo-nephritis
Septicaemia
TREATMENT
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Analgesics
Antibiotics
Warm saline Gargles
RECURRENT TONSILITIS
It is recurrent inflammation of the mucosa of the Tonsils
Recurrent attacks of sore throat for past two years, usually 4 to 5 attacks
per year,
and each attack lasting for 4 or 5 days with fever
CAUSES
Increase virulence of the organisms
Low body resistance
Improper and inadequate treatment of acute tonsillitis
Ch. Rhinitis & Ch. Sinusitis
CAUSES
Post nasal drip & Nasal Obstruction
Adenoid hypertrophy, and Nasopharyngitis
Poor oral hygiene
Mouth breathers
Excessive use of cold and sour things
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TYPES
CHRONIC FOLLICULAR TONSILLITIS
Tonsillar crypts are full of debris and pus
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CHRONIC HYPERTROPHIC (PARENCHYMATOUS) TONSILLITIS
Tonsils are grossly enlarged and oedematous.
May interfere with speech and swallowing
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CHRONIC ATROPHIC (FIBROID) TONSILLITIS
Tonsils become small and fibrosed due to repeated infections
CLINICAL FEATURES SYMPTOMS
Persistent or recurrent sore throat
Bad Taste
Dry cough
Mouth breathing
Difficulty or pain on swallowing
Apneic attacks during sleep
Thick voice
SIGNS
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Ant. Pillar congestion
Halitosis
Debris in Tonsillar crypts
Palpable Jugulodiagastric lymph nodes
Tonsils may be enlarged OR
small due to fibrosis
If the patient comes during the acute attack S/S of Acute Tonsillitis
DIAGNOSIS
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History
Clinical Examination
Lab. Investigation
Imaging Studies
X-ray Chest & X-ray PNS
DIAGNOSIS
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Lab. Investigation
Blood C.P. & ESR
Bleeding and Clotting Time
Prothrombin Time (PT)
Activated Partial Thromboplastin Time
Urine D/R
A.S.O. Titre
Throat swab for C/S
(APTT)
TREATMENT
CONSERVATIVE TREATMENT
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Proper Antibiotics after C/S
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Treat Causative factor e.g. Rhinosinusitis etc.
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Improve gen. Condition of patient
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Improve oral hygiene
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If no improvement Consider
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Tonsillectomy and
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Refer to ENT surgeon.
TREATMENT
SURGICAL TREATMENT
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Tonsillectomy
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Refer to ENT surgeon
INDICATIONS
Ch Tonsillitis i.e. Four or more attacks of tonsillitis per year for two
consecutive years. Each attack lasting for four or more days with fever.
Prolonged absence from school due to tonsillitis.
Six weeks after one attack of Quinsy
Grossly enlarged tonsils causing
sleep apnea or difficulty in swallowing
Tonsillar stones or cyst
INDICATIONS (cont.)
For taking biopsy of tonsil
Tonsillar lymphoma or malignancy
As a part of uvulo-palato-pharyngo-plasty (UV3P)
For glossopharyngeal neurectomy
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For approach (removal) of styloid process.
TONSILLITIS TREATMENT
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Surgical
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TONSILLECTOMY
CONTRAINDICATIONS
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Acute Tonsillitis
Bleeding and or Clotting Disorders
Low Haemoglobin level (<10)
Acute upper respiratory tract infection
Uncontrolled systemic diseases, e.g. Diabetes, Jaundice etc.
Pregnancy
Menstruation
Epidemic of Poliomyelitis
TYPES OF TONSILLECTOMY
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Guillotine method
Conventional Dissection Method
Diathermy
LASER
Cobolation Tonsillectomy (NEW)
COMPLICATIONS
PER-OPERATIVE
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Anesthetic Complications
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Damage to lips, teeth, gums, uvula and palate
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Primary Haemorrhage
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Dislocation of Temporo-Mandibular Joint
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Aspiration of blood into lungs
COMPLICATIONS
IMMEDIATE
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Anaesthetic Complications
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Reactionary Haemorrhage
COMPLICATIONS
EARLY
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Haematoma and Oedema of uvula
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Infection
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Secondary Haemorrhage
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Pulmonary complication (Pneumonia, Lung Abscess)
COMPLICATIONS
LATE
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Scarring of soft palate
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Tonsillar Remnants
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Velopharyngeal Insufficiency
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Sub-acute Bacterial Endocarditis
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