The Nasopharyngeal Tonsil • It is a mass of sub-epithelial lymphoid tissue present at the junction between the roof & posterior wall of the nasopharynx • The free surface has 6 folds • It has no capsule • It is covered by pseudoThe palatine tonsil has a capsule stratified columner on its lateral surface epithelium which separate the lateral wall from bed • It drains tothe the The palatine tonsil Retropharyngeal lymph is covered by stratified nodes Upper Deep columner epithelium Cervical Lymph Nodes The palatine tonsil drains to The Jagulodigastric lymph nodes below the angle of the mandible Adenoid Definition Age Causes of enlargement • Hypertrophy of the nasopharyngeal onsil sufficiently to produce symtoms 2 -12 years • Physiological enlargement : at 3-7 years • Pathological: recurrent upper respiratory tract infection Symptoms - Bilateral Nasal Obstruction - Mouth Breathing Snoring & OSA Speech hyponasality Difficult suckling Rhinolalia clausa (speech hyponasality) ‫ينطق الميم مثل الباء‬ • Bilateral Nasal discharge - Mucoid or mucopurulent discharge WHY? Due to blockage of the choanae ‫األنف تفرز‬of ‫ أن‬the ‫هل تعلم‬nasal - Excoriation ‫لتر&ونصف من‬upper ‫حوالي لتر الي‬ vestibule lip - ‫السائل المخاطي يوميا‬ ‫ماذ يحدث في حالة االنسداد الخلفي لألنف‬ ‫تتحول للنزول‬ ‫كل هذه الكمية‬ Post‫من‬nasal discharge ‫لألنف‬frequent ‫الفتحة االمامية‬nocturnal causing cough Signs • Posterior Rhinoscopy  difficult • Digital palpation not pleasant • Endoscopic examination the best Investigations • Lateral soft tisue X ray of the nasopharynx It is not the size of the nasopharyngeal tonsil which is important but the size of the mass in relation to the nasopharyngeal space Complications 1- OSAS: - During Sleep: - During day time 2- Descending infection 3- ِAdenoid Facies Restless sleep, Night mare, ‫كوابيس‬ Nocturnal eneuresis ‫تبول الارادي‬ Morning headache Impaired concentration Excessive day-time sleepiness Recurrent OM Pharyngitis, Laryngitis, bronchitis Idiot look Pinched nostril Short upper lip Prominent incisor High arched palate ‫• الطفل طول الليل نايم فاتح فمه وبيشخر وكل شويه تنفسه يتوقف ويصحي‬ ‫يأخد نفسه وينام تاني‬ ‫• وبالنهار دايما نايم علي نفسه وتركيزه قليل‬ ‫• وعنده تبول الارادي‬ Treatment Adenoidectomy operation Acute tonillitis Acue inflammation of the palatine tonsils Age: Any age but common in children Etiology : - Beta hemolyic streptococci Streptococcus pneumonia Hemophylus influenza Mode of transmission droplet infection Symptoms Rapid onset of - Fever, Headache, Anorrhexia, Malaise - Severe sore throat ± referred otagia - Halitosis Signs General : High Fever with flushed face Pharyngeal Acute follicular tonsillitis Acute membranous tonsillitis Acute parynchymatous tonsillitis Cervical Enlarged tender jugulo-digastric lymph nodes The yellowofspots may The crypts the tonsils Marked hyperemia and Coalease to formexudate a are full of purulent enlargement of the tonsils Giving yellow spots on the Yellow membrane tonsils Acute follicular T. Acute membranous T Acute parynchymatous T Complications Local: - Peritonsillar abscess Parapharyngeal abscess Retropharyngeal abscess Systemic - Rheumatic fever (carditis and arthritis) Acute glomerulonephritis Quinzy Treatment Antibiotics: 10 dayes Rest Ample fluid intake Cold compresses Analgesic Antipyretics Gargles Chronic Tonsillitis Chronic inflammation of the palatine tonsils Etiology : Repeated attacks of acute tonsillitis Symptoms: one or more of the following - History of repeated attacks of AT - Irritation in the throat - Foetor oris If hypertrophic - Difficult swallowing - Obsrtuctive sleep apnea Signs: Pharyngeal - Asymmetry of the size of the tonsils - Hypertrophy of the tonsils - The crypts ooze pus on pressure by tongue depressor - Hyperaemia of the anterior pillars Cervical Persistent enlargement of jagulodigastric lymph nodes Treatment of Chronic Tonsillitis Surgical By Tonsillectomy operation