TONSILLOPHARYNGEAL INFECTIONS


Tonsils are large
lymphoid tissue
situated in the
lateral wall of the
oropharynx.
They form lateral
part of the
Waldeyer's ring.
ANATOMY
WALDEYER’S RING.
palatine tonsils
(Tonsilit)
 adenoids (Nasal
pharyngeumdaki
tonsil)
 Lingual tonsil
 Lateral pharyngeal
bands.

#1
#2
ACUTE TONSILLITIS

Signs and symptoms:
 Fever
 Sore
throat (Boğaz Ağrısı)
 Tender cervical lymphadenopathy
 Dysphagia (Yutkunamama)
 Erythematous tonsils with exudates
 (Akıntı
Yapan Kanamalı Tonsiller)
VIRAL TONSILLITIS/PHARYNGITIS
Having additional rhinitis (burun enfeksiyonu),
hoarseness (Ses Boğukluğu), conjunctivitis and
cough
 Pharyngitis is accompanied by conjunctivitis in
adenovirus infections
 Oral vesicles, ulcers point to viruses

7
DUE TO STREPTOCOCCI:
Spreads by close contact and through air
 Spread more in crowded areas (KG, school,
army..)
 Most common among 5-15 age group
 More frequent among lower socio-economic
classes
 Most common during winter and spring
 Incubation period 2-4 days

8
SIGNS/SYMPTOMS (STREPTOCOCCI)



Sore throat
Anterior cervical LAP
Fever > 38 C (virüslerde daha
düşüktür)





Tonsillar hyperemia /
exudates
Soft palate petechia
Absence of coughing
Difficulty in swallowing
Öksürük Yok
Headache, fatigue
Absence of nose drip
Muscle pain
Burun Akıntısı Yok
Nausea, vomiting
Absence of hoarseness
Öksürük +, Boğuk Sesle
Ses Kısıklığı Yok
Konuşma + Burun
Akması +
9
CLINICAL EVALUATION

Viral
 Lower
grade fever
 Lower WBC, Lymphocytic shift
 Less tonsillar exudate

Bacterial
 Higher
WBC, Granulocytic shift
 More exudative
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LABORATORY

Throat swab

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Rapid antigen test

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

If negative need swab
ASO (Anti Streptolysin)


Gold standard
Shows we came across
this one in 1 year of
time period.
May remain + for 1 year
WBC count
Peripheral smear
11
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AIM OF TREATMENT
Prevention of complications
 Symptomatic improvement
 Bacterial eradication
 Prevention of contamination
 Reducing unnecessary antibiotic use

12
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GABHS (GROUP A BETA HEMOLYTIC
STREPTOCCUS)

Control culture after full dose treatment?


NO
If history of ARF:
 Take

control culture after treatment
No need to screen or treat carriers
13
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TREATMENT
Many different antibiotics can eradicate GABHS
from pharynx
 Starting treatment within 9 days is enough to
prevent ARF (Acute Rhemuatic Fever)
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COMMON DISEASES OF THE TONSILS AND
ADENOIDS
 Acute
tonsillitis
 Chronic tonsillitis
 Recurrent tonsillitis
 Obstructive tonsillar hyperplasia
 Acute adenoiditis
 Chronic adenoiditis
 adenoid hypertrophy
ACUTE TONSILLITIS
Etiology
 5-30% bacterial; of these
39% are beta-lactamaseproducing (BLPO)
 Anaerobic BLPO
GABHS most important
pathogen because of
potential sequelae
 Throat culture
 Treatment
CHRONIC TONSILLITIS
Chronic sore throat
 Malodorous (kötü kokulu) breath
 Presence of tonsillithis
 Peritonsillar erythema
 Persistent tender cervical lymphadenopathy
 Lasting at least 3 months

CHRONIC TONSILLITIS
No true consensus (fikir birliği) on the
definition.
 Symptoms greater than 4 weeks

RECURRENT ACUTE TONSILLITIS
Same signs and symptoms as acute
 Occurring in 7 separate episodes per year
 5 episodes per year for 2 years
 3 episodes per year for 3 years

OBSTRUCTIVE ADENOID HYPERPLASIA
 Adenoidler
bir araya değecek kadar büyür ve
tıkanıklığa sebep olur.

Signs and Symptoms
 Obligate
mouth breathing
 Hyponasal voice
 Snoring and other signs of sleep disturbance
ADENOID HYPERPLASIA

Triad
 Hyponasality
 Snoring
 Open

mouth breathing
Purulent rhinorrhea, post nasal drip, chronic
cough, and headache
ADENOID DISEASES


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
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Common in young
children
Adenoid hypertrophy
caused by: infections,
allergy, environmental..
Symptoms
Otitis media and sinusitis
Dx: palpation, X-ray,
endoscopy
Tx: Surgery
OBSTRUCTIVE TONSILLAR HYPERPLASIA
Snoring and other symptoms of sleep
disturbance
 Muffled voice
 Dysphagia

MALIGNANT NEOPLASMS

Most common is lymphoma
 Non-Hodgkin’s

lymphoma
Rapid unilateral tonsillar enlargement
associated with cervical lymphadenopathy and
systemic symptoms
INDICATIONS FOR TONSILLECTOMY
1.Infection



Recurrent, acute tonsillitis
(more than six episodes
per year or three episodes
per year for 2 years)
Chronic tonsillitis: halitosis,
persistent sore throat,
tender cervical adenitis
Peritonsillar abscess
2. Obstruction

Excessive snoring and
chronic mouth-breathing

Obstructive sleep apnea
or sleep disturbances
3. Neoplasia

Asymmetric tonsillar
hypartrophy
ADENOTONSILLECTOMY
Most commonly performed procedure in the
history of surgery
 $500 million annually in healthcare
expenditures

INDICATIONS FOR ADENOIDECTOMY
Obstruction:




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Chronic nasal obstruction or obligate mouth breathing
OSA with FTT, cor pulmonale
Dysphagia
Speech problems
Severe orofacial/dental abnormalities
Infection:


Recurrent/chronic adenoiditis (3 or more episodes/year)
Recurrent/chronic OME (+/- previous BMT)
PERITONSILLAR ABSCESS

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“Hot potato voice” (Vö Vö Vö Vö)
Trismus and difficulty speaking
Asymmetric tonsillar enlargement
Uvula pushed away from abscess
Fluctuant mass frequently palpable
INCISION AND DRAINAGE



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Needed for incomplete
needle aspiration
Vertical incision through
mucosa
Curved hemostat to break up
loculations
Swab inside of abscess for
culture
TREATMENT
Preferably admitted to hospital and treated
with analgesics and antibiotics.
 In a patient with an early peritonsillar
abscess which is really a peritonsillar
cellulitis incision and drainage are not
recommended.
