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The tonsils are predominantly -cell organs with lymphocytes comprising 50% to65% of all tonsillar lymphocytes. T-cell lymphocytes comprise approximately 40% oftonsillar lymphocytes and 3% are mature plasma cells. Tonsils are inoled ininducing secretory immunity and regulating immunoglo!ulin production. The tonsilsare faoura!ly located to mediate immunologic protection of the upperaerodigestie tract as they are exposed to air!orne antigens. "oreoer# there are

$0 to 30 crypts in each tonsil that are ideally suited to trapping foreign material andtransporting it to the lymphoid follicles. The proliferation of cells in the germinalcentres of the tonsils in response to antigenic signals is one of the most importanttonsillar functions. The human tonsils are immunologically most actie !etween theages of four and $0. nolution of the tonsils !egins after pu!erty# resulting in adecrease in the -cell population and a relatie increase in the ratio of T- to -cells.&lthough the oerall immunoglo!ulin production is reduced# there is stillconsidera!le -cell actiity if seen in clinically healthy tonsils. The immunologicconse'uences of tonsillectomy are unclear. t is eident# howeer# that tonsillectomydoes not result in a ma(or immunologic de)ciency.

The complications of tonsillitis may !e classi)ed into suppuratie and

nonsuppuratie complications. The nonsuppuratie complications includescarlet feer# acute rheumatic feer# and post-streptococcalglomerulonephritis. *uppuratie complications include peritonsillar#parapharyngeal and retropharyngeal a!scess formation.

*carlet feer is secondary to acute streptococcal tonsillitis orpharyngitis with

production of endotoxins !y the !acteria.

+roup & *treptococcal ,haryngitis for one to four wees. ertain proteinsfound in heart muscle appear to !e antigenetically similar to protein found onthe streptococcus.

,ost-streptococcal glomerulonephritis may !e seen after !oth pharyngeal and

sin infections. The typical patient deelops an acute nephritic syndrome oneto two wees after a streptococcal infection.

,eritonsillar a!scess most commonly occurs in patients with recurrent

tonsillitis or in those with chronic tonsillitis who hae !een inade'uately

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treated. The spread of infection is from the superior pole of the tonsil with pusformation !etween the tonsil !ed and the tonsillar capsule.

ultures of peritonsillar a!scess usually show a polymicro!ial infection# !oth

aero!ic and anaero!ic.

&n a!scess in the parapharyngeal space can deelop if infection or pus drains

from either the tonsils or from a peritonsillar a!scess through the superior

constrictor muscle. & retropharyngeal a!scess may also result from a peritonsillar a!scess. The

source of the a!scess is a chain of lymph nodes on either side of the midlinein the retropharyngeal space.

ellulitis should !e di/erentiated from a!scess in the management of

peritonsillar infections. *ome a!scesses may !e clinically o!ious whereasothers are less o!ious. lues in the history that increase the suspicion ofa!scess include a history of recurrent tonsillitis# inade'uate anti!iotictreatment and a long duration of illness.

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