TONSILLITISAMRUTHA R

TONSILLITIS

• Inflammation of tonsils

• 3-7yrs

RESEARCH

• Health news of NHS choices• Admission rates for tonsillectomy has

reduced between 1999 and 2010

Tonsils

WALDEYERS RING

TONSILS

TONSILLITIS DEFINITION

• Infection of tonsils which are glands on either side of the throat.

CAUSES

• Bacterial

• Viral

• Infectious mononucleosis

Bacterial

• Group A beta hemolytic streptococcus

VIRAL• Adenovirus• Rhinovirus• Influenza virus• Para influenza virus• Entero virus

Infectious mononucleosis

• Epstein barr virus

Types

ACUTE• Catarrhal stage

• Follicular

• Parenchymatous

• Peritonsillar abscess/ quincy

CatarrhalFollicular

ParenchymatousPeritonsillar abscess/ quincy

Chronic

• Repeated attacks• Enlarged spongy appearance• Fibrous tissue• Scarring of tissue• Adults

Pathophysiology

tonsillitis - pathogenesis

• disruption of the drainage function of the lacunae, accumulation of a secretion and waste products of microbes;

• disturbance of tissue metabolism in the tonsils;

• reduction of barrier properties of the tonsils, including production of secretory immunoglobulins A;

• appearance of inflammatory reactions in the form of frequent pain and metatonsillar complications.

Clinical features

• Frequent throat infections• Breathing difficulties• Dysphagia• Redness of anterior pillers• Breathing through mouth• Dry mucous membrane• Oedema

Clinical features

• Drooling• Fever• Loss of appetite• General feeling of unwell• Swollen tonsils• Change in sound

Clinical features

• Nausea vomiting• Abdominal pain• Furry tongue• Halitosis• Trismus

Local signs of tonsillitis

Unpleasant mouth odor

Unpleasant mouth odor

Unpleasant feeling in the throat

Unpleasant feeling in the throat

Lymph nodes are small and dense

Lymph nodes are small and dense

Pus or tonsil stones in lacunae

Pus or tonsil stones in lacunae

Local signs of tonsillitis - changes in the palatine arches

HyperemiaHyperemiaSlight swelling

Slight swelling

Investigations

• History collection• Physical examination

• Throat swab• Blood tests• ASO titre

Management

General measures• Gargles• Rest• Hydration• Foods• Air• Lozenges• Avoid irritants

DRUGS

Analgesics• Ibuprofen• Acetaminophen

Antibiotics

ANTIBIOTICS

• Penicillin V 25-50 mg/kg/day divided q6h for 10d or

• Benzathine penicillin G 25,000 U/kg IM once (maximum 1.2 million U) or

• Amoxicillin 50 mg/kg/day PO in 2 or 3 divided doses for 10d or

ANTIBIOTICS

• Amoxicillin-clavulanate 500-875 mg PO q12h for 10d

• Cefdinir 14 mg/kg PO once daily for 10d or

• Cefuroxime axetil 10 mg/kg PO BD for 4-10d

ANTIBIOTICS• Azithromycin 12 mg/kg PO once daily for

5d or

• Clarithromycin 250 mg PO q12h for 10d or

• Erythromycin succinate 20 mg/kg PO BID for 10d or

• Clindamycin 20 mg/kg/day PO in 3 divided doses (maximum 1.8 g/d) for 10d

RESEARCH

• JOURNAL of antimicrobial chemotherapy• Sept 1993- J HAMMIL

SURGICAL MANAGEMENT

Surgery

Indications• Obstructive sleep apnoea• Breathing difficulty• Absess• Dysphagia• Malignant growth

TONSILLECTOMY

METHODS

• Cold stress

• Diathermy

• Coblation

• Electrocautery

CARE AFTER SURGERY

• Antibiotics• Analgesics• Fluid intake• Food• Prevention of complications

COMPLICATIONS

Research

• Child health news in Feb. 2011• Tonsillectomy increases the risk of

pediatric obesity• 795 children selected

Nursing management

ASSESSMENT

DIAGNOSIS

INTERVENTION

• Promoting airway clearance• Maintaining fluid volume• Pain management• Prevent complications• Health education

Evaluation