adenotonsillar disease Flashcards
what are the role of tonsils and adenoids?
-main function is to trap bacteria and viruses on inhalation, exposing them to the immune system
what is Waldeyer’s ring?
- ring of lymphoid aggregation in the sub epithelial layer of oropharynx and nasopharynx
- comprised of palatine tonsils (tonsils), adenoids (pharyngeal tonsils) and lingual tonsil
what do the tonsils (palatine tonsils) sit in?
nestlesd in a fossa formed by the muscular anterior and posterior tonsillar pillars and lie superficial to the superior constrictor muscle
why is it important to preserve the muscular condensations and overlying mucosa in the superior constrictor muscle and muscular anterior and posterior pillars?
its critical the preserve the condensations and the overlying mucosa to maintain physiological function of the palate postoperatively
describe the histology of tonsils?
- specialised squamous epithelium
- have deep crypts
- contain lymphoid follicles
- have a posterior capsule
describe the histology of adenoids?
- ciliated pseudo stratified columnar
- stratified squamous
- transitional
- deep folds
describe the upper aero digestive histology?
- ciliated columnar respiratory type mucosa (where air goes)
- squamous epithelium (where food goes/high use/trauma)
is most acute tonsillitis bacterial or viral?
viral
what virus often cause acute tonsillitis?
- EBV
- rhinovirus, influenza, parainfluenza, enterovirus, adenovirus
what bacteria often cause chronic tonsillitis?
- streptococcus pyogenes (group A beta haemolytic streptococcus)
- H.influenza
- S.aureus
- streptococcus pneumonia
what are symptoms if the tonsilitis is viral?
- malaise
- sore throat, mild analgesia requirement
- temperature
- able to undertake near normal activity
- possible lymphadenopathy
- lats 3-4 days
what are symptoms if the tonsilitis is bacterial?
- systemic upset
- fever
- odynophagia
- halitosis
- unable to work/school
- lymphadenopathy
- lasts about 1 week, need antibiotics to settle
what criteria is used to distinguish between viral and bacterial sore throat?
FeverPAIN criteria
Fever (during previous 24 hours)
Purulence (pus on tonsils)
Attend rapidly (within 3 days after onset of symptoms)
Severly inflamed tonsils
No cough or coryza (inflammation of mucus membranes in the nose)
Each score 1 point (max is 5)
0 or 1= low association of isolating streptococcus
2 or 3= moderate assistance, consider delayed prescription of antibiotics
4 or 5= highest association of isolating streptococcus, treat with antibiotics
what is the treatment for tonsillitis?
Supportive:
- eat and drink
- rest
- OTC analgesia (paracetamol, NSAID)
Antibiotic:
- penicillin 500mg qid for 10 days
- clarithromycin if allergic
Hospital:
- IV fluids
- IV antibiotics
- steroids
surgery
what is the criteria to tonsillectomy?
- sore throats are due to acute tonsillitis
- the episodes of sore throat are disabling and prevent normal function
- seven or more well documented, clinically significant, adequately treated sore throats in preceding year or
- five or more such episodes in each of the preceding 2 years or
- three or more preceding episodes in each of the preceding 3 years
