Adenotonsillar disease Flashcards
What is Waldeyer’s ring?
A ring of lymphoid aggregation in the subepithelial layer of the oropharynx and nasopharynx
What three things is Waldeyer’s ring comprised of?
Palatine tonsils
Adenoids (pharyngeal tonsil)
Lingual tonsil
What epithelium lines the luminal surface of palatine tonsils?
Specialised stratified squamous epithelium
How does the surface of tonsils and adenoids differ?
Tonsils - crypts
Adenoids - very little crypts
What epithelium lines the surface of the adenoids?
Ciliated pseudostratified columnar epithelium
What two types of epithelium are seen in the upper aerodigestive tract?
Ciliated columnar respiratory
Squamous epithelium
What main type of epithelium can be seen in trauma / high use areas of the throat?
Squamous epithelium
What type of epithelium is seen in the areas which air goes?
Columnar epithelium
What are the common symptoms of viral tonsilitis?
Malaise
Sore throat
Temperature
Lasts 3-4 days
What are the common symptoms of bacterial tonsillitis?
Systemic upset and fever
Odynophagia
Halitosis
Lymphadenopathy
Lasts ~1 week
What is the FeverPAIN criteria?
Fever
Purulence
Attend rapidly
Inflamed tonsils
No cough / coryza
What does a high FeverPAIN score suggest?
Bacterial tonsillitis - streptococcal cause
How is tonsillitis managed?
Supportive measures - NSAIDs, rest, eating and drinking easy food
Antibiotic - penicillin 500mg for 10 days, clarithromycin if allergic
What is the main concern following tonsillectomy?
Haemorrhage
What type of abscess can occur as a complication of acute tonsillitis?
Peritonsilar abscess
What is the classic history of a peritonsilar abscess?
Unilateral throat pain
Pdynophagia
Trismus
3-7 days of preceding acute tonsillitis
How should a peritonsilar abscess be managed?
Aspiration and antibiotics
What are the classic signs of glandular fever?
Gross tonsillar enlargement
Marked cervical lymphadenopathy
Palatal petechial haemorrhages
General lymphadenopathy
Hepatosplenomegaly
How is glandular fever diagnosed?
Atypical lymphocytes in peripheral blood
+ve Monospot / Paul-Bunnell test
Low CRP
What should NEVER be prescribed in glandular fever?
Ampicillin / amoxicillin
How should glandular fever be managed?
Symptomatic treatment
Antibiotic prevention - penicillin
Steroids
What are the signs of chronic tonsillitis?
Chronic sore throat
Malodorous breath
Tonsilliths
Persistent tender cervical lymphadenopathy
What are signs of adenoid obstructive hyperplasia?
Obligate mouth breathing
Hyponasal voice
Snoring / sleep disturbance
What are the signs of tonsillar obstructive hyperplasia?
Snoring / sleep disturbance
Muffled voice
