Adenotonsillar Disease Flashcards
Describe the histology of the tonsils
- Luminal surface covered by stratified squamous epithelium
- Invaginates the tonsil forming crypts
- Dense collagenous semi-capsule separates the base from muscles
- Lymphoid follicles are dispersed beneath the epithelium of crypts
Describe the histology of adenoids
- Surface is covered by ciliated pseudostratified columnar epithelium
- Deeps folds with fewer crypts
- stratified squamous layer thickens in chronic infection
What causes acute tonsillitis?
Viral - EBV, rhinovirus, H.influenza, parainfluenza, adenovirus
Group A beta haemolytic strep
What is the serious complication of GABHS?
Rheumatic fever
Is a throat swab recommended in tonsillitis?
no
How will viral tonsillitis typically present?
Malaise, sore throat, temperature, lasts 3-4 days but can continue with daily tasks
How will bacterial tonsillitis typically present?
Systemic upset, fever, odynophagia and halitosis, unable to work, 1 week off
Name two criteria that can be used to assess if antibiotics are required in tonsillitis
- Centor
- Fever pain
How is acute tonsillitis treated?
Supportive
Penicillin 500mg QID for 10 days (clarithromycin if allergic)
When will a tonsillectomy be considered?
> 7 adequately treated sore throats in 1 year
5 episodes in each of the preceding 2 years
3 episodes in each of the preceding 3 years
Name the most common complication of acute tonsillitis
Peritonsillar abscess/quinsy
What is the classic history of peritonsillar abscess?
Unilateral sore throat, odynophagia, trimus (lockjaw), 3-7 days after tonsillitis
On examination what might be seen in a patient with a peritonsillar abscess?
Medial displacement of the tonsil and uvula
Concavity of the palate lost
What is the name for glandular fever and what causes it?
Infectious mononucleosis - Ebstein Barr Virus
How will glandular fever present?
Gross tonsillar enlargement with membrane exudate
Cervial lymphadenopathy
Palatial petechial haemorrhages
Hepatosplenomegaly (no sport to prevent rupture)
How can glandular fever be diagnosed?
Atypical lymphocytes in peripheral blood, low CRP, specific antibody test
How is glandular fever managed?
Symptomatically, antibiotics for secondary bacterial infection, steroids
What antibiotic should not be given in tonsillitis?
Amoxicillin/Ampicillin
Why should amoxicillin and ampicillin not be given in tonsillitis?
EBV may be present and will result in a rash that scars
How will adenoid hyperplasia present?
Obligate mouth breathing
Hypo nasal voice
Snoring/sleep disturbance
AOM/OME
How will tonsil hyperplasia present?
Snoring/sleep disturbance
Muffled voice
Dysphagia
What might cause unilateral tonsillar enlargement?
Non-neoplastic - infective, hypertrophy, congenital
Neoplastic - papilloma, lymphoma
What would indicate neoplasm of the tonsils?
Change in appearance - colour/ulceration
Define glue ear
Inflammation of the middle ear accompanied by accumulation of fluid without sings/symptoms of acute inflammation
