Complications Of Tonsillitis Flashcards
Complications of tonsillitis
Infectious complications:
Recurrent otitis media
Deep neck spaces infection
Lemierre’s syndrome
Chronic tonsillitis
Non infective complications:
Rheumatic fever
PSGN
Subacute bacterial endocarditis
Sleep apnoea
Tonsillolith
Tonsillar cyst
Features of chronic tonsillitis
Hyperaemia / congestion of anterior pillar
On compression of anterior pillar pus oozes out - IRWIN MOORE SIGN
Enlarged upper deep cervical nodes /jugulodigastric nodes
What is Lemierre’s syndrome?
Septic thrombophlebitis of INTERNAL JUGULAR VEIN following oropharyngeal infection
Patients presents with
Neck pain
Tenderness
Features of septicaemia
Major complication of sleep apnoea
Cor pulmonale(right heart failure)
Apnoea causes pulmonary vasoconstriction leading to
Pulmonary hypertension causing right heart failure
Indications for tonsillectomy
Infectious indications :
Recurrent infection ( according to paradise criteria )
Peritonsillar abscess
Chronic tonsillitis
Non infective indications:
Sleep apnoea ( according to Friedman score)
Carriers of streptococcus and diphtheria
For eagle’s syndrome
Glossopharyngeal neuralgia
Assymetrically enlarged tonsils
Uvulo palato pharyngoplasty done in bulky oropharynx
Contraindications of tonsillectomy
Acute infection
Hb<10 gm /dl
Bleeding diathesis
Polio epidemic
Position for tonsillectomy ?
Rose position
Pillow placed below shoulders;extension of cervical thoracic joint and Atlanto occipital joint
With which instrument mouth is opened in tonsillectomy?
Boyle’s- Davis mouth gag this is stabilised by draffin’s bipod stand
Methods for tonsillectomy
Hot method (using heat)
Laser Cautery Coblation
Cold method (without using heat)
Harmonic scalpel Microdebrider Cold knife Cryosurgery
What is the instrument that is used for pulling the tonsils medically during surgery?
Dennis brown forceps
Jaws are blunt and one jaw is bigger than the other
What is dissection and snare method ?
Done with mollison tonsil dissector and anterior pillar retractor
Eve’s tonsillar snare - crush and cut the lower pole to reduce bleeding
Most common complication of tonsillectomy
Haemorrhage
M/C from paratonsillar or external palatine vein
Types of hemorrhage as complication of tonsillectomy
Primary - bleeding during surgery
Reactionary - bleeds after surgery but within 24 hrs of surgery
Secondary - bleeds after 24hrs upto 10 days
Days which is most common for hemorrhage
5-6 days
What is the best position for preventing hemorrhagic complication?
Recovery / coma position - best protection from air occlusion or aspiration of fluids into lungs
