Chronic Tonsillitis - Etiology, Types, Clinical Features, Treatment & Complications
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🦠 Chronic Tonsillitis
Chronic tonsillitis is the chronic inflammation of the palatine tonsils, occurring as a result of:
- Repeated attacks of acute tonsillitis
- Inadequately resolved acute tonsillitis
⭐ The palatine tonsils form a part of Waldeyer's ring, a major part of the immunity of the upper aerodigestive tract.
What are the structures forming the Waldeyer's ring?
What is the clinical significance of Waldeyer's ring?
Age Group Affected
- Children
- Young adults
⭐ Very rare after 50 years of age.
Etiology of Chronic Tonsillitis
1- Complication of Acute Tonsillitis
Repeated attacks of acute tonsillitis.
What is the pathological change behind acute tonsillitits converting to chronic tonsillitis?
2- Subclinical Infection of the Tonsils
Without any acute attack of tonsillitis.
3- Predisposing Factor - Source of Infection Elsewhere
- Nose
- Sinuses
- Teeth
What is the most common causative organism in Chronic Tonsillitis?
Types of Chronic Tonsillitis
Three clinicopathological types of Chronic Tonsillitis are seen:
1- Chronic Follicular Tonsillitis
⭐ More common in adults
- Occurs after repeated attacks of acute tonsillitis, including upper respiratory tract infections
- Tonsillar crypts get infected and filled with cheesy material
- Appears as yellowish spots on the medial surface of the tonsil
What are the pathological changes seen in Chronic Follicular Tonsillitis?
2- Chronic Parenchymatous Tonsillitis
⭐ More common in children (4–15 years)
- Occurs following repeated attacks of acute tonsillitis
- Hyperplasia of the lymphoid follicles in the tonsillar parenchyma
- Leads to uniform enlargement of the tonsils on both sides
What are the pathological changes seen in Chronic Parenchymatous Tonsillitis?
3- Chronic Fibrotic Tonsillitis
- Tonsils become fibrotic, atrophic and small in size
- History of repeated attacks of sore throat
- Remnants of tonsillar tissue may still get infected, leading to recurrent attacks
| Type | Size of Tonsil |
|---|---|
| Chronic Parenchymatous Tonsillitis | Enlarged |
| Chronic Fibrotic Tonsillitis | Small and atrophic |
What are the types of Acute Tonsillitis?
Clinical Features of Chronic Tonsillitis
Symptoms of Chronic Tonsillitis
- Recurrent attacks of sore throat
- Chronic irritation in the throat with cough
- Hawking
- Foul breath (halitosis) and bad taste in the mouth
- Snoring and sleep apnea
- Choking episodes at night
- Change in voice (thick speech)
- Dysphagia
What is the most common symptom seen in Chronic tonsillitis?
What are the Paradise Criteria for tonsillectomy?
What is the cause behind halitosis in chronic tonsillitis?
What is the cause behind Sleep Apnea in chronic tonsillitis?
Signs of Chronic Tonsillitis
Oral Cavity
- Dry and coated tongue
Causes of Dry & Coated Tongue
- Mouth breathing due to concomitant adenoid hypertrophy with nasal obstruction
- Poor intake of food and drinks
What are the features of Adenoid Facies?
Findings According to Type of Tonsillitis
| Type | Findings |
|---|---|
| Chronic Follicular Tonsillitis | Yellowish white spots of pus on the medial surface of the tonsil |
| Chronic Parenchymatous Tonsillitis | Varying grades of tonsillar enlargement |
| Chronic Fibrotic Tonsillitis | Small, atrophic tonsils; frank pus or cheesy material expressed on pressing the anterior pillar |
What is the Brodsky Grading of Tonsillar Enlargement?
What are Kissing Tonsils?
⭐ Cardinal Signs of Chronic Tonsillitis
⭐ Very important viva question
1- Flushing of the anterior tonsillar pillar
2- Irwin Moore Sign positive
3- Persistent non-tender jugulodigastric lymphadenopathy
At least two of the three signs must be present to diagnose chronic tonsillitis.
What is Irwin Moore sign? How do you elicit Irwin Moore sign?
What is the reason behind Flushing of Anterior Pillar in chronic tonsillitis?
Investigations of Chronic Tonsillitis
Chronic tonsillitis is primarily a Clinical diagnosis, based on history and clinical examination.
- No specific investigation is usually necessary
- Pre-operative investigations are required if the patient is being planned for surgery
Treatment of Chronic Tonsillitis
1- Conservative Treatment
Acute Exacerbations
Treated exactly like acute tonsillitis:
- Rest
- Plenty of fluids
- Antibiotics
- Antipyretics (Paracetamol)
- Antiseptic gargles (Betadine or lukewarm saline)
Other Measures
- Treat any focus of infection in the nose, sinuses or teeth
- Attention to general health and diet
2- Surgical Treatment
👉 Tonsillectomy
⭐ Tonsillectomy is the mainstay of treatment in chronic tonsillitis.
What are the indications and contraindications of tonsillectomy?
What are the steps of Tonsillectomy?
What are the different hot and cold techniques of Tonsillectomy?
Complications of Chronic Tonsillitis
- Peritonsillar Abscess
- Intratonsillar Abscess
- Tonsillolith
- Tonsillar Cyst
- Focus of Infection - Chronic tonsillitis may act as a focus of infection in:
- Rheumatic fever
- Acute glomerulonephritis
- Eye and skin disorders
What is Tonsillolith? How do you treat it?
What is Tonsillar cyst?
🧠 Viva Pearls
- Chronic tonsillitis is the most common indication for tonsillectomy.
- Chronic follicular tonsillitis is more common in adults.
- Chronic parenchymatous tonsillitis is more common in children aged 4–15 years.
- Brodsky grading is used to grade tonsillar enlargement.
- Cardinal signs are flushing of anterior pillar, Irwin Moore sign and persistent non-tender jugulodigastric lymphadenopathy.
- At least two cardinal signs must be present to diagnose chronic tonsillitis.
- Mainstay of treatment is tonsillectomy.
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