--- title: "Chronic Tonsillitis - Etiology, Types, Clinical Features, Treatment & Complications" description: "ENT notes on Chronic Tonsillitis - etiology, clinicopathological types, symptoms, signs, treatment and complications." source: "The ENT Resident" author: "Dr. Mausumi Das" canonical_url: "https://www.theentresident.com/ent-notes-lectures/chronic-tonsillitis-symptoms-treatment-types-causes" categories: ["Pharynx"] video: "https://www.youtube.com/watch?v=M7vASEZXkiw" image: "https://media.theentresident.com/og-images/chronic-tonsillitis-symptoms-treatment-types-causes.png" --- # Chronic Tonsillitis - Etiology, Types, Clinical Features, Treatment & Complications ENT notes on Chronic Tonsillitis - etiology, clinicopathological types, symptoms, signs, treatment and complications. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=M7vASEZXkiw ## 🦠 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. --- ## About This Note This free ENT note on Chronic Tonsillitis - Etiology, Types, Clinical Features, Treatment & Complications was written by Dr. Mausumi Das and is paired with a corresponding video lecture. 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