Notes On Tonsilitis by Dr. Ramseer Ali

TONSILLITIS

Palatine tonsils are two in number

Each tonsils are ovoid mass of lymphoid tissue situated in the lateral wall of oropharynx between the anterior and posterior pillars.

FUNCTIONS OF TONSILS

Palatin tonsils have a protective role.

Acts as sentinals at the portal of air and food passage.

Tonsils are larger in child hood and gradually diminish near puberty.

ACUTE  TONSILLITIS

CLASSIFICATION

1.ACUTE CATARRHAL OR SUPERFICIAL TONSILLITIS.

Tonsillitis is a part of generalized pharyngitis.

Mostly seen in viral infectins

2.ACUT E FOLLICULAR TONSILLITIS.

Crypts filled with purulent material.

Presenting at the opening of crypts as yellowish spots.

3.ACUTE PARENCHYMATOUS TONSILLITIS.

Tonsil is uniformly enlarged and red.

4.ACUTE MEMBRANOUS TONSILLITIS.

Exudation from the crypts coalesces to form a membrane on the surface of tonsil.

AETIOLOGY.

Commonly affect school going  childrens.

Also affects adults.

Rare in infants and persons above 50 years of age.

Haemolytic strepto coccus is the most commonly infecting organism.

Other causes of infection may be staphylo cocci,pneumococci,or h.influenae.

SYMPTOMS.

Predominant symptoms are;

1.       Sore throat

2.       Difficulty in swallowing.

3.       Fever,it may be 38 to40 c and may be associated with chill and rigor

4.       Earache.it is either from tonsil or the result of acute otitis media.

5.       Constitutional symptoms.

It includes head ache,general body aches,malaise and constipation.

SIGNS.

1.breath is foetid and tongue coated

2.tonsils are red and swollen with yellowish spot of purulent material presenting at the opening of crypts,in acute follicular tonsillitis

Whitish membrane on medial surface of tonsil ,in acute membranous tonsillitis.

Tonsils may enlarged and congested,in acute parenchymatous tonsillitis.

3.the jugulo digastrics lymph nodes are enlarged and tender.

COMPLICATIONS.

1.chronic tonsillitis with recurrent acute attacks.

2. peri tonsillar abscess.

3.parapharyngeal abscess.

4.cervical abscess.

5.acute otitis media

6.rheumatic fever

7.acute glomerulonephritis.

8.subacute bacterial endocarditis.

CHRONIC TONSILLITIS

AETIOLOGY

1.it may be a complication of acute tonsillitis.

2. subclinical infections of tonsils without an acute attack.

3.mostly affects children and young adults.

4. chronic infections in sinuses or teeth may be a predisposing factor.

CLASSIFICATION

1.CHRONIC FOLLICULAR TONSILLITIS.

Here tonsillar crypts are full of infected cheesy material.

2.CHRONIC PARENCHYMATOUS TONSILLITIS.

Tonsils are very much enlarged and may interfere with speech,deglution  and respiration.

Attacks of sleep apnoea may occur.

3.CHRONIC FIBROID TONSILLITIS.

Tonsils are small but infected,with history of repeated sore throats.

CLINICAL FEATURES

1.recurrent attacks of sore throat or acute tonsillitis.

2.chronic irritation in throat with cough

3. bad taste in mouth and foul breath

4.thick speech,difficulty in swallowing and choking spells at night.

EXAMINATION

1.tonsils may show varying degree of enlargement,sometimes they meet in mid line

2. there may be yellowish beads of pus on the medial surface of tonsil

3.tonsils are small but pressure on anterior pillar expresses frank pus or cheesy material

4. enlargement of jugulodigastric lymph nodes is a reliable sign of chronic tonsillitis.

COMPLICATIONS

1.       PERITONSILLAR ABSCESS
2.       PARAPHARYNGEAL ABSCESS.
3.       INTRATONSILLAR ABSCESS.
4.       TONSILLOLITH.
5.       TONSILLAR CYST.
6.       RHEUMATIC FEVER.
7.       ACUTE GLOMERULONEPHRITIS.

DISEASES OF LINGUAL TONSILS

1.       ACUTE LINGUAL TONSILLITIS.
Acute infection of lingual tonsillitis give rise to unilateral dysphagia and feeling of lumb in throat
Cervical lymph nodes may enlarged.
2. LINGUAL TONSILS.HYPERTROPHY OF
Usual complains are discomfort on swallowing,feeling of lump in throat,dry andcough and thick voice.
3.ABSCESS ON LINGUAL TONSIL.
It is a rare condition but can follow acute lingual tonsillitis.
Symptoms are severe unilateral dysphagia,pain in tongue, excessive salivation and some degree of trismus.

Jugulodigastric lymph nodes will be enlarged and tender.

HOMOEOPATHIC MEDICINES

1.BARYTA CARB

Take cold easily,with stitches and smarting pain

Suppurating tonsils from every cold.

Tonsils inflamed,with swollen veins.

Smarting pain when swallowing,worse empty swallowing,

Can only swallow liquids.

Stiching pain in tonsils.

2.BELLADONNA

Tonsils red,dry and glazed

Tonsils enlarged,throat feel constricted.

Difficult deglution,worse on right side.

Sensation of lump.

Continous inclination to swallow.

3.LACHESIS

Tonsils purplish.

Purple, livid colour of throat.

Sore, worse on left side,swallowing liquids.

Pain aggravated by hot drinks.

Touch is even more annoying.

Collar and neck band must be very loose.

Pain in throat shoot in to ear.

4.MERCURIUS

Bluish red swelling.

Smarting, burning in throat,

Stitches in to ear when swallowing.

Complete loss of voice.

Burning in throat,as from hot vapor ascending.

Ulcers and inflammation.

5.CALCAREA FLUORICA

Follicular tonsillitis

Plugs of mucus are forming on crypts of tonsils.

Pain and burning on throat,better by warm drinks,worse cold drinks.

REFERENCE BOOKS

1.DISEASES OF EAR,NOSE AND THROAT .BY P L DHINGRA.

2.A CONCISE REPERTORY OF HOMOEOPATHIC MEDICINES BY DR.S.R. PHATAK

3.REPERTORY OF HOMOEOPATHIC MATERIA MEDICA BY J.T.KENT.

4.POCKET MANUAL OFHOMOEOPATHIK MATERIA MEDICA BY BOERICKE.