Tonsillitis

Tonsillitis

Tonsilliitis is inflammation of the tonsils, two oval-shaped pads of tissue located at the back of the throat (one tonsil on each side). Tonsillitis is contagious especially before signs and symptoms show up. Tonsils act as filters, trapping germs that could otherwise enter the air way and cause infection in our body. They also make antibodies. Tonsillitis may be acute or chronic.

Tonsils
  • They consist of a mass of lymphoid tissue, situated on each side of the oropharynx.
  • They function as a defense mechanism.
  • They help prevent the body from infection.
CAUSES OF TONSILLITIS
  • Tonsillitis may be caused by viruses as in common cold(most common cause of tonsillitis causing viral tonsillitis), It is commonly caused by viruses causing viral tonsillitis. The viruses that causes the common cold are often the source of tonsillitis but other viruses cause it. These include; Rhino viruses, Epstein-Bar virus, Hepatitis A,HIV etc.

Since the Epstein Bar virus can cause both Mononucleosis & tonsillitis; some people with mono will develop tonsillitis as a secondary bacterial infection.

  • The other cause of tonsillitis is a bacteria. Normally the bacteria is called streptococcus( strep throat) but other bacteria’s can cause it, Tonsillitis is common in children between 5 and 8 years
  • The tonsils (made of lymphatic tissues) are frequently affected with acute infections.

tonsillitis vial bacterial

TYPES OF TONSILLITIS

  • Acute tonsilitis
  • Chronic tonsilitis

ACUTE TONSILLITIS(Recurring): This is sudden generalized inflammation of tonsils. It is usually accompanied by inflammation of fornices and pharynx . It is common in children than adults, normally caused by group A Beta streptococcus and some times viruses.

CHRONIC TONSILLITIS: Is defined as persistent progressive inflammation of the tonsils . If acute attack re-occurs 5-6 times a year , it indicates that some one has failed to develop immunity &it is considered to be chronic

CLINICAL FEATURES OF TONSILLITIS

  • Sudden onset
  • Sore throat
  • Fever and shivering
  • Snoring due to obstruction
  • Headache and vomiting
  • Difficult in swallowing which may be painful
  • Enlarged tonsils with exudates
  •  Enlarged lymph nodes
  • Excessive secretion of saliva
  • Halitosis
  • Neck stiffness, loss of weight especially in chronic
  • Sometimes coughing and stuffy nose in viral tonsillitis
DIAGNOSIS AND INVESTIGATIONS
  • History taking
  • Do a physical examination of the throat by palpating to feel for enlarged lymph nodes.
  • Pus swab from the back of the throat for C/S (Throat swab)
  • Blood for complete blood count(CBC) to check whether the cause is bacterial or viral for appropriate treatment.

Management can be Medical or Surgical

AIMS

  • To limit the spread/prevent spread
  • To relieve signs and symptoms like pain and fever
  • To treat the cause
  • To prevent complications
  1. Admit the patient in medical isolation ward and emphasize Isolation and barrier-nurse the patient to limit the spread.
  2. Re-assure the patient and relatives
  3. Observations both vital (TPR & BP) Plus specific are taken and recorded i.e enlargement of tonsils.
  4. Relieve high fever/temperatures by tepid sponging
  5. Drugs: Administer Antibiotics especially Penicillin(Pen-V 500mgs 6hrly for 10 days) but if  the cause is viral then they are not needed
  6. Give analgesics to relieve pain or fever like Tablets Aspirin
  7. Throat gaggling with normal saline
  8. Encourage plenty of oral fluids(atleast 4-5 litres in 24hrs) and oral hygiene (mouth goggling)   
  9.  Do daily nursing care like for any other patient.
  10. If  the patient is a child, support the neck while swallowing.

  11. Give a highly nourishing soft and light diet gradually.

     

  12. Hygiene-mouth care should be done frequently

    Special observations

    1. Observe for facial oedema in the morning which may be suggestive of nephritis

    2. Observe for painful joints suggestive of rheumatic fever

    3. Observe and monitor fluid in take and output for diminished urine output and albumin

    4. Continue to observe for other complications

SURGICAL MANAGEMENT (only for chronic tonsilitis)

  • The management of chronic tonsillitis is the surgical removal of the tonsils i.e. ‘Tonsillectomy’. However in simple enlargement removal is not indicated. Normally tonsils in children are large but decrease in size with age.

 The pre-operative mgt is like for any other condition.

TONSILLECTOMY

Tonsillectomy is a surgical removal of the enlarged tonsils. It is only indicated in severe and chronic tonsillitis and where the disease has chronically interfered with schooling(chronic re-occurrence and where there is fear of complications from the disease.

The operation is carried under general anesthesia and the tonsil is dissected from the underlying pharyngeal tissue.

Pre-operatively; The patient is prepared like any other patient for general operation but more emphasis put on oral care and pre-operative antibiotics like I.V Ceftriaxone

POST-OPERATIVE CARE

After handing over the patient to theatre staff, a post operative bed is made with all its accessories.

  • Post-operatively the patient is received & nursed on the lateral position with the head down in order to prevent the patient from in haling blood, tonsil fragments hence avoiding aspiration OR (recovery position) with the head down so as not to inhale blood or tonsil fragments. He/she is maintained in such position until alert.
  • Post operative observations are carried out i.e. TPR & BP
  • Observe the skin colour and observe for bleeding mostly detected on frequent swallowing and the patient will need to be returned to theatre for ligation of the bleeding points.
  • Encourage the patient to spit the secretions
  • Give antibiotics for prophylaxis/treat infections e.g iv ceftriaxone, in acute then penicillin v orally 6hrly.
  • The next day, the patient is encouraged to drink  and eat soft foods.
  • Oral care-better using warm saline water(throat goggling) . When he improve , he is discharged on advice.

 

Complications of tonsilitis
  • Rheumatic fever
  • Nephritis
  • Asthma
  • Peri-tonsillar abscess(quinsy)
  • Peri-tonsillar cellulitis
  • Otitis media
Complications following tonsillectomy
  • Hemorrhage is the most common
  • Secondary bacterial infections.
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