Tonsillitis is an inflammation of the tonsils that is usually caused by a bacterial or viral infection. The tonsils are located in the back of the throat and help the body fight infections. There are different types of tonsillitis, including acute, subacute, and chronic, depending on the causative agent and duration of symptoms. Common symptoms include sore throat, fever, difficulty swallowing, and enlarged lymph nodes in the neck. Tonsillitis is usually diagnosed based on symptoms and signs during a physical exam. It is often treated with antibiotics, pain relievers, and gargling saline for relief. In some cases of recurring tonsillitis, surgery to remove the tonsils (tonsillectomy)

1. TONSILLITIS
SUBMITTED TO
Mrs Mamta toppo
Associated professor college of nursing RIMS RANCHI
Submitted by:
Munmun raj
Roll no -07
Basic b.sc nursing 3rd year

2. contents
 TONSIL
 FUNCTION OF TONSIL
 TONSILLITIS
 CAUSE
 TYPE OF TONSILLITIS
 SIGN AND SYMPTOMS
 COMPLICATION
 DIAGNOSIS
 PATHOPHYSIOLOGY
 MEDICAL MANNAGEMENT
 SUGICAL MANAGEMEMENT
 NURSING MANAGEMENT
 PREVENTION
 RECENT RESEARCH
 SUMMARY
BIBILIOGRAPHY

3. THE TONSILS
• Tonsils are two masses of tissue at the back side
of throat ; its function is to defend the body
against toxic substance that are found in blood .
• An anatomically the tonsils are classified based on
their location into: –
1. palatine
2. Nasopharyngeal (“adenoid”)
3. Lingual
4. Tubal tonsils
• Generally the palatine tonsils reffered to as the
tonsils.

4. Waldeyer ring
 The lymphoid tissues surrounding opening into respiratory
and digestive system forms a ring.
 The lateral part is formed by palatine tonsils and tubal tonsil
around the auditory tube opening
 The upper part is formed by pharyngeal tonsils on the roof of
the nasopharynx
 The lower part – lingual tonsil on the posterior 1/3 of tongue.

5. WHAT IS THE DIAGRAM GIVEN BELOW?

6. QUIZ

7. Function of tonsils
Immunity
Antibodies formation
Lymphocyte formation
Barrier to infection

8. QUIZ

9. TONSILLITIS
Tonsillitis is defined as an inflammation of the tonsils
and characterized by sore throat and fever

10. QIUZ

11. CAUSE
 Bacterial and viral infection can cause tonsillitis through
droplet infection.
 A common cause is beta-haemolytic streptococci bacteria.
 Other common cause include:-
a) Adenoviruses
b) Influenza virus
c) Epstein –Barr virus
d) Corona virus
e) Enteroviruses
f) Herpes simplex virus

12. QUIZE
1.Which is the most common bacterial pathogen
causing tonsillitis ?
a. Beta haemolytic streptococci
b. Alpha haemolytic streptococci
c. herps simplex virus

13. TYPE OF TONSILLITIS
 Tonsillitis is often labelled as acute , sub-acute, or chronic.
 Acute tonsillitis tend to be bacterial or viral in nature.
 Sub-acute tonsillitis is cause by the bacterium Actinomyces.
 Chronic tonsillitis last for long time and is caused by bacteria.
ACUTE
TONSILLITIS
SUB ACUTE
CHRONIC
TONSILLITIS

14. ACUTE TONSILLITIS
 Acute infection of the tonsils involving the surface epithelium
crypts and lymphoid tissue
Acute superficial
tonsillitis
Acute parenchymatous
tonsillitis
Acute membranous
tonsillitis
Acute follicular tonsillitis

16. Acute superficial tonsillitis
 When tonsils are inflamed as part of the generalised
infection of the oropharyngeal mucosa it is called acute
superficial tonsillitis and also called catarrhal tonsillitis.

17. Acute follicular tonsillitis
In acute follicular infection spread into the crypts –
filled with purulent material – yellowish spots at the
openings.

18. Acute parenchymatous
Uniformly enlarge and erythematous with exudates,
Edema of uvula and soft palate

19. Acute membranous
 Some times from the crypts may coalesce to form a
membrane over the surface of tonsil, giving rise to clinical
picture of membranous tonsillitis.

20. SIGNS OF ACUTE TONSILLITIS
 Tonsil appear congested and swollen
- yellowish spots – follicular
-whitish membrane – membranous
- red and enlarged – parenchymatous
 Hyperemia of pillars, uvula, soft palate
 Halitosis, impeded movements of palate and increased
secretion.
 Enlarge and tender jugulodigastric nodes.

21. Symptoms of acute tonsilLitis
 Sore throat - raw sensation in the throat.
 Refusal to eat due to odynophagia.
 Earache – either referred pain from the tonsil or due to acute
otitis media.
 Voice become thick and muffled
 Jugulodigastric nodes are enlarged and painful.
 Fever, may be associated with chills and rigor, headache ,
tachycardia.

22. QUIZ

23. Sub acute tonsilLitis
Sub-acute tonsillitis (which can last between 3week
and 3 month ) is caused by the acntinomyces
bacterium.

24. Chronic tonsillitis
Chronic tonsillitis is a persistent infection of the
tonsil and can cause tonsil s
tone.
AETIOLOGY
i. Complication of acute sinusitis
ii. Subclinical infection of tonsil.
iii. Chronic infection of sinuses or teeth

25. Type of chronic tonsillitis
Chronic follicular
tonsillitis
Chronic fibroid
tonsilitis
Chronic
parenchymatous
tonsillitis

26. Chronic follicular tonsillitis
Tonsillar crypts are full of cheesy material
resulting in yellow spots on the surface
.

27. Chronic parenchymatous tonsillitis
Tonsils are very much enlarged almost
touching each other and may interfere with
speech diglutition and respiration long
standing cases may develop pulmonary
hypertension

28. Cronic fibroid tonsillitis
Tonsil are small but infected, with history of repeated
sore throats

29. SIGNS OF CHRONIC TONSILLITS
 Appearance :hypertrophied, congested- chronic
parenchymatous; small, fibrotic with cheesy debris-chronic
follicular
 squeezing; pus oozes out-should be distinguished from
lymphatic fluid of normal tonsils
 Enlarged jugulodigastric nodes
 Retention cysts; yellowish swellings filled with yellow liquid
and debris

30. Symptom of chronic tonsillitis
Recurrent throat pain
Cough
Halitosis and bad taste in the mouth
Quiescent phase; discomfort, irritation,
pain; asymptomatic

31. COMPLICATION Chronic tonsillitis- incomplete resolution of acute tonsillitis
 Peritonsillar abscess
 Parapharyngeal abscess
 A cute otitis media- recurrent attacks
 Cervical abscess due to suppuration of jugulodigastric nodes.
 Rheumatic fever –groupA ,B –hemolytic streptococci.
 Substance bacterial endocarditis (patient with valvular heart disease) – streptococcus
viridans.
 Tonsillar cyst
 Tonsiolith
 Retropharyngeal abscess.

32. PATHOPHYSIOLOGY

33. DIAGNOSIS
 THROAT SWAB (strep test )- this is used to get a sample of
the secretion from the back of the throat.
 MONOSPOT TEST ;a blood test can detect certain antibodies
,which can help confirm that a persons symptoms are due to
mononucleosis.
 EPSTEIN-BARR VIRUS ANTIBODIES if a mono spot test test is
negative ,antibodies in the blood against EBV might help
diagnose mononucleosis.
 BLOOD TEST – this primarily includes a complete blood count
(CBC) which is done to confirm the presence of infection.

34. MEDICAL MANAFGEMENT
Antibiotic are used to treat acute tonsillitis .penicillin
being most commonly used .
In addition , the patient is instructed to minimize bed
rest and increase adequate amount of fluid intake.
Saline through irrigation or gargles may relives the
discomfort.
Ibuprofen or other analgesic can help to decrease
edema and inflammation.

35. Which drugs are used for patient to patient allergic to penicillin
?
a. Erythromycin
b. Clarithromycin
c. Ciprofloxacin
d. Both A and B

36. QUIZ

37. SURGICAL MANAGEMENT
 Surgical removal of the tonsils (TONSILLECTOMY ) and
adenoids(ADENOIDECTOMY) is collectively called(
TONSILLOADENECTOMY”)

39. INDICATION OF TONSILLOADECTOMY
 Recurrent episodes of acute or chronic
tonsillitis .
Tonsillar or adenoid hypertrophy causing obstruction
of a airway and impaired swallowing.
Resolution of a peri tonsillar abscess.
Repeated ear problems related to eustachian tube
obstruction.
Sinus complication.

40. NURSING MANAGEMENT OF THE
TONSILLECTOMY
After tonsillectomy, place the client in a lateral
decubitus position until the client awake and alert .
Monitoring vital sign , haemorrhage is the most
serious complication.
Start oral feeding if once recovery from anesthesia.
Pain is the first 7 to 10 post operative days this can
usually controlled with liquid Tylenol
(acetaminophen) or Tylenol with coden

41. Cont…
 Avoid medication containing aspirin ,ibuprofen or other
inflammatory medication for 2 weeks .
 FEVER- A low grade fever following surgery may occur and
should be treated with Tylenol (acetaminophen)while a
children have fever they should play quietly or remain in bed.
 ICE COLLAR-gently lay the ice bag on the front of neck .
 BLEEDING- most bleeding is minor and you may only see a
little coting of blood on the tongue. Put your child into bed ,
sitting upright and place an ice collar on the neck .and watch
for spitting ,coughing , or vomiting of blood.

42. quiz

43. QUIZ

44. QUIZ

45. Nursing management
 Promoting airway clearance
 Provide side lying or prone position to facilitate safe drainage of
secretion
 Suctioning if necessary should be done to avoid trauma to the
surgical site
 Maintaining fluid volume
 Inspect throat to the surgical site discourage the child from
coughing , clearing the throat , blowing the nose and using straws.
 Encourage children to take any fluids
 Cittrous juice and brown or red fluid should be avoided
 Relieving pain
 Administer analgesic

46. Recent reserch in india

47. Study of common bacterial isolate in acute tonsillitis in india
Dr GD Manajan,Dr Mayur Ingale
professor ,Assistant professor
department of ENT ,p Dr D Y Patil medical college , pimpri , pune
ABSTRACT;
tonsil is a common condition encountered in the ENT out patient department of every
hospital .1 out of every 10 children visiting the ENT OPD suffer from acute tonsillitis
Material or method- our perspective observational study was carried
out in the otorhinolaryngology department in a medical college hospital and
research centre the period of study was from june 2015 to august 2015
Randomized throat swabs were collected from 50 patient visiting the ENT OPD. A
certified of approval of the institutional ethics committee was obtained before
commencing the study . Aninfor med consent was obtained from every patient
who was a part of this study before commencing the study .

48. result
Out of 50 patient from whom the throat swabs were
collected and analysed , 45 were positive for
staphylococcus aureus pyogenes while the other was
positive for beta haemolytic streptococci
CONCLUSION
Staphylococcus aureus appear to be the main
causative agent in the pathogenesis of acute
tonsillitis in our area with a prevalence of about 90
percent (40/50 positive isolates)

49. SUMMARY
 Tonsillitis is an infection of the tonsils, the small masses of
glandular tissue at the back of the throat .
 Tonsillitis most commonly affects children between the ages
of one and five years
 Tonsillitis is usually not serious unless a rare complication
known as a tonsillar abscess develops. This is a collection of
pus just behind the tonsils.
 Obstruction to breathing by enlarged tonsils may cause
snoring and disturbed sleep
 Tonsillitis caused by bacteria is treated with antibiotics. Virul
tonsillitis does not respond to antibiotics.
 Tonsillectomy is performed for significant airway obstruction
or in cases of recurring or serious infection.

50. EVALUATION
 WHAT Is waldeyer s ring?
 Define tonsillitis ?
 What are the type of acute tonsillitis ?
 What are the sign and symptoms of tonsillitis ?
 What are the diagnostic evaluation of tonsillitis?
 Explain Tonsillectomy ?
 What is electrosurgical tonsillectomy?
 Explain pathophysiology of tonsillitis?
 What are the nursing management of tonsillitis?
 Is tonsillitis is contagious?
 Discuss some Home Remedies for tonsillitis?

51. bibliography
 Ansari javed ,a text book of medical surgical
nursing- II ,pv publication,page no;-107-109 ,
 Brunner and suddarth , text book of medical surgical nursing vol-II
south Asian edition ,wolters Kluwer, page no;-499-503
 www.Wikipedia.com

52. Thanku