1. Disease of Tonsils
Structure of Tonsils
Consists of paired aggregates of Lymphoid Tissues,located in the pocket formed by palatoglossus &
palatopharynx arch.
A complete circle of Lymphoid tissue surrounding the entrance of GIT&Respiratory tract.Lymphoid
tissue elsewhere adenoid,payer patches,appendix.Lymphoid follicle embedded in a stroma of
connective tissue.
Stratified squamous mucosal covering of the tonsil extends irregular convoluted into parenchyma
forming pits or crypt. Microorganism ,desquamated epithelium &food debris(follicle).
Normal flora
Group A Beta haemolytic Streptococcus. 40% people have this organism.
HI
α Haemolytic streptococci
Brahamella
Mycoplasma
Chlamydia
Anaerobe.
FNAC from core> No growth of pathogenic organism.
Recurrent Ts >HI & Staphylococcus, mixed Oganism.
Functions of Tonsils
No afferent lymphatic,Germinal centre are located immediately submucosaly.T&B cells.Bcell
generate of polymeric IgA which express on mucosa & also IgG which circulate in blood.
Polymeric IgA production markedly reduced by recurrent Ts. In Tonsillectomy no evidence of
impaired immunity.Extensive back up of the immune system.
Further Bacteria & virus may act synergistically. Latent Virus Epistein –Barr virus ,adenovirus, Herpes
simplex sensitizing the pathogenic Bacteria on the Tonsil.

2. Acute Ts
Inflammatory episode affecting the Tonsils may occur as an isolated or Generalized Pharyngitis as
URTI or as a part of systemic infection(Infectious mononucleosis).Severe Ts in IM.
Organism of acute Ts;Group A β Haemolitic Streptococcus.
Epidaemiology
Sore throat common presentation,not true Ts but also Pharyngitis.Commom in Automn& Winter.
Clinical Evaluation
Pyrexia ,sore throat, Painful swallow
O/EPharyngeal erythema with or without Tonsillar exudates, Painful cervical adenopathy.
Aetiology of inflammatory disease
Both Bacteria &virus play a part in Acute Inflammation either separately or together. Or Probable
factors that impair immune system of the patient render susceptible to episode of infection.there is
no evidence that viral Ts is more or less severe than bacterial Ts or that the duration of the illness
varies significantly in either ease(exception severe in IM)
Diagnosis of Causative agent
Throat swab for C/S shows 40% culture positive in asymptomatic carrier.Again organism culture
from surface of Ts. May varies from bacterial flora deep with Tonsillar crypts.
Treatment
Primary management principally supportive use of analgesic &adequate hydration.
Specific Treatment; No Bacteria are cultured , a viral aetiology is assumed.Average Duration of an
episode of acute Ts is 2 to 3 days.Indiscriminate antibiotic prescription resist organism, allergy,
anaphylaxis.
Efficacy of varies Antibiotic cephradine over penicillin for 7days ,benefit insufficient to justify their
use. A single dose of dexamethasone as adjuract therpy is significant benefit in reducing pain in
acute Pharyngitis.

3. Complications of Acute Ts
1) Systemic sepsis > septicaemia &septic arthritis.
2) GABHS > acute exanthematous reaction >Macular rash>scarlet fever.
3) Immune complex > RF &AGN.
Peritonsillar abscess
Peritonsillar abscess in which a collectin of pus forms in the potential space between the the
Tonsillar capsule & superior constrictor.
Organism GABHS ,Streptococcus viridians ,Staphylococcus aureus ,HI, Anaerobes.
Treatment
Hospitalization
I/V fluid
I/D of abscess
Antibiotic (cephradine+ Metronidazole)
Tonsillectomy following 2nd attack of quinsy.
Lemierre’s Syndrome
Potentially fatal complications of oropharyngeal function ,characterised by septic thrombophelibitis
in the internal jugular vein with metastatic absceses.
Fusiform Bacillus > severe neck pain, septicaemia, &2ndary to Tympanomastiod infection.
Treatment
Prolonged antibiotic >Beta lactm + metronidazole
Anticoagution if spreading thrombophilitis
Significant mortality.

4. Tonsillitis &psoriasis
Tonsillitis due to GAHBS & exacerbation of Psoriasis particularly of the guttate varity(small psoriasis)
by each episode of the acute Ts >immune phenomena>Tonsillectomy.(1/3 to1/2 of the patient
improved , 7% worsening)
Recurrent Ts
Acute episode appear to follow a pattern of recurring infection every few wks or months.This
sequence of episode may gradually abate &some Individual runs a course to several yrs.
Low dose penicillin if episode are happening close together.
Chr. Ts
Chr. Low grade infection, affecting the quality of life, throat discomfort,production of unpleasant
Psmelly yellowish debris may become inspissated Tonsillolith, low grade fever,Chr. Tonsil sepsis.
NO natural resolution.
Infectious mononucleosis
Severe Acute Pharyngotonsillar infection, seen in young adult , severe systemic upset,
Haemotological disturbance, Liver function disturbance, spleenomegaly,
Dx by monospot test(Heterophil antiboby,)Confirm by Antibody to EBV.
Treatment
Penicillin+ Metronidazole ,ampicillin must be avoided.
Short course Corticosteroid
No evidence of support to use antiviral drugs.