Transcript
Tonsillitis扁桃体炎
AnatomyAnatomy
HistologyHistology• Specialized squamous epithelium (E) • hemi-capsule (Cap)• 10-30 Crypts• Lymphoid follicles (F)
Grade of Tonsil Size
Grade % 0 in fossa–1 <25–2 25-50–3 51-75–4 >75
1. Acute Tonsillitis
2. Chronic Tonsillitis
(Recurrent Acute Tonsillitis)
3. Obstructive Tonsillar Hyperplasia
Clinical classification
Acute tonsillitis
Etiology (Etiology (病原学病原学))
• BLPO (beta-lactamase-producing )
• Anaerobic BLPO
• GABHS (GroupA beta-hemolytic streptococcus):
most important pathogen because of potential
sequelae
signs and symptomssigns and symptoms
•High fever, malaise, headache, and vomiting
•Sore throat and Odynophagia
•Dysphagia
•Tender cervical lymphadenopathy
•Erythematous/exudative tonsils
•Purulent exudate from the crypts
•A white membrane
•Viral–Lower grade fever–Lower WBC, Lymphocytic shift–Less tonsillar exudate
•Bacterial–Higher WBC, Granulocytic shift–More exudative
Clinical EvaluationClinical Evaluation
Acute Tonsillitis
•Evidence of inflammation of the tonsils
PLUS
•pyrexia of at least 38.50C, measured orally.
•enlarged, tender, anterior cervical lymph nodes.
•documentation of GABHS infection by throat swab (antigen detection or culture).
DiagnosisDiagnosis
•Infectious mononucleosis•Vincent's angina•Malignancy: lymphoma, leukemia, carcinoma•Diphtheria•Scarlet fever•Agranulocytosis
Differential diagnosisDifferential diagnosis (AT鉴别诊断)
Complications Complications
•Peritonsillar abscess
•Cervical adenitis
•Acute myocarditis
•Acute glomerulonephritis
•Rheumatic fever
PeritonsillarPeritonsillar CellulitisCellulitisAnd Abscess And Abscess
aspiration or incision
Medical ManagementMedical Management
•Bed rest. •PCN is first line, even if throat culture
is negative for GABHS.•Local treatment:Gargle, spray.
Recurrent Acute Tonsillitis
•Seven episodes in a single year
•Five or more episodes in 2 years
•Three or more episodes in 3 years
Recurrent Acute Tonsillitis
Treatment:
1. PCN injection if concerned about
noncompliance or antibiotics aimed
against BLPO and anaerobes.
2. Tonsillectomy
Chronic Tonsillitis
•No true consensus on the definition.
•Symptoms greater than 4 weeks
DEFINITIONS:
MicrobiologyMicrobiology(CT)
Most common organisms cultured from patients with chronic tonsillar disease
•Streptococcus pyogenes (GABHS)•H. influenza•S. aureus•Streptococcus pneumoniae
SymptomsSymptoms
•Low grade intermittent sore throat
•Halitosis
SignsSigns
•Enlarged, mildly red tonsils that are scarred with large pits
•Crypts tend to become impacted with white foul-smelling (especially to the owner) debris.
•Slightly enlarged lymph nodes that are not usually tender
DiagnosisDiagnosis
•Histories of recurrent throat infections is the most important.
•Examinations–The size of tonsil is not correlative with
the degree of inflammation.
Differential Diagnosis Differential Diagnosis
•Infectious Mononucleosis–EBV
•Scarlet Fever•Corynebacterium diptheriae•Malignancy
ICA AneurysmICA Aneurysm
PleomorphicPleomorphic AdenomaAdenoma
Other Other TonsillarTonsillar PathologyPathology
Hyperkeratosis Hyperkeratosis ((角化症角化症))
CandidiasisCandidiasis((念珠菌病念珠菌病))
Syphilis Syphilis 梅毒
Retention CystsRetention Cysts潴留囊肿
SupratonsillarSupratonsillar CleftCleft
Complications of CTComplications of CT
•Myocarditis
•Glomerulonephritis
•Rheumatic fever
•Fever
Medical TherapyMedical Therapy
•First Line–Penicillin/Cephalosporin for 10 days–Injectable forms for noncompliance
• BLPO, co pathogens
•Macrolides–Penicillin allergy–Erythromycin/Clarithromycin 10 days–Azithromycin (12mg/kg/day) 5 days
Medical TherapyMedical Therapy
•Patients with recurrent otitis media history have higher bacterial concentrations with BLPO.–Initial treatment with anti-BLP antibiotic.
•Adenotonsillar size may respond to a one month course of antibiotic therapy.
•Adenoid hyperplasia may respond to a 6-8 week course of intranasal steroid.
Surgical IndicationsSurgical Indications
•Absolute–Obstructive airway with cor pulmonale
–Severe dysphagia
–Failure to thrive
•Relative–Recurrent acute tonsillitisepisodes/year for 2 years or 3 episodes/year for 3 years–Chronic tonsillitis–Obstructive Sleep Apnea–Peritonsillar Abscess–Halitosis–Suspected Neoplasia/ Tonsillar hyperplasia
Surgical IndicationsSurgical IndicationsSurgical IndicationsSurgical Indications
Innovative Surgical TechniquesInnovative Surgical Techniques
•Cold Dissection•Electrosurgery•Intracapsular partial tonsillectomy•Harmonic Scalpel•Radiofrequency tonsillar ablation and
coblation.
Complications
Mortality rate is 1 in 16000-35000•Postoperative Bleeding•Anesthetic complications•Eustachian tube injury•Nasopharyngeal stenosis•Pulmonary Edema•Atlantoaxial subluxation
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