Tonsillitis

Tonsillitis
Is the inflammation of the tonsils that can be acute,

sub-acute, and chronic due to causative factors
affecting it.
Acute tonsillitis can either be bacterial or viral in
origin. Subacute tonsillitis is caused by the
bacterium Actinomyces. Chronic tonsillitis, which
can last for long periods if not treated, is mostly
caused by bacterial infection.
Tonsils are made –up of adenoids tissue that
secretes lymphocytes that help in fighting
against systemic infection of the body.
The adenoids are glands located in the roof of the

mouth, behind the soft palate where the nose
connects to the throat. The adenoids produce
antibodies (white blood cells) that help fight
infections. Typically, the adenoids shrink during
adolescence and may disappear by adulthood.
Causative agents:
1. Bacteria (streptococci, staphylococci)

2. Virus (Adenovirus, mononucleosis)
3. Spirochetes
4. Treponema
Causative factors enter the upper
respiratory tract via nose and mouth
Enters the nose and mouth causing
inflammation to the tonsils.
Signs and symptoms are;
1. Sore throat as referred pain to the ears

2. Painful or difficult swallowing (Dysphagia)
3. Crouch coughing
4. Headache, fever, chills
5. Red swollen tonsils with pus
6. Swelling and tenderness of the submandibular
glands
Diagnostic procedures:
1. Buccal swab for Culture & sensitivity test to

identify streptococci and staphylococci
infections
2. Complete blood count for elevated white blood
cells & lymphocytes
Incubation period:
Acute Tonsillitis is 72 hours.

Sub-acute tonsillitis is 2-3 days.
Chronic Tonsillitis is 4-6 days.
Recurrent Tonsillitis is 1-2 weeks.
Treatment:
1.Saline gargle (Mouthwash if needed)
2.Analgesics (Ponstan, Brufen)
3.Antipyretics & Increase fluid intake
4.Soothing Lozenges (Orofar-L, Strepsils)
5.Antibiotics (Penicillin is drug of choice)
but may use erythromycin & cefuroxime
6.Tonsillectomy for recurrent chronic cases
Complications:
1.Peritonsillar abscess (tonsils with pus)
2.Lemierres syndrome (septicemia)
3.Hypertrophy of tonsils (snoring, mouth breathing,
disturbed sleep and obstructive sleep apnea)
4.Rheumatic heart disease
5.Glomerulonephritis
6.Tonsillolith (tonsil debris in whitish color)
7.Halitosis (bad breath)
PHARYNGITIS
Is the inflammation of the pharynx called sore

throat that can be acute or chronic due to
causative factors affecting it. It is usually
precedes illness of colds and flu that doesn’t
require antibiotics unless otherwise caused by
bacterial infection because most disappear by
their own in weeks or less.
Causative Agents
1. Bacteria (Streptococci, Staphylococci)

2. Virus (Adenovirus, Mononucleosis)
3. Allergens (dust, mist, pollens, smokes)
4. Alcohol
5. Use of tobacco
Causative agent enters the upper
respiratory tract, causing inflammation of
the pharynx.
Signs and symptoms:
I. Pharyngitis with colds

1.Sneezing
2.Cough
3.Low fever
4.Mild headache
II. Pharyngitis with flu
1. Fatigue
2. Body aches
3. High fever
4. Chills
III. Pharyngitis with bacterial infection
1.Enlarges lymph nodes in neck & armpit
2.Headache
3.Anorexia
4.Swollen spleen
5.Swollen tonsils
6.Liver inflammation
7. Dysphagia
8. Red & edematous pharynx with exudates
IV. Pharyngitis with viral infection
1. sore throat
2. coryza
3. body malaise & fatigue
4. hoarseness of voice
5. Low-grade fever
1. Buccal swab for culture & sensitivity test

to identify bacterial infection.
2. Complete blood count for increase white
blood cell and its differentials.
Incubation Period
Acute Pharyngitis is 72 hours.

Sub-acute Pharyngitis is 2-3 days.
Chronic pharyngitis is 7-10 days.
Recurrent Pharyngitis is 1-2 weeks.
Treatment
1.Saline gargle (Mouth wash if needed)

2.Analgesics (Ponstan, Brufen)
3.Antipyretics (Panadol extra)
4.Increase fluids but not soft drinks & not too sweet juices
5.Removal of allergens
6.Antiobiotics (Penicillin is drug of choice)
7.Vitamin-C for viral infection as the case don’t need
medication for it disappear by its own.
8. Hospitalization if cannot swallow fluids to provide I.V.
hydration.
Complications
1. Tuberculosis
2. Liver cirrhosis
3. Rheumatic heart disease
Pharyngotonsillitis
Is the inflammation of the pharynx and tonsils due
to infectious (bacterial & viral) and non-infectious
(pollens, dust, mist, sandstorms) factors affecting
it that can be acute, sub-acute, and chronic.
Causative agents:
1.Bacteria (Group-A betahemolytic streptococci)

2.Virus (Adenovirus, Mononucleosis)
3.Non-infectious (chemicals, dust, mist, pollens)
Causative agents enters the upper respiratory
tract and inflamed the pharynx and tonsils.
Signs and Symptoms
I. Pharyngitis with bacterial infection

1.Fever
2.Sore throat
3.Nausea and vomiting
4.Erythema of the pharynx and tonsils
5.Enlarged cervical glands
6.Exudative tonsils
7.Palatal petechia
8.Scarlet fever rash
II. Pharyngotonsillitis with viral infection
1. Cough
2. Rhinitis
3. Conjunctivitis
4. Diarrhea
5. Sore throat
6. Fever
1. Buccal swab for culture and sensitivity to

detect infectious agent.
2. Complete blood count for increase white blood
cell and its differentials.
Incubation period:
Acute Pharyngotonsillitis is 72 hours.

Sub-acute Pharyngotonsillitis is 2-3 days.
Chronic Pharyngotonsillitis is 4-10 days.
Recurrent Pharyngotonsillitis is 2-3 weeks.
Treatment:
1. Saline gargle (mouth wash if needed)

2. Analgesics
3. Antipyretics
4. Lozenges
5. Antibiotics (Penicillin is best but may use amoxicilin &
augmentin if allergy to Pen-G)
6. Increase fluids to correct dehydration of the pharynx
and tonsils.
7. Humidify the air inhaled.
8. Vitamin-C intake
Complications:
1. Tuberculosis
3. Septicaemia
Laryngitis
Is the inflammation of the larynx (voice box) due to
overuse, irritation, infection (bacterial & viral),
and non-infectious agents (mist, pollens, dews,
sandstorms, dust, chemicals, smokes) that can be
acute, sub-acute, and chronic.
Causative agents:
Acute Laryngitis
1.Virus infection (colds, measles)
colds secretions enter the larynx via nasopharynx &
caused inflammation
2.Voice overuse
over talking dries the larynx tissues causing irritation
and inflammation
3.Bacterial infection (diptheria)
airborne microorganism invades the larynx & caused
inflammation
II. Chronic Laryngitis
1.Irritants inhalation
2.Chronic sinusitis
3.Acid reflux (gastroeasophageal)
4.Excess alcohol intake
5.Smoking
Larynx- it opens and closes during
sounds production
Causative agents enter the upper
respiratory tract and inflamed the larynx.
Normal Larynx or not inflamed Inflamed Larynx

Signs and symptoms:
1.Hoarseness of voice due to distortion of the

larynx during vibration of sound production.
2.Loss or weakness of voice.
3.Tickling sensation and rawness of the
throat.
4.Dry, sore throat.
5.Dry cough.
1. Laryngoscope confirmed exudates,

redness and inflamed larynx.
2. Biopsy of the larynx.
3. Culture and sensitivity swab to identify the
causative agent.
Incubation period:
Acute laryngitis is 72 hours.

Sub-acute laryngitis is 2-3 days.
Chronic laryngitis is 4-10 days.
Recurrent laryngitis is 2-3 weeks.
Treatments:
1. Steam inhalation
2. Rest / no talking to relax larynx
3. Increase fluids to dehydrate larynx
4. Saline gargle, mouth wash if needed
5. Analgesics
6. Antipyretics
7. Antibiotics
8. Corticosteroids
9. Acid reflux medication
10. Heart burns treatment
11. Provide communication pads
12. Anticipate patient needs instead of asking
13. Maintain air humidification
Complications:
1. Cancer of the larynx

3. Tuberculosis
4. Permanent loss of voice / hoarseness

Tonsillitis

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Tonsillitis

Is the inflammation of the tonsils that can be acute,

The adenoids are glands located in the roof of the

1. Bacteria (streptococci, staphylococci)

1. Sore throat as referred pain to the ears

1. Buccal swab for Culture & sensitivity test to

Acute Tonsillitis is 72 hours.

Is the inflammation of the pharynx called sore

1. Bacteria (Streptococci, Staphylococci)

I. Pharyngitis with colds

1. Buccal swab for culture & sensitivity test

Acute Pharyngitis is 72 hours.

1.Saline gargle (Mouth wash if needed)

1.Bacteria (Group-A betahemolytic streptococci)

I. Pharyngitis with bacterial infection

1. Buccal swab for culture and sensitivity to

Acute Pharyngotonsillitis is 72 hours.

1. Saline gargle (mouth wash if needed)

Normal Larynx or not inflamed Inflamed Larynx

1.Hoarseness of voice due to distortion of the

1. Laryngoscope confirmed exudates,

Acute laryngitis is 72 hours.

1. Cancer of the larynx

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