Download MBBS (Bachelor of Medicine and Bachelor of Surgery) 4th Year (Final Year) ENT disease of waldeyers ring Handwritten Notes
ADENOIDS
AETIOLOGY
Adenoids are subject to physiological
enlargement in childhood. Certain children
have a tendency to generalized lymphoid
hyperplasia in which adenoids also take part.
Recurrent attacks of rhinitis, sinusitis or chronic
tonsil itis may cause chronic adenoid infection
and hyperplasia.
Al ergy of the upper respiratory tract.
SYMPTOMS
1. NASAL SYMPTOMS
Nasal obstruction is the commonest
symptom. This leads to mouth breathing.
Nasal obstruction also interferes with
feeding or suckling in a child.
Nasal discharge. It is partly due to choanal
obstruction, as the normal nasal secretions
cannot drain into nasopharynx and partly
due to associated chronic rhinitis. The child
often has a wet bubbly nose.
Sinusitis. Chronic maxillary sinusitis is
commonly associated with adenoids.
Epistaxis. When adenoids are acutely
inflamed, epistaxis can occur with nose
blowing.
Voice change. Voice is toneless and
loses nasal quality due to nasal
obstruction
2. AURAL SYMPTOMS
Tubal obstruction. Adenoid mass blocks the
eustachian tube leading to retracted
tympanic membrane and conductive
hearing loss.
Recurrent attacks of acute otitis media
Chronic suppurative otitis media may fail to
resolve in the presence of infected
adenoids.
Serous otitis media.
3. GENERAL SYMPTOMS
Adenoid facies.
Chronic nasal obstruction and mouth breathing lead
to characteristic facial appearance called adenoid
facies.
The child has an elongated face with dul expression,
open mouth, prominent and crowded upper teeth
and hitched up upper lip.
Nose gives a pinched in appearance due to disuse
atrophy of alaenasi.
Hard palate in these cases is highly arched as the
moulding action of the tongue on palate is lost.
Pulmonary hypertension. Long-standing
nasal obstruction due to adenoid
hypertrophy can cause pulmonary
hypertension and cor pulmonale.
Aprosexia, i.e. lack of concentration
ADENOID FACIES. PATIENT IS A MOUTH
BREATHER.
ACUTE TONSILLITIS
CLASSIFICATION
1. Acute catarrhal or superficial tonsil itis.
Here tonsillitis is a part of generalized
pharyngitis and is mostly seen in viral
infections.
2. Acute fol icular tonsil itis. Infection
spreads into the crypts which become
filled with purulent material, presenting at
the openings of crypts as yellowish spots
3. Acute parenchymatous tonsil itis. Here
tonsil substance is affected. Tonsil is
uniformly enlarged and red.
4. Acute membranous tonsil itis. It is a
stage ahead of acute follicular tonsillitis
when exudation from the crypts
coalesces to form a membrane on the
surface of tonsil
ACUTE FOLLICULAR TONSILLITIS.
ACUTE FOLLICULAR TONSILLITIS. NOTE PUS BEADS ON THE
SURFACE OF LEFT TONSIL. ON THE RIGHT PUS BEADS HAVE
COALESCED TOGETHER TO FORM A MEMBRANE.
AETIOLOGY
Acute tonsillitis often affects school-going
children, but also affects adults. It is rare in
infants and in persons who are above 50
years of age.
Haemolytic streptococcus is the most
commonly infecting organism. Other causes
of infection may be staphylococci,
pneumococci or H. influenzae.
These bacteria may primarily infect the
tonsil or may be secondary to a viral
infection.
SYMPTOMS
Sore throat.
Dif iculty in swal owing. The child may
refuse to eat anything due to local pain.
Fever. It may vary from 38 to 40?C and
may be associated with chills and rigors.
Earache. It is either referred pain from the
tonsil or the result of acute otitis media
which may occur as a complication
Constitutional symptoms. They are usually
more marked than seen in simple
pharyngitis and may include headache,
general body aches, malaise and
constipation. There may be abdominal pain
due to mesenteric lymphadenitis simulating
a clinical picture of acute appendicitis
SIGNS
Often the breath is foetid and tongue is
coasted.
There is hyperaemia of pil ars, soft palate
and uvula.
Tonsils are red and swollen with yellowish
spots of purulent material presenting at the
opening of crypts (acute follicular tonsil itis)
or there may be a whitish membrane on
the medial surface of tonsil which can be
easily wiped away with a swab (acute
membranous tonsil itis)
The tonsils may be enlarged and
congested so much so that they almost
meet in the midline along with some
oedema of the uvula and soft palate
(acute parenchymatous tonsil itis).
The jugulodigastric lymph nodes are
enlarged and tender.
CHRONIC TONSILLITIS
AETIOLOGY
It may be a complication of acute
tonsillitis.
Subclinical infections of tonsils without an
acute attack
Mostly affects children and young adults.
Rarely occurs after 50 years.
Chronic infection in sinuses or teeth may
be a predisposing factor.
CLASSIFICATION
1. Chronic fol icular tonsil itis. Here tonsil ar
crypts are full of infected cheesy material
which shows on the surface as yel owish spots.
2. Chronic parenchymatous tonsil itis. There is
hyperplasia of lymphoid tissue. Tonsils are very
much enlargedand may interfere with speech,
deglutition and. Attacks of sleep apnoea may
occur. Long-standing cases develop features
of cor pulmonale.
3. Chronic fibroid tonsil itis. Tonsils are small but
infected, with history of repeated sore throats.
CLINICAL FEATURES
Recurrent attacks of sore throat or acute
tonsillitis.
Chronic irritation in throat with cough.
Bad taste in mouth and foul breath
(halitosis) due to pus in crypts.
Thick speech, difficulty in swallowing and
choking spells at night (when tonsils are
large and obstructive).
PARENCHYMATOUS TONSILLITIS. THE TWO TONSILS ARE
ALMOST TOUCHING EACH OTHER CAUSING PROBLEMS OF
DEGLUTITION, SPEECH AND RESPIRATION.
This post was last modified on 11 August 2021