Tonsillitis Most frequently seen in children but is not uncommon in adults Causative organism 1. Viral most common 2. B-hemolytic streptococcus : most common 3. Streptococcus pneumonae 4. Hemophilus influenza 5. Clinical feature 6. Symptoms 7. Sorethroat 8. Odynophagia 9. Fever 10. Earache (referred otalgia) 11. 12. Sign 13. Congested and enlarged tonsil (bilateral) with or without pus point 14. Enlarged tender jugulodiagastric lymphnode Investigations Clinical diagnosis Tonsillar swab- culture sensitivity Complete blood count Treatment adequate fluid intake for first 2-3 days Oral analgesic 1. Paracetamol 500mg *qid *pc 2. Ibuprofen 400mg *tds *pc 3. Nimesulide 100mg *bd *pc Salt water or betadine gargle Antibiotics Oral penicillin: 1. Amoxycillin 250-500mg *tds for7-12 dys (choice of drugs) 2. Ampicillin 250-50mg *qod for 7-10 dys 3. Erythromycin 250-500mg *qid for 7-10 days 4. Cloxacillin 250-500mg *qid for 7-10 dys 5. Cephalexin 250-500mg*qid for 7-10 dys 6. Ciprofloxacin 250-500mg*bd for 7-10 dys I/M antibiotics 1. Inj. Penicillin 10 lakh I/M 6 hrsly or for 24-48hrs 2. Benzathine penicillin 6-12lakh I/M *od for 10 dys If condition is severe and patient unable to swollen due to pain, patient should be hospitalized and antibiotics should be given intravenously Complication 1. Tonsillitis due to B-hemolytic streptococcus group A can cause 2. rheumatic fever and acute glomerulo nephritis CHRONIC TONSILLITIS Person suffering from recurrent attacks of acute tonsillitis are also referred to as having chronic tonsillitis D/D of ulcer & white patch on tonsil Infection 1. Ac tonsillitis 2. Peritonsillar abscess 3. Candidiasis 4. Infectious mononucleosis 5. TB 6. Diptheria 7. Syphilis Neoplasm Blood disease Tonsillectomy Indications 1. 5 or >5 of acute tonsillitis over a period of 2 years 2. Obstructive sleep apnea syndrome (OSAS) along with adenoidectomy 3. Suspected neoplasm of tonsil There is no evidence of any deleterious long term immunological side effects after tonsillectomy Contraindications 1. Bleeding disorder 2. During acute infection Post operative care following tonsillectomy 1. Nursing care should be directed towards early detection of bleeding and to prevent its aspiration pulse examined every 10 minutes and BP every 30 min in early post operative period: a rising pulse rate and falling BP are signs of bleeding 2. In semiconscious patient noisy breathing and frequent swallowing are indirect sign of bleeding 3. Patient is encouraged to have normal food as soon as possible 4. Chewing and swallowing decreases post operative pain by preventing spasm of pharyngeal muscle