Tonsils And Adenoid Diseases
What is the Function of Tonsils and Adenoid?
The rich lymph tissue in the back of the nose (nasal) and throat is called Waldeyer’s Ring and plays an important role in the body defense system’s response to infections that come through the mouth and nose, especially in the first years of life.
Structures Constituting the Waldeyer Ring; Tonsils (tonsils), tongue root tonsils (lingual tonsils), adenoids (adenoid, pharyngeal tonsil), lymphoid tissue in the mouth of the Eustachian duct in the nasal cavity (tubal tonsils, Gerlah’s tonsil), lymphoid follicles located in the back wall of the throat. Among these anatomical structures in children, especially tonsils and adenoidsThey are of different importance because they can be a focus of chronic infection and cause secondary problems as a result of their enlargement.
Tonsils are lymphatic tissues located on both sides of the throat and separated from the surrounding tissues by a capsule. Lymph cell groups located around 15-20 recesses on the tonsils, called crypts, play an important role in the formation of the defense system response against micro-organisms that come through the mouth. Tonsils can become a source of chronic infection due to dead cells accumulating in these recesses and bacteria that settle in food residues and cannot be completely cleaned with drug treatments. In cases where the body resistance decreases in children and adults with chronic infection foci in their tonsils, even if a new infection is not transmitted from the outside, existing foci of infection may cause recurrent acute tonsillitis by activating them. The enlargement of the size of the tonsils as a result of the proliferation of lymph tissues in the tonsils due to recurrent infections may also cause complaints such as snoring, sleep obstruction and apnea due to narrowing in the respiratory canal.
The adenoid, which is located on the ceiling of the nasal region behind the nose, is in the form of widespread lymph tissue and does not have a capsule bordering the surrounding tissues such as tonsils. The adenoid, which is the first response of the body’s defense system against infectious agents coming through the nose, enlarges as a result of the infections and becomes so large that it clogs the holes (choana) where the nose opens to the back of the nasal cavity, which may cause complaints such as nasal congestion, snoring, and sleep obstruction (apnea). As the lymph tissue in the adenoid, which is small at birth, encounters external factors coming through the nose in the first years of life, it multiplies at different rates from person to person depending on the structural features and the frequency of infection, and complaints related to nasal congestion are usually seen in children with this reaction at the age of three to four years. starts. The lymphatic tissue proliferation in the adenoid continues until the age of six or seven, and then gradually decreases, and the adenoid, which begins to shrink, generally regresses to a size that does not cause obstruction in volume from the age of 10-12. At the same time, frequently recurring adenoid infections may cause negative pressure and fluid collection in the middle ear (otitis media with effusion) or recurrent middle ear infections (acute otitis media) by disrupting the functions of the Eustachian canal, which opens on both sides of the nasal region and provides equalization of the middle ear pressure.
Acute Tonsillitis Surgery (Acute Tonsillitis)
with active infection of the tonsils acute tonsillitisIt causes complaints and findings of varying severity depending on the microorganism that causes it and the resistance of the patient’s defense system. Main Factors causing acute tonsillitis: bacteria :Group A Beta hemolytic Streptococci, Staphylococci, Pneumococci, H. influenza, and anaerobic bacteria, viruses: Influenza, parainfluenza viruses, Herpes simplex virus, Coxsackie virus, Ecoviruses, Rhinoviruses, Respiratory syncytial virus (RSV).
What are the Symptoms of Acute Tonsil Inflammation?
Especially in tonsillitis caused by beta hemolytic streptococci, the complaints are more severe than viral infections. With the onset of infection, high fever and chills are observed in a short time, followed by severe sore throat. Affecting the muscles in the throat area causes difficulty in swallowing. There are headaches, pain in the ears, weakness, joint pains. Complaints usually begin to regress after 4-6 days and resolve in 7-8 days. Complaints can be brought under control within 24-48 hours in patients who are treated appropriately in the early period. Viral agents in preschool children and bacterial agents in adolescents and young adults are more common sources of infection.
What are the Examination Findings in Acute Tonsillitis?
In the examination of the patients, different amounts of white membranes on the tonsils and inflammation are observed in the openings of the recesses (crypts) on the tonsils. There may be foci of bleeding on the tonsils and a reaction in the entire lymphoid tissue in the throat. The throat is generally red and swollen. In the upper part of the neck, enlargement and pain in the lymph nodes behind the corner of the jaw are often observed.
Laboratory Findings in Acute Tonsil Inflammation
There is an increase in white blood cells in the blood count examination. CRP, sedimentation values are usually above normal.
Normal Antistreptolysin O antibody (ASO) level in blood is 166-200 u/dl, values above this suggest previous streptococcal infection.
The microorganism causing the infection is determined by gram staining in the microscopic examination of the swab taken from the throat, it can also be produced in the throat culture and it can be determined to which antibiotics it is sensitive.
Rapid streptococcal test can also be used in the diagnosis of streptococcal infections, but it should be kept in mind that it may give false negative results.
Treatment of Acute Tonsil Inflammation
Adequate fluid intake and rest are very important in the treatment of the disease. Oral antiseptics, pain relievers, antipyretic drugs and antibiotics are used in bacterial infections. In patients who are started on oral antibiotic therapy, the treatment should be used for at least 10 days. If the clinic is severe, the treatment can be started by intravenous or intramuscular injection, taking into account the difficulty of taking oral medication. In this case, the first choice is intramuscular (IM) procaine penicillin. In adult patients, 800,000 u of IM twice a day is continued for 3-4 days, and with the improvement of the clinic, the treatment can be completed for 10 days by using penicillin group drugs orally, or the treatment can be terminated by intramuscular injection of 1,200,000 u of depot benzathine penicillin once. If beta-lactamase-producing microorganisms are present, the response to penicillin treatment will be reduced. Following the detection of this situation by culture, an antibiogram should be performed and appropriate antibiotic should be started.
Differential Diagnosis of Acute Tonsillosis
The diseases most confused with acute tonsillitis are infectious mononucleosis, diphtheria and scarlet fever.
Infectious Mononucleosis The causative agent of the disease is Epstain Barr Virus (EBV). This infection, which is frequently observed in school-age children and is also known as the kissing disease among the public, is transmitted through saliva and airborne droplets. Its clinical findings are very similar to acute tonsillitis, with high fever, sore throat, enlargement and redness of the tonsils, followed by the white-gray colored membrane covering the tonsils. Along with the enlargement of the lymph nodes in the neck, the spread of the virus in the blood causes enlargement of the liver and spleen. In the diagnosis, an increase in cells called monocytes in the blood, monitoring of cells specific to this disease and immunological tests are used. The absence of an increase in the total number of white blood cells, increased sedimentation and CRP, elevated liver enzyme levels, detection of liver and spleen enlargement are other useful findings in the diagnosis. Blood smear evaluation with a microscope in patients is very important in terms of differentiating other blood diseases that may cause similar findings.
In diphtheria The onset period is slow, the general findings are not clear. Hoarseness, shortness of breath, cough, swelling of the lymph nodes in the neck are observed. A thick, gray, tightly adherent membrane forms on the tonsils. Bleeding is typical when the membrane on the tonsils is removed. Due to the secretion of toxins affecting the nervous system and heart, heart palpitations incompatible with fever can be detected. Diagnosis is made by Gram stain and throat culture. The incidence of the disease has decreased considerably with vaccination programs.
scarlet fever It occurs due to streptococci producing a special toxin, thick membrane formation on the tonsils and a red spotted appearance (strawberry tongue) on the tongue. There are widespread raised rashes on the body. Diagnosis is made by throat culture and immunological tests.
Chronic Tonsil Inflammation
It is a persistent inflammation of the tonsils that develops due to recurrent infections. Enlargement of the tonsils, deterioration in its structure, clogging in its recesses (crypt), and often the accumulation of infected dead cell residues (magma) are observed. Although tonsils usually enlarge with recurrent infections, they can sometimes shrink and disappear. The causative agent in chronic tonsillitis is bacteria located in the crypts of the tonsils.
Findings of Chronic Tonsillitis:Recurrent sore throats, enlargement of the tonsils and increased vascularity, dirty yellow-white colored, foul-smelling cells and food residues accumulated in the crypts, occasional recurrent episodes of febrile infection, joint pain, weakness, swelling of the lymph nodes in the neck.
Treatment in Chronic Tonsil Inflammations
Although preventive antibiotics (monthly depot penicillin injections) can be used in frequently recurrent infections, removal of the tonsils (tonsillectomy) is generally preferred. In children younger than three years of age, if the tonsils are too large, although frequent infections do not occur, it may be preferable to partially reduce the tonsils in a way that will relieve the air canal, instead of completely removing them in order to protect their contribution to the body defense system, which is evident in this period of life. The techniques applied for this purpose will be discussed under the title of tonsil surgery.