Adenoids

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TONSILLITIS ADENOID
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The Nasopharyngeal Tonsil

• It is a mass of sub-epithelial lymphoid tissue
  present at the junction between the roof
  posterior wall of the nasopharynx
• The free surface has 6 folds
• It has no capsule
• It is covered by pseudo-stratified columner
  epithelium
• It drains to the Retropharyngeal lymph nodes
  ?Upper Deep Cervical Lymph Nodes

The palatine tonsil has a capsule on its lateral
surface which separate the lateral wall from
the bed
The palatine tonsil is covered by stratified
columner epithelium
The palatine tonsil drains to The
Jagulodigastric lymph nodes below the angle of
the mandible
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Adenoid

• Definition
• Age
• Causes of enlargement

• Hypertrophy of the nasopharyngeal onsil
  sufficiently to produce symtoms

2 -12 years

• Physiological enlargement at 3-7 years
• Pathological recurrent upper respiratory tract
  infection

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Symptoms

• Bilateral Nasal Obstruction
• Mouth Breathing
• Snoring OSA
• Speech hyponasality
• Difficult suckling

• Bilateral Nasal
• discharge
• Mucoid or mucopurulent discharge WHY? Due to
  blockage of the choanae
• Excoriation of the nasal vestibule upper lip
• Post nasal discharge causing frequent nocturnal
  cough

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Rhinolalia clausa (speech hyponasality) ????
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Signs

• Posterior Rhinoscopy ? difficult
• Digital palpation? not pleasant
• Endoscopic examination? the best

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Investigations

• Lateral soft tisue X ray of the nasopharynx
• It is not the size of the
• nasopharyngeal tonsil which is
• important but the size of the
• mass in relation to the
• nasopharyngeal space

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Complications
Restless sleep, Night mare, ?????? Nocturnal
eneuresis ???? ???????

• 1- OSAS
• During Sleep
• During day time
• 2- Descending infection
• 3-? Adenoid Facies

Morning headache Impaired concentration Excessive
day-time sleepiness
Recurrent OM Pharyngitis, Laryngitis, bronchitis
Idiot look Pinched nostril Short upper
lip Prominent incisor High arched palate
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• ????? ???? ???????

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Treatment

• Adenoidectomy operation

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Acute tonillitisAcue inflammation of the
palatine tonsils

• Age Any age but common in children
• Etiology
• Beta hemolyic streptococci
• Streptococcus pneumonia
• Hemophylus influenza
• Mode of transmission
• droplet infection

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• Symptoms
• Rapid onset of
• - Fever, Headache, Anorrhexia, Malaise
• - Severe sore throat referred otagia
• - Halitosis

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• Signs
• General
• High Fever with flushed face
• Pharyngeal
• Acute follicular tonsillitis
• Acute membranous tonsillitis
• Acute parynchymatous tonsillitis
• Cervical
• Enlarged tender jugulo-digastric lymph nodes

The yellow spots may Coalease to form a Yellow
membrane
The crypts of the tonsils are full of purulent
exudate Giving yellow spots on the tonsils
Marked hyperemia and enlargement of the tonsils
Acute parynchymatous T
Acute follicular T.
Acute membranous T
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• Complications
• Local
• Peritonsillar abscess
• Parapharyngeal abscess
• Retropharyngeal abscess
• Systemic
• Rheumatic fever (carditis and arthritis)
• Acute glomerulonephritis

Quinzy
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Treatment

• Antibiotics 10 dayes
• Rest
• Ample fluid intake
• Cold compresses
• Analgesic Antipyretics
• Gargles

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Chronic TonsillitisChronic inflammation of the
palatine tonsils

• Etiology
• Repeated attacks of acute tonsillitis
• Symptoms one or more of the following
• History of repeated attacks of AT
• Irritation in the throat
• Foetor oris
• If hypertrophic?
• Difficult swallowing
• Obsrtuctive sleep apnea

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• Signs
• Pharyngeal
• Asymmetry of the size of the tonsils
• Hypertrophy of the tonsils
• The crypts ooze pus on pressure by tongue
  depressor
• Hyperaemia of the anterior pillars
• Cervical
• Persistent enlargement of jagulodigastric lymph
  nodes

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Treatment of Chronic Tonsillitis

• Surgical By
• Tonsillectomy operation