It is the Chronic inflammation of tonsils. In my previous post, I have shown you the Anatomy and Physiology of tonsils. If you have not seen that yet, I am requesting you to visit Tonsils In children Causes, Features, Diagnosis, Treatment of Tonsillitis here. I discussed here the basic things about tonsils. In that post, I wrote about Acute Tonsillitis. Today in this post I am going to discuss Chronic tonsillitis, its sign-symptoms, diagnosis, investigations and treatment. the ultimate treatment of Chronic Tonsillitis is Tonsillectomy. I will also discuss the Methods of Tonsillectomy, Indications of Tonsillectomy, Contraindications, Complications after tonsillectomy, post-operative care, post Tonsillectomy pain management commonly known as “tonsillectomy pain“, how to control tonsillectomy bleeding, diet for tonsillectomy and at last some basic tips about tonsillectomy recovery tips etc.
Chronic Tonsillitis Two types:-
- Chronic Pareynchymatous tonsillitis
- Chronic Follicular or Fibrotic tonsillitis
Usually follows acute or subacute attacks of Tonsillitis when treatment is inadequate. It is common in children at the age of 4-15 years. Some times it may follow any of the exanthemas.
Clinical Features of Chronic Tonsillitis
- Persistent or recurrent sore throat more than 3 times a year.
- Persistent cervical adenitis.
- Irritating cough.
- Occasional rise of temp.
- Pain in the limb.
- Foul-smelling from mouth or Halitosis.
- Anorexia, gastric upset.
- Tonsils are enlarged or fibrosed.
- Anterior pillars are congested.
- Tonsillar lymph node or Jugulodigastric LN are enlarged, palpable, mobile & non tender.
- Inspissated pus may come out on from the tonsillar crypts after pressing the anterior pillars.
Investigations and Differential diagnosis are quite same as Acute Tonsillitis.
Treatment of Chronic Tonsillitis:
As I have said earlier Treatment is Surgery which is Tonsillectomy. Medical Conservative treatment is indicated when there is a contraindication to surgery, patient refuge to surgery, in an early stage. Special attention is given to improve the general health, nutritious diet and well-ventilated room for the patient.
Conservative treatment of Chronic Tonsillitis-
- Antibiotic: Low dose oral penicillin twice daily for a long time.
- Antiseptic mouth wash
- Removal of other septic foci.
Surgical treatment or Tonsillectomy Operation:
Tonsillectomy is the Commonest operation done by ENT surgeons worldwide. The first tonsillectomy was done by Celsus in 50 AD. Guillotine tonsillectomy was first described by McKenzie. Now there is a various method for tonsillectomy.
Indications of Tonsillectomy:
- Following an attack of peritonsillar abscess
- Repeated attack of acute tonsillitis at least 3-4 attacks in the past.
- Chr.Tonsillitis with acute exacerbation at least3-4 times in a year and bedridden with the interference of normal daily activity and fails medical treatment.
- Huge enlargement of the tonsils causing mechanical obstruction to food or airway.
- Ulcer in the tonsil suspicious to malignancy
- Unilateral enlargement of tonsil suspicious of malignancy
- Persistent carriers of the streptococcus or Diphtheria bacilli
- Persistent cervical adenitis where tonsil is the source of infection
- As a route of glossopharyngeal neurectomy or removal of the styloid process
- Benign tumour of the tonsil
- Recurrent attacks of acute Rheumatism if associated with tonsillitis.
- Attack of acute glomerulonephritis
- Chr.S.O.M. when tonsils are the source of infection.
- Recurrent cough, low general health, failure to gain weight.
- As a part of Uvulo palate pharyngoplasty.
Contra-Indications of Tonsillectomy:
- Acute tonsillitis or Upper respiratory tract infections
- Blood dyscrasia and haemorrhagic diathesis
- During the epidemic of polio.
- Uncontrolled Allergic rhinitis & Asthma
- Systemic infection
- Uncontrolled DM & HTN
- In early pregnancy
- Cleft palate.
Methods of Tonsillectomy:
- Dissection method
- Coblation Tonsillectomy: Better than LASER, Ultrasonic scalpel or Cryo with Minimum bleeding, Minimum heat generated at the operation site, Minimum post-operative pain. Now practising in most of the Hospitals.
- Ultrasonic Scalpel: Minimum bleeding and Moderate Post Operative Pain.
- LASER: Minimum bleeding but more tonsillectomy pain. Not routinely done now.
- Bipolar Diathermy.
Post Operative Management:
- Keep the patient in lateral position until full recovery from anaesthesia.
- Keep watching any bleeding from Nose or mouth.
- Record Pulse, Blood pressure, temperature, respiration and swallowing.
- IV Antibiotics and Analgesics are given to prevent infection and Reduce post-tonsillectomy pain. Sore throat is quite common and it can be reduced by drugs.
- Tonsillectomy Recovery Tips: Ice cream and cold Milk is given after 4-6 hours. Drink cold fluids. Get a good cool air humidifier, Chew sugarless gum. When the pain gets referred to the ears, and it often does, chewing gum can ease the ear pain. See here Janell’s Personal Experience about Tonsillectomy. She is a 30-year-old female. Her tonsillectomy took place in November 2011. The doctor used a cobalation method, and it was an out-patient procedure. Janell’s Top 10 Adult Tonsillectomy Recovery Tips & Top 5 Surprises (with Advice)
Complications After Tonsillectomy:
- Primary Haemorrhage
- Reactionary Haemorrhage:-It occurs within the first 24 hrs.
- Secondary Haemorrhage:- Bleeding from tonsillar fossae usually occurs 5-10 days after operation.
- Anaesthetic complications.
- Otitis media
- Oedema of the soft palate
- Cervical lymphadenitis
- Parapharyngeal abscess
- Pneumonia or lung abscess
- Flare-up distant infection
- Dental injuries
Among all the complications Haemorrhage is the most significant and furious.
After finishing this article you can view these for more information. I Have not copied anything rather something may be contradictory. The source of my information is our ENT book by Dr. Matin Sir, FRCS and Various weblinks given below:
http://tonsillectomyrecovery.com/- Everything about Tonsils
http://kidshealth.org- Tonsils and Tonsillitis
Your Tonsillectomy as Day Surgery-http://www.patient.co.uk