Chronic tonsillitis : Chronic inflammation of tonsil.
Types:
1.Parenchymatous
2.Follicular
3.Fibrosed
Features :
1.Repeated attack of URTI
2.Repeated attack of sore throat
3.Discomfort in throat
4.Foul smelling breath
Hall marks of chronic tonsillitis :
1.Both tonsils are enlarged or fibrosed
2.Anterior pillers are injected.
3.On pressing the anterior pillers,inspissated pus may come out through crypts.
4.Both jugulo digastric lymph nodes are enlarged but non tender.
[number of crypts are 16-17 in number & largest one is crypta magna, lies in upper 1/3 of the tonsil.]
Investigation :
>No specific investigation is needed.
>Investigations are done to check fitness for G/A( Routine investigation:CBC,BT,CT,PT)
>If age is more than 40years_
1.X ray
2.ECG
3.RBS
Treatment :
Tonsillectomy following general anesthesia
Indication of tonsillectomy :
1.Sore throat due to repeated attack of acute tonsillitis occurring 5 times in a year
2.Peritonsilar abcess occuring once or more in lifetime.
3.Sore throat hampering daily activities
4.Unilateral enlargement of tonsil which is suspicious for malignancy
5.Bilateral enlargement of tonsils causing Obstructive sleep apnea
6.Careers of diphtheria,streptococcus not relieved by taking medications.
Contra indication:
1.Any acute condition or acute inflammation
2.Age of the pt.less than 3year
3.Hb conc.less than 10g/ dl
4.pt.with bleeding disorder or uncontrolled systemic disease
Position of patient:
Rose’s position, a sandbag is placed in between two shoulder blade to extend head & neck
Position of Surgeon :
Sitting or standing behind the head of the patient
Complications of tonsillectomy :
➤Hemorrhage –
1.primary ( during OT)
2.Reactionary (within 24hours of surgery)
3.Secondary( after 24 hour of surgery to healing)
➤Injury to the surrounding structures
Management of hemorrhage :
★Primary hemorrhage :
>Pressure & packing
>Ligate on pressure point
>Diathermy
★Reactionary hemorrhage :
>Assess hemodynamic status of the patient
>Iv fluid & ABCD resuscitation
>Remove blood clot using gauze
>If bleeding doesn’t stop pressure the fossa with gauze soaked in H2O2 for 10min & repeat 2-3 times
>If beeding still continues call a senior surgeon & further steps
★Secondary hemorrhage :
>Control the infection by taking broad spectrum antibiotic (Ciprofloxacin/ Ceftriaxone + Metronidazole+ Gentamicin)
Advice: Gurgling with diluted H2O2 solution.
Raiyyan Tahsan Date:26-02-2025 Wednesday Time:-1-24-45 Pm
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