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Diseases of the pharynx (tonsillitis (Classification (localization:…
Diseases of the pharynx
- Waldeyer’s lymphatic ring: palatine tonsils, pharyngeal tonsil, lingual tonsil, tubal tonsils, lymph follicules and lateral lymphatic bands on the posterior wall of the pharynx
- Hipokrates
Acute inflammation of lymphatic tissue of the pharynx with inflammatory reaction of pharyngeal mucosa
tonsillitis
Classification
- localization: (palatine tonsils, pharyngeal tonsil, lingual tonsil, tubal tonsils, lymph follicles and lateral lymphatic bands on the posterior wall of the pharynx)
- dynamics (acute, chronic)
- etiology viral, bacterial, fungal, allergic
- local clinical picture:
catarrhal angina,
lacunar angina,
angina with superficial ulceration of the epithelium
angina with deep ulceration of the epithelium, accompanying to mononucleosis, Plaut-Vincent’s angina.
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Catharral angina
- Etiology: viruses
- Symptoms: gradual, cough, discharge from the nose, FEVER, decrease of temperature on the 3-rd day and improvement of local and general state
- Tretment: symptomatic
Lacunar angina
- Etiology: bacterial, most common streptococcal.
- Symptoms: sudden high fever, headache, chills, arthralgia, xerostomy, pain during swallowing (odynofagia), otalgia
- after 1-2 days coatings on the tonsills can be easily removed withoud bleeding, the inflammatory reaction occurs of the paratonsillar tissue and the trismus may follow
- in advanced form: enlarged, painfull submandibular and nuchal lymph nodes
- examination: red pharynx mucosa, enlarged, red palatine tonsills, white covered tongue, fetor ex ore (halitosis).
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Mononucleosis
- Etiology: EBV, young adults, mainly males.
- Symptoms: enlarged, painfull submandibular and cervical lymph nodes, enlargement of liver with spleen, leucocytosis, atypic lymphocytes (mononuclears)
- examination: enlargement of palatine tonsills, covered with white coating
- Angina not regressing after 3-4 days of treatment with antibiotics or rush after penicyline
- Differential diagnosis: quick agglutination tests (Monospot, Monotest) i Paul-Bunnell-Dawidson reaction (heterofile antibodies - second week of the disease)
- Treatment: staying in bed, NSAIDs, gargling i antiseptics NO antibiotic
Diphteria
- Etiology: C. diphteriae, droplet infection.
- Symptoms: temperature up to - 38°C, headache, vomiting, fatigue.
- examination: tonsills hyperaemia and enlarged, white or grey coating (false membranes), difficult removable with bleeding.
- antibiotic
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Chronic tonsillitis
- Etiology: reccurnet acute tonsillitis.
- Forms: I - tonsillar hypertrophy (young), II - atrophic small tonsills
- Symptoms: dysphagia, sensation of foreign body, sore throat intensed after cold drink or ice creams. Enlarged digastric lymph nodes and sometimes fetor ex ore and bad taste.
- ENT examination:
red of pharyngeal folds,
PAIN,
limited mobility,
enlarged, painfull lymph nodes.
- Caution!!! White or yellow follicles - physiological (tonsillar stones) - remainins of food in tonsillar crypt
- The only treatment of chronic tonsillitis is tonsillectomy.
Indications for tonsillectomy are:
I. local: chronic tonsillitis, recurrent pharyngitis, peritonsillar abscess,
tonsillar hypertophy impaired breaything and swallowing,
recurrent otitis media and sinusitis persistent after adenotomy and nose decongestion.
II. general: septicemia, pyemia, thrombosis and focal diseases from the tonsil.
- Indication for tonsillectomy are 3 or more epizodes of acute tonsillitis per year, more than 5 epizodes per 2 years and more than 7 epizodes per 3 years. Every epizode should be charecterized by some of these symptoms:
High fever over 38°C,
Enlargement of the neck lymph nodes (>2 cm),
White coating of the palatine tonsil,
Beta-haemolytic streptococcus group A in pharyngeal swab.
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