Chronic Tonsillitis: Causes, Types, Signs, Treatment, Complications

Aetiology:

1. It may be a complication of acute tonsillitis.
Pathologically, microabscesses walled off by fibrous
tissue have been seen in the lymphoid follicles of
the tonsils.
2. Subclinical infections of tonsils without an acute
attack.
3. Mostly affects children and young adults. Rarely
occurs after 50 years.
4. Chronic infection in sinuses or teeth m.ay be a predisposing
factor.

Types

Chronic follicular tonsillitis. Here tonsillar crypts a re full of
infected cheesy material which shows on the surface as yellowish
spots.
Chronic parenchymatous tonsillitis . There is hyperplasia
of lymphoid tissue Tonsils a re very much enlarged and
may interfere with speech , deglutition and respiration.
Attacks of sleep apnoea may occur. Longstanding
cases develop features of cor pulmonale.
Chronic fibroid tonsillitis. Tonsils are small but infected,
with history of repeated sore throats.
Clinical Features
1. Recurrent attacks of sore throat or acute tonsillitis.
2. Chronic irritation in throat with cough.
3. Bad taste in mouth and foul breath (halitosis) due to
pus in crypts.
4 Thick speech, difficulty in swallowing and choking
spells at night (when tonsils are large and
obstructive) .
Examination
1. Tonsils may show varying degree of enlargement.
Sometimes they meet in the midline (chronic
parenchymatous type).
2. There may be yellowish beads of pus on the medial
surface of tonsil (chronic follicular type).
3. Tonsils are small but pressure on the anterior pillar
expresses frank pus or cheesy material (chronic fibroid
type) .
4. Flushing of anterior pillars compared to the rest of
the pharyngeal mucosa is an important sign of
chronic tonsillar infection .
5. Enlargement of Jugulodigastric lymph nodes is a reliable
sign of chronic tonsillitis. During acute attacks,
the nodes enlarge further and become tender.
Treatment
1. Conservative treatment consists of attention to general
health, diet, treatment of co-existent infection
of teeth, nose and sinuses.
2. Tonsillectomy is indicated when tonsils interfere
with speech, deglutition and respiration or cause
recurrent attacks.
Complications:
1. Peritonsillar abscess.
2. Parapharyngeal abscess.
3. Intra tonsillar abscess.
4 Tonsilloliths.
5. Tonsillar cyst.
6. Focus of infection in rheumatic fever, acute
glomerulonephritis, eye and skin disorders.