Specialized Pathology Part 1

4.1. Acute pharyngitis:

- Gargle with 9 ‰ salt water

- Throat aerosol: saline - essential oils - antibiotics - corticosteroids

- Cough relief: peppermint and licorice cough drops

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- Oral or injectable antibiotics: Ampicillin 0.5g x 4 tablets/day

Or injection: lincomicin 600mg x 2 tubes/day

Gentamicin 80mg x 2 tubes/day

- Fever reducer: paracetamol 0.5g x 2 tablets/day

4.2. Chronic pharyngitis:

- Gargle with 9 ‰ salt water

- Throat aerosol: antibiotics - corticosteroids

- Cough relief

- Throat: Glycerin borate 5%

Glycerin Iodine 1%

- Antibiotics used for prolonged fever

- Throat burning: silver nitrate , electric cote , nitrogen cryotherapy

liquid (196 o C)

Lesson 16

Tonsillitis, Tonsillitis

I. ADENOIDITIS

1. General

1.1. Anatomy overview

- VA ( Vegetation – Adenoides ) is a lymphoid tissue in the roof of the pharynx, belonging to the Waldeyer ring .

- Adenoids appear from childhood until the age of 7-8 and then atrophy on their own. In special cases, adults still have adenoids.

1.2. Definition

- Acute adenoiditis is an acute exudative or purulent infection of the lymphatic tissue in the roof of the nasopharynx.

- Chronic adenoiditis is adenoid tissue that is fibrotic and

hypertrophy due to repeated acute inflammation.

1.3. Causes

- Caused by bacteria: streptococcus, pneumococcus

- Due to viruses : flu, measles, whooping cough

- Endocrine disorders cause adenoids to overgrow.

2. Symptoms

2.1. Systemic symptoms:

Fever 39 – 39 o C, fatigue, poor sleep and appetite.

2.1.2. Functional symptoms

- Children: fussy, refuse to eat

- Older children: headache, tinnitus, hearing loss, burning sensation in the throat

- Stuffy nose, should often open mouth to breathe

- Speak with a nasal voice

2.1.2. Physical symptoms

- Nasal cavity full of mucus

- The pharyngeal mucosa is congested, with a layer of mucus flowing from the palate down.

- The eardrum loses its luster and becomes more sunken.

- Examination of the palate with a mirror or index finger reveals enlarged adenoids.

2.2. Chronic adenoiditis

2.2.1. Systemic symptoms

- Usually no fever, slow body development, thin , weak.

- Cold hands and feet, children often startle and panic at night, bedwetting

- Poorly developed intelligence

2.2.2. Functional symptoms

- Frequent stuffy nose so have to open mouth to breathe

- Green runny nose

- Speak with a nasal voice

- Cough, grind teeth

2.2.3. Physical symptoms:

- Nasal cavity full of mucus and pus

- The throat mucosa has a layer of mucus flowing from the upper throat down.

- There may be a perforated eardrum.

- Examine the arch with your finger or a mirror.

The dome shows hypertrophy or fibrosis of the adenoid tissue.

- Has VA face: Narrow and long face, narrow nasal cavity, lips

undersized, narrow and flat chest, slightly hunched back

3. Treatment

3.1. Use of medication

- Systemic antibiotics:

 Oral: ampicillin 0.5g x 2 tablets/day

 Or injection: Ampicillin 1g x 1 - 2 vials/day

- Acgyrol nasal drops (no more than 3 days)

- Throat aerosol: saline - essential oils - antibiotics - corticosteroids

- Fever reducer and pain reliever: paracetamol

3.2. Adenoidectomy:

Adenoidectomy from 1 year of age and older. After adenoidectomy, combine with medication as above.

II. TONSILLITIS

1. General

1.1. Anatomy overview

- Tonsils are palatine lymphoid tissue belonging to the Walayer ring . Normally the size of an almond is located between the anterior and posterior pillars.

- Function: produce lymphocytes to protect the body.

1.2. Definition:

Tonsillitis is acute or chronic inflammation of the palatine lymphoid tissue.

1.3. Cause:

- Caused by bacteria (commonly caused by streptococcus) or virus

- Favorable conditions:

- Anatomical structure of tonsils has many crevices and interstices.

habitat of bacteria

- Infection spreads from adjacent parts such as teeth,

mouth, nose, sinuses.

- Reduced resistance, weather changes.

2. Symptoms

2.1. Chronic tonsillitis

2.1.1. Systemic symptoms:

Feeling cold or shivering, then fever 38 – 39 o C, fatigue, headache, poor sleep and appetite

2.1.2. Functional symptoms:

- Dull pain on both sides of the throat, then sore throat, can spread to the ears, pain increases when swallowing, when coughing.

- Cough: usually coughs once, expectorates white, sticky phlegm

- Wheezing , loud snoring

2.1.3. Physical symptoms:

- Painful swelling of the lymph nodes in the angle of both jaws

- Red throat mucosa, swollen tonsils , red beyond the limit of two pillars, on the surface there are many small white dots, when pressing with a probe a little pus flows out.

2.1.4. Testing

Bacterial tonsillitis blood test has BC  , N  .

2.2. Chronic tonsillitis

2.2.1. Whole body and function:

- May or may not have fever

- Dull pain on both sides of the throat during relapses

- Coughing once, sometimes coughing up thick, sticky white phlegm

pus-like

- Wheezing and loud snoring are seen in the hypertrophic form.

2.2.2. Physical symptoms.

- Hypertrophy: Tonsils are swollen on both sides beyond the limit of the two pillars, on the surface there are many deep pus slots in the tonsil tissue .

- Submerged fibrous form: Tonsils are smaller than normal, rough surface, dark red , on the surface there are many white fibers sticking between tonsils and two pillars.

3. Treatment.

3.1. Conservative treatment

Conservative treatment of tonsillitis is the main treatment method.

- Gargle with 9 ‰ salt water daily.

- Throat aerosol: saline - essential oils - antibiotics - corticosteroids

- Oral or injectable antibiotics: lincomycin , gentamycin

- Fever reducer and pain reliever: paracetamol

- Cough suppressant: peppermint, licorice

3.2. Surgery