The Nasopharyngeal Tonsil

• It is a mass of sub-epithelial lymphoid tissue present at the junction between the roof & posterior wall of the nasopharynx

• The free surface has 6 folds• It has no capsule• It is covered by pseudo-

stratified columner epithelium

• It drains to the Retropharyngeal lymph nodes Upper Deep Cervical Lymph Nodes

The palatine tonsil has a capsuleon its lateral surface

which separate the lateral wall

from the bed The palatine tonsil

is covered by stratified columner epithelium

The palatine tonsil drains to The Jagulodigastric lymph nodes below the angle of the mandible

Adenoid

• Hypertrophy of the nasopharyngeal onsil sufficiently to produce symtoms

Definition Age Causes of enlargement

2 -12 years

• Physiological enlargement : at 3-7 years• Pathological: recurrent upper respiratory

tract infection

Symptoms

- Bilateral Nasal Obstruction

- Mouth Breathing- Snoring & OSA- Speech hyponasality- Difficult suckling

• Bilateral Nasal discharge- Mucoid or mucopurulent

discharge WHY? Due to blockage of the choanae

- Excoriation of the nasal vestibule & upper lip

- Post nasal discharge causing frequent nocturnal cough

Rhinolalia clausa(speech hyponasality)

الباء مثل الميم ينطق

تفرز األنف أن تعلم هلمن ونصف لتر الي لتر حوالييوميا المخاطي السائل

لألنف الخلفي االنسداد حالة في يحدث ماذمن للنزول تتحول الكمية هذه كل

لألنف االمامية الفتحة

Signs

• Posterior Rhinoscopy difficult• Digital palpation not pleasant • Endoscopic examination the best

Investigations

• Lateral soft tisue X ray of the nasopharynx

It is not the size of the

nasopharyngeal tonsil which is

important but the size of the

mass in relation to the

nasopharyngeal space

Complications

1- OSAS:- During Sleep:- During day time2- Descending infection3- ِ Adenoid Facies Morning headache

Impaired concentrationExcessive day-time sleepiness

Recurrent OMPharyngitis, Laryngitis, bronchitis

Restless sleep, Night mare, كوابيسNocturnal eneuresis

الارادي تبول

Idiot lookPinched nostrilShort upper lipProminent incisorHigh arched palate

وكل • وبيشخر فمه فاتح نايم الليل طول الطفلتاني وينام نفسه يأخد ويصحي يتوقف تنفسه شويه

قليل • وتركيزه نفسه علي نايم دايما وبالنهارالارادي • تبول وعنده

Treatment

Adenoidectomy operation

Acute tonillitisAcue inflammation of the palatine tonsils

Age: Any age but common in

children Etiology :- Beta hemolyic streptococci

- Streptococcus pneumonia

- Hemophylus influenza

Mode of transmissiondroplet infection

SymptomsRapid onset of - Fever, Headache, Anorrhexia, Malaise- Severe sore throat ± referred otagia- Halitosis

SignsGeneral :High Fever with flushed face

PharyngealAcute follicular tonsillitisAcute membranous tonsillitisAcute parynchymatous tonsillitis

CervicalEnlarged tender jugulo-digastric

lymph nodesThe crypts of the tonsils are full of purulent exudateGiving yellow spots on the tonsils

The yellow spots may Coalease to form a Yellow membrane

Marked hyperemia and enlargement of the tonsils

Acute follicular T. Acute membranous T Acute parynchymatous T

Complications

Local:- Peritonsillar abscess- Parapharyngeal abscess- Retropharyngeal abscess

Systemic- Rheumatic fever (carditis

and arthritis)- Acute glomerulonephritis

Quinzy

Treatment

Antibiotics: 10 dayes

Rest

Ample fluid intake

Cold compresses

Analgesic Antipyretics

Gargles

Chronic TonsillitisChronic inflammation of the palatine tonsils

Etiology :

Repeated attacks of acute tonsillitis

Symptoms: one or more of the following

- History of repeated attacks of AT- Irritation in the throat- Foetor oris

If hypertrophic- Difficult swallowing- Obsrtuctive sleep apnea

Signs:Pharyngeal - Asymmetry of the size of

the tonsils- Hypertrophy of the tonsils- The crypts ooze pus on

pressure by tongue depressor

- Hyperaemia of the anterior pillars

Cervical Persistent enlargement of

jagulodigastric lymph nodes

Treatment of Chronic Tonsillitis

Surgical By

Tonsillectomy operation