Tonsils Important Question And Answers

Tonsils

Question.1. Write short note on peritonsillar abscess.

Answer. Peritonsillar abscess is also called as “Quinsy”.

Collection of pus in peritonsillar space, i.e. between capsule of tonsil and the superior constrictor muscle is known as peritonsillar abscess or quinsy.

Peritonsillar abscess Etiology

• As a sequelae of acute tonsillitis.
• De novo.

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Peritonsillar abscess Causative organisms

• Streptococcus pyogenes
• Staphylococcus aureus
• Anaerobic organisms

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Peritonsillar abscess Mechanism

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Peritonsillar abscess Clinical Features

Peritonsillar abscess General Features

• Presence of high-grade fever with chills and rigors.
• Malaise and bodyache and headache
• Nausea and constipation.

Peritonsillar abscess local Features

• Severe unilateral throat pain
• Odynophagia leading to dehydration
• Hot potato speech
• Foul breath
• Poor orodental hygiene
• Ipsilateral earache
• Trismus.

Peritonsillar abscess Examination

• Tonsils, pillars, soft palate: Congestion the involved side.
• Uvula: Swollen and pushed to the opposite side.
• Region of soft palate and anterior pillar above the tonsil appears bulged.
• Mucopus covering the tonsil.
• Cervical lymph nodes enlarged, tender.
• Torticollis: Head tilted to the involved side.

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Peritonsillar abscess Treatment

Conservative treatment

• Hospitalization is done and IV flids should be given.
• IV antibiotics for aerobic and anaerobic organisms should be given
• Analgesics are started
• Oral hygiene: Hydrogen peroxide and warm saline mouth gargles are started.

Surgical treatment

1. Incision and drainage:

• If no response to conservative management and frank pus is present, incision and drainage is done.
• Incision site: Point of maximum bulge above the upper pole of tonsil, just lateral to the meeting point of lines drawn at the base of uvula and along the anterior pillar.
  Once the incision is made, sinus forceps is inserted into the incision to open up the abscess.

2. Interval tonsillectomy:

• Interval tonsillectomy is done 4 to 6 weeks following quinsy.
• Abscess or hot tonsillectomy done in the presence of the abscess has the following disadvantages:

• Risk of rupture during anesthesia
• Increased bleeding.

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Peritonsillar abscess Complications

• Parapharyngeal abscess
• Laryngeal edema
• Septicemia
• Pneumonitis/lung abscess
• Endocarditis
• Nephritis
• Brain abscess
• Jugular vein thrombosis.

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Question.2. Write short answer on Singer’s nodule.

Answer. Vocal nodules are firous thickenings of vocal folds at the junction of middle and anterior third and are the result of vocal abuse.

They are known as Singer’s nodule in adults and screamer’s nodule in children.

In these speech therapy is the preferred treatment.

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Some of the lesions will resolve spontaneously in most of the cases.

Occasionally nodules will need to be surgically removed using modern micro laryngoscopic dissection or laser techniques, but speech therapy will be required for post-operative voice rehabilitation.