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ADENO-TONSILITIS
Dr. Tolkha Amaruddin, M.Kes., SpTHT Dr. Tolkha Amaruddin, M.Kes., SpTHT
RSUD SARAS HUSADA
PURWOREJO 2008
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ADENOID

A triangular shape mass of lymphoid tissue
located on the posterior aspect of the box like
nasopharynx (Bailey, 1998)
TONSIL

A paired, in general ovoid shaped masses
located on the lateral walls of the oropharynx.
(Bailey, 1998)
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Vascularisation - innervation the
adenoids:
The pharyngeal branches of the external
carotid artery.
Sensory the glossopharyngeal &
vagus nerves.
Referred pain from the adenoids (as
well as the tonsils) in both the ears
and throat.
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Vascularisation and innervation
The tonsils :
ascending pharyngeal
ascending palatine
lingual & facial arteries

The lymphatic drainage superior deep
cervical & jugular lymph nodes
inflammatory cervical adenitis/abscess in
children.
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Diagram skematis tonsil palatine & komposisi sel
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Distribusi kelas-kelas sel T (CD 3+), sel B ( CD 20+),
sel T helper (CD4+) dan sel T sitotoksik (CD 8+).
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Bacteria
Aerobic :
Group A beta hemolytic streptococcus, H.
influenza, S. pneumonia, Moraxella
cattaralis, S. aureus, H. parainflueza,
Neiseria sp, Mycobacteria sp

Anaerobic :
Bacteriodes sp, Peptococcus sp,
Peptostreptococcus sp, Actinomycosis sp.


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Virus : Epstein Barr, Adenovirus, Influenza A
and B, Herpes simplex,parainfluenza


Others : Mycobacterium (atypical
nontuberculous)

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PATOGENESIS OF ADENOTONSILAR DISEASE
Anatomic location organs of imunity
processing infection material a
focus of infection / inflamation loss
integrity of the crypt epithelium
chronic cryptitis & crypt obstruction
stasis of crypt debris & persistence
antigen
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CLINICAL CLASSIFICATION OF THE ADENOIDS &
TONSILS
Adenoids :
Acute adenoiditis
Recurrent acute adenoiditis
Chronic adenoiditis

Tonsils
Acute tonsillitis
Recurrent tonsillitis
Chronic tonsillitis

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CLINICAL FEATURES ADENOID
Symptoms & signs due to hypertrophy :
1. Nasal obstruction
2. Mouth breathing
3. Difficulty in eating
4. Noisy breathing snoring toneless voice
5. Adenoid facies
Eustachian obstruction:
1. Deafness
2. The presence of fluid in the middle ear

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Symptom & sign due to inflamation
1.Nasal discharge
2.Postnasal drip
3.Cough
4.Otitis media
5.Rhinitis & sinusitis
6.Cervical adenitis
Generalized disturbances
Mental dullness, apathy, poor breathing, bad posture,
deafness, nocturnal enuresis

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DIAGNOSIS ADENOID (Gray, 1992):

1. Rhinos copy posterior
2. The lateral soft tissue view
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Differential diagnosis adenoid
1. Other causes of nasal obstruction
Vasomotor rhinitis, foreign bodies, hypertropied
posterior ends of inferior turbinates, deflected nasal
septum, congenital choanal atresia

2. Orthodontic abnormalities
High arch palates, wedge shaped faces, narrow
upper jaws, crowded teeth.

3. Thornwaldts disease in which there is cystic
persistence of the median furrow of the
nasopharyngeal tonsil
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TREATMENT ADENOID
Conservative
The symptom are not marked:
Non irritan decongestants nasal drop, fresh
air, sensible diet, breathing and postural
exercise.
Surgical (Adenoidectomy)
Nasal obstruction
Deafness
Chronic otorhhoea
Recurrent otitis media
Sinusitis
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INDICATION FOR ADENOIDECTOMY
Obstruction:
chronic nasal obstruction
obligate mouth breathing
Sleep apnea and/or sleep disturbances.

Infection
Adenoid hyperplasis with Recurrent /chronic
adenoiditis
Recurrent/chronic otitis media with effusion
Chronic otitis media

Neoplasia
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CHRONIC TONSILLITIS

1. Chronic parenchymatous tonsillitis
2. Chronic follicular tonsillitis
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CHRONIC PARENCHYMATOUS
TONSILLITIS (Gray, 1992)
More common in children (between 4 and
15 years)
A chronic inflammatory hypertrophy
Associated with enlargement of the
nasopharengeal tonsil
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CLINICAL FEATURE

1. Persistent or recurrent sore throats
2. Persistent cervical adenitis
3. Marked tonsillar enlargement
4. Injected anterior faucial pillars
5. Irritation cough


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TREATMENT :
1. Conservative
Attention to general health and diet
2. Tonsillectomy
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CHRONIC FOLLICULAR TONSILLITIS
Most commonly in adults
Follow repeated attacks of acute follicular tonsillitis

Clinical feature :
1. Chronic irritation or repeated sore throat
2. Cervical adenitis
3. Cough
4. Bad taste and halitosis

Treatment : 1. Conservative
2. Tonsillectomy

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I. Seven or more episodes of tonsillitis in one
year
II. Five or more episodes of tonsillitis each year
over a period of two years
III. Three or more episodes of tonsillitis a year for
a period of three years
IV. Tonsillitis that recurs despite treatment with
antibiotics
V. Airway or swallowing obstruction due swollen
tonsils
Patient may be candidate for tonsillectomy
if patient meets one of the following criteria:

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