Pathology of tonsillitis

2021-01-31 12:00 AM

Feeling dry, burning, hot in the throat, especially the side of the throat where the tonsils are, a few hours later, it turns into a sore throat, aching pain in the ears, increasing pain when swallowing, coughing.


Intersections, airways have a protective lymphatic system including the Waldeyer ring and the cervical lymphatic system.

The Waldeyer ring includes:

Ammonia in the nasopharynx region (Amida Luschka).

Tapeworm (Amida Gerlach) is around the ear canal.

The female oral tonsils often called the tonsils for short, are almond-shaped on both sides of the throat wall, between the anterior and posterior pillars.

The laryngeal ammonia is located at the bottom of the net after the V tongue.

Ammonia was born and is a normal human organization. It develops in adulthood and slowly shrinks during puberty.

Acute tonsillitis

It is congestive inflammation and secretion of the female tonsils, commonly seen in children aged 3-4 years and older, caused by bacteria or viruses, often seen in the early stages of many inflammatory diseases, so some people consider the tonsils to be "entrance" of some bacteria or viruses such as acute arthritis, polio, epidemic encephalitis, meningitis ...


Bacteria: staphylococci, streptococci, spirochetes, anaerobic and anaerobic strains.

Viruses: flu, measles, whooping cough ...

Symptom identified


Start suddenly with a cold or chilling feeling and then have a fever of 380C-390C. Fatigue, headache, loss of appetite, little and dark urine. Defecation is usually an apple.


Feeling dry, burning, hot in the throat, especially the side of the throat where the tonsils are, a few hours later, it turns into a sore throat, aching pain in the ears, increasing pain when swallowing, coughing.

Often accompanied by VA inflammation, rhinitis or in children with tonsillitis wheezing, night snoring loudly, nasal voice.

Inflammation can spread down the larynx, trachea causing coughing bouts, pain and mucus, mild hoarse voice.


White tongue, dry mouth, red throat mucosa.

The tonsils are swollen and red, sometimes close together in the midline.

Sometimes the two tonsils are swollen red and white pus spots at the mouth of the cavities, gradually turning into a layer of pus covering the surface of the tonsils, not spreading to the pillars, not firmly attached to the tonsils, easy to clean without bleeding to reveal red and intact mucosa: it is a purulent form of tonsillitis caused by bacteria (streptococci, staph).

Lymphocytic organization in the posterior wall of the pharynx is large and red: it is erythematous tonsillitis usually caused by a virus.


Bacterial inflammation with leukocytes increased over 10,000, many neutrophils.

Diagnosis of acute tonsillitis from diphtheria


Acute tonsillitis










High fever, sudden onset

Fast, powerful circuit

Moderate fatigue, red face

Pus on the surface of the tonsils or purulent membranes, not beyond the tonsils

The soft latex membrane is fragile and does not adhere firmly to the tonsils

The cervical nodule usually does not swell except in severe cases

Very rarely Albumin in urine

No bacillus Klebs-Löffler was found

Fever, which starts slowly

The pulse is slow, weak

Visible fatigue, pale face

The hypothesis is not limited to the cavity and can extend beyond the tonsils

The fake is firm, sticky, difficult to peel off if peeled it will bleed easily

Hach's neck was swollen, even in common cases

Albumin is often present in urine

There are bacilli Klebs-Löffler

Chronic tonsillitis

Chronic tonsillitis is a frequent, inflammatory phenomenon. Depending on the severity of inflammation and the body's response, the tonsils may be (over productive) common in children or young people, or the tonsils may shrink (sink fibrosis). The rate of tonsillitis in our country: adults: 8-10%, children: 21%.

Advantageous factor

The weather changes suddenly (suddenly cold when it rains, high humidity ...).

Environmental pollution due to dust, gas, low living conditions and poor sanitation.

Poor resistance, allergic form.

There are inflammatory foci of infection in the throat and mouth: cavities, gingivitis, VA inflammation, sinusitis and due to the anatomical features of the tonsils with many fissures, niches, niches are the residence, hiding and developing. of bacteria.



Poor symptoms.

Sometimes there are no symptoms other than relapses or episodes of inflammation with symptoms similar to acute tonsillitis.

Sometimes the whole body was thin, pale, blue-skinned, cold-touched, dazed in the afternoon.


Often there is a feeling of swallowing in the throat.

Breathing is often bad despite regular oral hygiene.

Occasional coughing and hoarseness, children have wheezing, loud snoring.


On the surface of the tonsils, there are many slots and holes. These slots and sockets are filled with pea and often have white pus.

Overdeveloped form: the tonsils are as big as two almond seeds on either side of the throat wall and narrow the throat cavity, red anterior cylinder, common in children.

Classification of tonsils overgrowth

Excessive tonsillitis A1 (A +): large, round, compact-stalked tonsils. The width of the tonsils is less than or equal to 1/4 of the distance between the legs of the two front tonsils.

Excessive tonsillitis A2 (A ++): large, round, compact-stalked tonsils. The width of the tonsils is less than or equal to 1/3 of the distance between the legs of the two front tonsils.

Excessive tonsillitis A3 (A +++): Tonsillitis, round, compact stalk. The width of the tonsils is less than or equal to 1/2 of the distance between the legs of the two front tonsils.

Fibromyalgia: commonly seen in adults, small tonsils, rough face, punctures or white fibrosis manifesting multiple infections. Dark red, red front, thick posterior. The ammonia loses its normal softness, pressing against the tonsils can reveal pus in the cavities.


Chronic tonsillitis can be an inflammatory focus of other systemic diseases, but sometimes it is difficult and delicate to confirm it in specific cases. It has been proposed quite a few tests for definitive diagnosis:

Test Vigo-Schmidt: test white blood cell formula before testing. Use your finger to rub the surface of the tonsils for 5 minutes, retry the leukaemia formula. If the tonsils are inflamed, the white blood cell count increases. Leukocytes increase within 30 minutes, gradually decrease within 2 hours, then return to normal.

Lemée test: if the inflamed tonsils have caused complications, after rubbing on the surface of the tonsils there will be more pain in the joints, mild oedema or red blood cells in the urine.

Anti-streptolysin rate in blood: normal 200 units. Inflammation caused by streptococci will increase from 500-1000 units.


Inflammation around the tonsils.

Acute ear, nose, sinus, and bronchitis.

Inflammation of lymph nodes under the jaw or pharynx.


Rheumatoid arthritis.

Acute glomerulonephritis.



Treatment of acute tonsillitis.

Rest, snack, drink plenty of water.

Analgesic, antipyretic: Paracetamol ...

Antibiotics: in case of bacterial infection.

Small antiseptic nasal drops.

Gargle with warm alkaline solutions: Sodium Bicarbonate, Sodium Carbonate ... (a half teaspoon in a cup of warm water).

Supporting the body: trace elements, vitamins, calcium ...

Treatment of chronic tonsillitis: tonsillectomy is now very common. However, there should be strict indications. Only cut when the tonsils actually become a focal infection (focal infection) of the body.


Chronic inflammatory tonsils many times (usually 5-6 times a year).

Chronic inflammatory tonsils cause inflammatory complications, abscesses around the tonsils. 

Chronic inflammatory tonsils cause complications of rhinitis, sinusitis, otitis media, bronchitis, pneumonia, lymphadenitis under the jaw or throat side ...

Chronic inflammatory tonsils cause distal complications: endocarditis, glomerulonephritis, arthritis, prolonged digestive disorder, sepsis.

Excessive chronic inflammatory tonsils cause difficulty breathing (asphyxiation syndrome - Pickwick sleep syndrome), difficulty swallowing, voice is closed on something (difficult to speak).


Absolute contraindications:

Bleeding syndromes: haemophilia, blood clotting disorder.

Medical diseases such as high blood pressure, heart failure, decompensated renal failure ...

Relative contraindications:

When you have acute pharyngitis or have complications with tonsillitis.

In the presence of inflammation, acute infections such as rhinitis, sinusitis, pimples.

When there is inflammation, acute viral infections such as flu, measles, pertussis, polio, dengue fever ...

When there are complications due to tonsillitis such as acute nephritis, acute rheumatism ..., treatment must be stable, after the exacerbation, it must be removed.

When there are chronic unstable diseases such as diabetes, hepatitis, tuberculosis, syphilis, AIDS ...

Women who are menstruating, pregnant or breastfeeding.

The weather is too hot or too cold.

Children under 5 years old or adults over 30 years old.

Caution: in the case of previous hormonal drugs, or pain relievers, patients undergoing vaccination.

Surgical methods

Previously, surgery under local anaesthesia with methods: Sluder and Anse.

Today, it is mainly surgery under endotracheal anaesthesia by methods of Anse or directly with an electric knife.