Tonsils और Adenoids की Anatomy

Tonsils (Palatine Tonsils)

Location: Throat के दोनों sides पर, soft palate के पीछे

Size Changes with Age:

• Birth के समय छोटे
• 2-6 years में rapidly enlarge
• Maximum size around 7 years
• Adolescence के बाद gradually shrink
• Adults में usually small

Function:

• Antibody production (IgA mainly)
• First line defense against pathogens
• “Sample” bacteria/viruses को identify करना
• Immune memory develop करना

Tonsillar Grading (Brodsky Scale)

• Grade 0: Surgically removed
• Grade 1: Hidden within pillars
• Grade 2: Extend to pillars (25% airway)
• Grade 3: Beyond pillars (50-75% airway)
• Grade 4: Meet in midline (>75% airway – “kissing tonsils”)

Adenoids

Location: Nasopharynx में, nasal passages के पीछे (बाहर से visible नहीं)

Characteristics:

• Birth के समय present
• 3-7 years में maximum size
• Puberty के बाद atrophy
• Adults में usually absent या very small

Tonsillitis के प्रकार

1. Acute Tonsillitis

अचानक onset का throat infection जो 1-2 weeks तक रहता है।

Causes:

Viral (75-90%):

• Adenovirus (most common)
• Rhinovirus (common cold)
• Influenza virus
• Epstein-Barr virus (mono)

Bacterial (10-25%):

• Group A Streptococcus – most important
• Peak age: 5-15 years
• More severe symptoms
• Complications possible if untreated

Symptoms:

• Severe Sore Throat: खासकर निगलते समय
• High Fever: Often 39-40°C
• Odynophagia: Painful swallowing
• Referred Ear Pain
• Malaise, Fatigue
• Bad Breath (Halitosis)

Examination Findings:

• Red, swollen tonsils
• White/yellow patches (exudate)
• Tender, enlarged neck lymph nodes

Centor Criteria (Strep Likelihood)

Each = 1 point:

1. Tonsillar exudate
2. Tender anterior cervical nodes
3. Fever > 38°C
4. Absence of cough

• Score 0-1: Low risk (2-5% bacterial)
• Score 2-3: Moderate (10-17%)
• Score 4: High risk (43-63%)

2. Recurrent Acute Tonsillitis

Definition: 7+ episodes in 1 year, OR 5+ per year for 2 years, OR 3+ per year for 3 years

Causes:

• Biofilm formation in tonsillar crypts
• Bacterial persistence despite treatment
• Reinfection
• Immune deficiency
• Environmental factors

Impact:

• Frequent school/work absences
• Multiple antibiotic courses
• Chronic discomfort
• Sleep disturbance
• Dietary issues

3. Chronic Tonsillitis

Persistent low-grade infection और inflammation।

Features:

• Persistent sore throat (mild-moderate)
• Chronic bad breath
• Foreign body sensation in throat
• Tonsillar debris/stones (tonsilloliths)
• Enlarged, fibrotic tonsils

Tonsilloliths (Tonsil Stones)

• Calcified debris in tonsillar crypts
• Composed of: Food particles, dead cells, bacteria, calcium
• Cause bad breath, discomfort
• Visible as white/yellow spots

4. Peritonsillar Abscess (Quinsy)

Acute tonsillitis की serious complication।

Clinical Presentation:

• Severe Unilateral Pain: Often worse than tonsillitis
• Trismus: Difficulty opening mouth
• “Hot Potato” Voice: Muffled speech
• Drooling: Cannot swallow saliva
• High Fever
• Uvula Deviation: Pushed to opposite side

Treatment:

• Needle aspiration – immediate relief
• Incision and drainage if needed
• IV antibiotics
• Pain management
• Interval tonsillectomy recommended (4-6 weeks later)

5. Adenoid Hypertrophy

बच्चों में common problem।

Symptoms:

• Nasal Obstruction: Bilateral, chronic
• Mouth Breathing: Day and night
• Snoring
• Hyponasal Speech: “बंद नाक” की आवाज़
• Recurrent Rhinosinusitis
• Otitis Media: Ear infections
• Adenoid Facies: Facial changes से long-term mouth breathing
  • Long, narrow face
  • High-arched palate
  • Dental malocclusion

6. Obstructive Sleep Apnea (OSA) in Children

Adenotonsillar hypertrophy बच्चों में OSA का most common cause।

Signs and Symptoms:

• Loud Snoring: Every night
• Witnessed Apneas: Parents देखते हैं breathing stops
• Restless Sleep
• Nocturnal Enuresis: Bedwetting
• Morning Headaches
• Daytime Symptoms:
  • Excessive sleepiness
  • Behavioral problems (ADHD-like)
  • Poor school performance
  • Growth problems

Untreated Complications:

• Neurocognitive impairment
• Behavioral issues
• Growth retardation
• Cardiovascular problems

Prime ENT Center में Diagnosis

1. Clinical History

• Frequency: कितनी बार throat infections?
• Severity: Fever, absences from school/work?
• Duration: कितने समय से?
• Sleep history: Snoring, apneas?
• Daytime symptoms: Mouth breathing, fatigue?
• Ear symptoms: Recurrent infections?

2. Physical Examination

• Tonsillar Size: Grading 0-4
• Appearance:
  • Acute: Red, swollen, exudate
  • Chronic: Scarred, cryptic, stones
• Lymph Nodes: Cervical examination
• Nasal Endoscopy: Adenoid size assessment

3. Investigations

• Throat Swab Culture: Identify organism, antibiotic sensitivity
• Rapid Strep Test: Quick detection (10-15 minutes)
• Complete Blood Count: Viral vs bacterial differentiation
• Lateral Neck X-ray: Adenoid size
• Sleep Study: For suspected OSA

Treatment at Prime ENT Center

Medical Management

Acute Viral Tonsillitis:

• Rest and adequate fluids
• Soft diet
• Pain management
• Warm salt water gargles
• Usually resolves in 7-10 days

Acute Bacterial Tonsillitis:

• Antibiotics as prescribed by doctor
• Complete full course even if better
• Supportive care

Surgical Management – Tonsillectomy

Indications (Paradise Criteria)

Absolute Indications:

• Recurrent tonsillitis meeting 7/5/3 rule
• Peritonsillar abscess (after acute treatment)
• Obstructive sleep apnea due to tonsils
• Suspected malignancy

Relative Indications:

• Chronic tonsillitis with halitosis, stones
• Severe dysphagia causing weight loss
• Recurrent febrile seizures

Surgical Techniques at Prime ENT Center

1. Cold Steel Dissection (Traditional):

• Classic method
• Tonsils sharply dissected
• Time-tested

2. Coblation Tonsillectomy (Advanced):

• Radiofrequency energy at low temperature (40-70°C)
• Advantages:
  • Less thermal damage
  • Reduced post-op pain
  • Less bleeding
  • Faster recovery
  • Return to normal diet sooner
• Available at Prime ENT Center

3. Harmonic Scalpel:

• Ultrasonic device
• Cutting and coagulation simultaneously
• Minimal thermal spread

Pre-operative Preparation

• Complete blood count, bleeding profile
• Chest X-ray, ECG (as per age)
• Anesthetic fitness
• No active infection for 2-3 weeks
• Detailed counseling

Day of Surgery

• Morning admission, fasting from midnight
• General anesthesia
• Duration: 30-45 minutes
• Recovery room observation
• Same-day या overnight stay

Post-operative Care – Week by Week

First 24 Hours:

• Monitor for bleeding
• Ice chips/popsicles
• Pain management
• Encourage fluids

First Week:

• Rest at home
• Soft, Cool Diet:
  • ✓ Recommended: Ice cream, kheer, dahi, soups, mashed potatoes
  • ✗ Avoid: Spicy, hot, acidic, rough foods
• Regular pain medication
• Gentle salt water gargles (after 24 hours)
• White membrane on throat – normal healing process
• Avoid strenuous activities

Second Week:

• Gradual return to normal diet
• Resume school/work if comfortable
• Still avoid heavy exercise

Follow-up:

• Check-up at 1 week
• Complete healing by 3 weeks
• Full activity resumption

Possible Complications (Rare)

• Primary Hemorrhage: Within 24 hours (<1%)
• Secondary Hemorrhage: 5-10 days post-op (2-3%)
  • When slough separates
  • Requires immediate medical attention
• Infection: Rare with antibiotics
• Dehydration: If inadequate intake

Adenoidectomy

Indications:

• Adenoid hypertrophy with nasal obstruction
• Recurrent/chronic rhinosinusitis
• Persistent otitis media with effusion
• Obstructive sleep apnea
• Adenoid facies development

Procedure:

• General anesthesia
• Curettage या suction diathermy
• Can be combined with tonsillectomy
• Duration: 15-20 minutes

Recovery:

• Usually easier than tonsillectomy
• Less pain
• Faster return to activity
• Same-day discharge common

Expected Outcomes After Surgery

• Dramatic reduction in throat infections
• Improved sleep quality
• Better daytime alertness and behavior
• Normal breathing pattern
• Improved appetite and growth (children)
• Resolution of OSA in most cases
• Improved quality of life

Special Considerations for Children

Age Considerations

• <3 years: Surgery usually avoided unless severe OSA
• 3-7 years: Most common age for surgery
• >7 years: Adenoids often regressing naturally

Parental Counseling at Prime ENT Center

डॉ. हर्षिता सिंह और डॉ. प्रतीक पोरवाल parents को comprehensive counseling:

• Realistic expectations
• Procedure details in simple language
• Post-op care at home
• Warning signs to watch for
• 24/7 emergency contact

School and Activities

• Usually 1 week school leave
• No swimming for 2 weeks
• No sports/PE for 2 weeks
• Gradual return to full activity by 3 weeks

Why Choose Prime ENT Center?

• Experienced Surgeons: डॉ. हर्षिता सिंह (12+ years), डॉ. प्रतीक पोरवाल (15+ years)
• Advanced Techniques: Coblation tonsillectomy available
• Child-Friendly Approach: Specialized pediatric care
• Modern Equipment: Latest endoscopy and surgical instruments
• Comprehensive Care: Pre-op evaluation to post-op follow-up
• Accessible Location: Hardoi with patients from 60km radius
• Emergency Support: 24/7 availability for complications