Abses Peritonsilar and

Hipertropi Adenoid

Tharisa Kurnia
712017021

1
BAB I
BACKGROUND
 Tonsils and adenoids  lymphoid tissues in the pharynx or throat region

Both have existed since the child was born and began to function as part of
the body's immune system after immunity from the mother began to disappear
from the child's body. At that time the tonsils and adenoids are the main organ
of immunity in children, because other lymphoid tissues in the entire body have
not worked optimally.
 Adenoid hypertrophy Peritonsillary abscess

Peritonsillary abscess is the most common

infectious disease in the head and neck.
If there are infections of the upper
Peritonsillary abscess can happen in 10-60
airways  become adenoid hypertrophy
years, but most often at the age of 20-40
 blockage of the koana and Eustachian
years. In children it is rare except in those
tube
who have a decreased immune system
BAB II
THEORY
Peritonsillar abscess
 “
“ Peritonsillar abscess is an accumulation of pus which is localized in the
peritonsillar tissue formed

ETIOLOGY

Aerob Bacteria An-aerob Bacteria

Streptococcus pyogenes (Group A Beta- Fusobacterium. Prevotella, Porphyromonas,

hemolitik streptoccus), Staphylococcus aureus, Fusobacterium,dan Peptostreptococcus spp.
and Haemophilus influenzae
 Can happen in 10-60 years old
Most often  at the age of 20-40 years.

Epidemiology

Rare in children except imunodeficienccy But More significant obstruction in children

This infection has the same proportion between men and women
 Pathophysiology
The pathophysiology of PTA is not fully known.
However, the most accepted theory is progression
episodes first exudative tonsillitis becomes
peritonsillitis and then occur actual abscess
formation (frank abscess formation).
Infiltration stadium swelling the surface and
hyperemic. When the process continues, the
area is softer and yellowish
Tonsil push to middle, front, and below, 
inflammation of surrounding tissue  iritation
of m.pterigoid interna  become trismus.
 Abses can rupture spontaneously 
aspiration can occur to the lungs.
“
• Hypersaliva
• Dinophagia (pain swallowing)
• Muttering voice (hot potato
• usually on the same side ear
voice)
pain (otalgia)
• Difficult to open the mouth (
• there may be vomiting (
trismus)
regurgitation)
• Swelling of the submandibula
• halitosis (foetor ex ore)
r gland with tenderness
“ Complete blood count (electrolytes and blood culture)

Monospot test (heterophile antibodies)

“Throat culture” or “throat swab and culture

Plain radiographs

Computerized tomography (CT scan):

Ultrasonography
 Treatment
Infiltration stadium  antibiotic and
symptomatic drugs
Gargle mouth with warm water and
cold compresses on the neck.
Antibiotic  penisilin 600.000-1.200.000
unit or ampisilin/amoksisilin 3-4 x 250-500 mg
or sefalosporin 3-4 x 250-500 mg, metronidazol
3-4 x 250-500 mg2.
If there is abses  puncture in the area of
the abscess Insicion
Tonsilektomi
 Complications

1. Abscesses spontaneously rupture, can result in bleeding, pulmonary

aspiration or pyemia
2. Circulation of infections and abscesses to the parafaring area,
resulting in parafaring abscesses. On subsequent propagation, it
enters the mediastinum, resulting in mediastinitis.
3. If there is spread to the intracranial area, it can result in cavernous
sinus thrombus, meningitis and brain abscess
 Prognosis

1. Almost always recurs if not followed by tonsillectomy.

2. Peritonsillary abscess  rarely causes death unless complications
spontaneous rupture of the abscess and causing aspiration to the
lungs.
Adenoid Hypertrophy
 “ Adenoid  a mass consisting of lymphoid tissue on the posterior nasopharyngeal in
the Waldeyer ring.

Physiologically in children, adenoids and tonsils If there is frequent infection of the upper
experience hypertrophy. This adenoid enlarges in airway, adenoid hypertrophy can occur which
children age 3 years and then shrinks and will result in blockages in the koana and
disappears altogether at the age of 14 years. Eustachian tube.
Etiologi

The physiological adenoid  hypertrophy during its peak period

of 3-7 years

Adenoid hypertrophy  experience chronic or recurrent infections

of the upper respiratory tract or ARI
 The prevalence of adenoid hypertrophy can be estimated by the amount of adenoidectomy
performed

Epidemiology

Data from Dr. General Hospital Sardjito found that the number of cases for 5 years (1999-2003) show
ed a tendency to decrease the number of tonsilloadenoidectomy operations. And 275 cases in 2000
and continued to decline to 152 cases in 2003.
 Patofisiology
In toddlers the lymphoid tissue in the Waldey
er ring is very small.
In 4-year-old children getting bigger because
of immune activity, because the tonsils and
adenoids (pharyngeal tonsils) are the first
lymphoid organs in the body that phagocytes
pathogenic germs.
Adenoid tissue will physiologically shrink with
age
The main cause of adenoid tissue hypertrophy
is recurrent upper airway infection. Infection of
bacteria that produce beta-lactamase, such as
Streptococcus Beta Hemolytic Group A (SBHGA),
Staphylococcus aureus, Moraxella catarrhalis,
Streptococcus pneumonia and Haemophilus
influenzae, when it comes to adenoid tissue it
causes inflammation and hypertrophy.
Chronic obstructions in the upper respiratory tract will result in mouth
breathing and the development of adenoid facial syndrome

Adenoids can also cause obstruction of the nasal airway, which affects sound.

Enlargement of adenoids can cause obstruction of the Eustachian tube

which eventually becomes conductive deafness due to fluid in the middle
ear
 “
“
Obstruction of Nasi

Adenoid enlargement can partially clog or total nasal respiration resulting

in snoring, hyponasal conversation, and allowing the child to continue
breathing through the mouth.
“ Sleep Apnea

Sleep apnea in children in the form of episodes of sleep apnea and

daytime hypersomnolence.
“ Facies Adenoid

Open mouth, promising upper teeth and short upper lip.

The nose is small, the maxilla is not developed / hypoplastic, the upper
alveolar angle is narrower, and the palate arch is higher.
 “
“
Clinical signs and symptoms

• If adenoid hypertrophy persists, an adenoid face will appear

• Because breathing through the nose is disrupted by adenoid obstruction
in koana, hearing loss occurs and sufferers often runny.
 “Anterior rhinoscopy

Anterior rhinoscopy examination by seeing the retention of the mole

palate velum movement at phonation time

Posterior rhinoscopy (in children it is usually difficultt)

Nasoendoskopi

can help to see the size of the adenoid directly.

Rontgen

The nasopharyngeal adenoid ratio is obtained by dividing the size of the adenoid by
the size of the nasopharyngeal space, which is the AN = A / N ratio.

Ratio adenoid – nasopharing 0 – 0,52 : no enlargement

Ratio adenoid – nasopharing 0,52 – 0,72 : Moderate enlargement- non obstruction
Ratio adenoid – nasopharing > 0,72 : Enlargement with obstruction
 “ CT scan

Modality is more sensitive than plain photographs for identification of soft

tissue pathology, but its disadvantages are due to the high cost.

Endoskopi
 Treatment

Adenoidektomi

INDICATION
• Blockage: nasal obstruction which causes breathing through the mouth, sleep apnea, swallowing
disorders, speech disorders, facial facial and dental deformities (adenoid face).
• Infection: recurrent / chronic adenoiditis, recurrent / chronic otitis media, recurrent acute otitis
media.
• Suspicion of benign / malignant neoplasms
 Prognosis

Adenotonsillectomy is a curative action in most individuals.

If the patient is handled well, it is hoped that he can
recover completely
Terima
End
Kasih