Diseases Of The Nose Throat And Ear

122 THE PHARYNX AND NASOPHARYNX

anorexia and the development of changes in temperament, such as tantrums
or bouts of crying for little reason. There is a lack of the usual vigour.

CLINICAL FEATURES. Examination of the throat may reveal these white
particles at the mouths of the crypts from which they may be easily removed,
in contradistinction to those of keratosis pharyngis (p. 108). There is flushing
of the margins of the palatoglossal arches, and the cervical glands are
palpable. Pressure on the anterior pillars may squeeze fluid pus from the
crypts.

TREATMENT. The treatment is removal of the tonsils. Should there be
contra-indications to surgery, such as haemophilia, severe diabetes, acute
pulmonary tuberculosis, gross hypertension, advanced age, etc. conservative
therapy with long-term antibiotics may be ordered, and the throat may be
painted regularly with MandPs paint or a paint containing resorcin 0-3 g in
28-5 ml glycerine, or astringent gargles of hydrogen peroxide or ferric chloride
may be prescribed.

TUBERCULOSIS OF THE TONSIL

Tuberculosis of the tonsil is now extremely rare in countries where the milk
supply is controlled, and it presents no characteristic features. Attention is
drawn to the tonsils by the diagnosis of tuberculous cervical glands. The
tubercle bacilli in infected milk are presumed to reach the glands via the
tonsils, which may or may not remain infected. There is no means of diagnos-
ing this by clinical inspection, and the condition is discovered by histological
examination after tonsillectomy. This is the more unfortunate because half of
the tonsils so sectioned do not show evidence of tuberculosis. It is, however,
sound surgical practice to remove the tonsils from children who have a
tuberculous cervical adenitis rather than to leave potentially infected tonsils
in situ. Full antituberculous therapy should be started when the diagnosis is
made in the glands.

CALCULUS OF THE TONSIL

A calculus, or tonsillolith, may originate in the upper pole of the tonsil from
calcification of cheesy food debris, and it may attain considerable size. It may
be seen on the surface or detected with a probe. Sometimes the calculus is
extruded spontaneously, or it may be removed with a probe. In many instances
the tonsil must be removed, and this would be recommended if it were deemed
septic.

BONE AND CARTILAGE IN THE TONSIL

Small islands of cartilage have occasionally been demonstrated in tonsils at
microscopic examination, and they are thought to represent the remains of the
first and second branchial arches.

Enlarged styloidprocess is occasionally found in the tonsil and, although it
usually causes no symptoms, it may give rise to pain radiating to the ear,
The bony spine may be palpated with the finger or it may be demonstrated
radiologically. It may be removed surgically with relief.