Evaluation of Normative Tonsils Size in Sudanese Children by Using Ultrasound

ABSTRACT 

Defining the normal value of the palatine tonsil size among the young Sudanese population is essential for a reliable evaluation of children with enlargement or signs and symptoms of tonsil disease. An ultrasound measurement was therefore undertaken to determine the normal range of the tonsil diameter among Sudanese children. The purpose of this study was to investigate a large ultrasound imaging study to evaluate the normal size of the tonsil during development of children using height and transverse diameters in which it’s diameter in centimeter was assumed to equal the age of child in years, also to show the effect of the increase size of inflamed tonsil in the vascularity of it. A total of 100 normal children and 50 patients with tonsillar diseases acute/chronic tonsillitis, recurrent tonsillitis and peritonsillar abscess were recruited in this study. On ultrasound scan the height, transverse diameters and Doppler blood flow of the tonsils where obtained from each subject and the data were analyzed with excel and specific package of social statistics version 14 (SPSS). The study showed correlation between measured height diameter in centimeter and the age of child in years in which the correlation (R²= 0.788). The ANOVA-test for significant showed a significant difference between the normal height diameter in centimeter and corresponding age in years at p=0.05 which was differ from the right to the left tonsil, moreover within the same age group, moreover the paired t-test for significance showed difference which was statically significant at (p>0.0001) and (R²= 0.788) this means that it can’t be practically used to estimation of the tonsils size throughout childhood. The study showed strong correlation between measured transverse diameter in centimeter and the age of child in years in which the correlation R²= 0.803. The ANOVA-test for significant showed a significant difference between the measured transverse diameter in centimeter and corresponding age in years at p=0.05, but however the paired t-test for significance showed IV no difference which was statically significant at (p< 0.022) thus the transverse diameter can be used with confidence in evaluation of the vascularity of the tonsil. 

List of contents

contents Page

Dedication I

Acknowledgement II

Abstract (English) III

Abstract (Arabic) V

List of contents VI

List of figures VIII

List of tables XI

List of abbreviations XII

 Chapter one : Introduction

1-1 Introduction 1

1-2 Research problem 3

1-3 Objectives 3

1-3-1 General objectives 3

1-3-2 Specific objectives 3

1-4 Thesis outlines 4

Chapter Two: Literature review and previous studies

2-1 Anatomical revision 5

2-1-1 Embryology and Development 6

2-1-2 Surface anatomy 7

2-1-3 Blood supply of the tonsil 7

2-1-4 Nerve supply of the tonsil 8

2-1-5 Lymphatic drainage of the tonsil 9

2-2 Functions of the tonsil 9

2-3 Pathology of the tonsil 10

2-3-1 acute tonsillitis 10

2-3-1-1 Complication of acute tonsillitis 10

2-3-2 Peritonsillar abscess (quinsy) 10

2-4 Assessment of the size of the tonsil 11

2-4-1 Clinical assessment 11

2-4-2 Tonsillar imaging 12

2-4-2-1 lateral soft tissue x-ray 13

2-4-2-2 Magnetic resonance imaging (Aren method 2002) 13

2-4-2-3 Ultrasound examination 13

2-5 Literature review 16

Chapter Three : Materials & Methods

3-1 Study area and study population 19

3-2 The study design and study duration 19

3-3 Study variable 19

3-4 Sampling 19

3-4-1 inclusion criteria 19

3-4-2 exclusion criteria 20

3-5 Data collection 20

3-6 Technique 20

3-7 Method of measurement 21

3-8 Data analysis 21

 Chapter Four: Result

 The Result 22

 Chapter Five: Discussion, Conclusion &Recommendations

5-1 Discussion 43

5-2 Conclusion 48

5-3 Recommendations& Suggestion for future studies 49

 References 50

 Appendices