Tonsillitis

From Ganfyd

Tonsillitis is a common condition that can cause a great deal of misery.

Aetiology

• Common disease
• Most frequent in childhood

Pathology

• Not fully understood
• May be the result of a viral infection, leading to secondary bacterial infection
• Viruses include adenovirus, enterovirus and rhinovirus
• Bacteria include Beta haemolytic streptococcus, streptococcus pnaemoniae, haemophilus influenzae and anaerobic organisms

Clinical assessment

• Usually a prodromal illness with pyrexia, malaise
• Sore throat
• Pain may radiate to the ears (otalgia) or to the neck
• Swallowing painful (odynophagia)
• Occasionally trismus due to pterygoid plate irritation
• Tonsils are found to be hyperaemic
• Often enlarged
• Tonsillary crypts are filled with yellow discharge
• Cervical lymphadenopathy

Management

• Analgesia
• Consider antibiotics
  • Oral penicillin
  • Erythromycin in allergic patients
  • Cefuroxime in erythromycin sensitive patients
  • Do not use ampicillin or amoxicillin as these can cause a maculopapular rash in patients with infectious mononucleosis
• Bedrest
• Difflam mouthwash
• Consider a Paul Bunnell test if infectious mononucleosis is suspected
• For recurrent tonsillitis, a tonsillectomy may be required

Indications to refer a case of tonsillitis to ENT

• Patient unable to swallow liquids
• Does not respond to antibiotics
• Abscess formation

Usual management is IV antibiotics, usually cefuroxime and metronidazole along with IV fuid replacement and analgesia. Some advocate the use of steroids.

Complications

Local

• Abscess formation
  • Peritonsillary (quinsy)
  • Parapharyngeal
  • Retropharyngeal
• Acute otitis media
• Recurrent acute tonsillitis

General

• Septicaemia
• Meningitis
• Acute rheumatic fever
• Acute glomerulonephritis

Differential diagnosis

There are several other conditions that can cause an inflamed or ulcerated tonsil.

Infection

• Acute tonsillitis
• Infectious mononucleosis
• Diphtheria
• Vincent's angina

Neoplasm

• Squamous cell carcinoma of the tonsil
• Lymphoma
• Salivary gland tumours

Blood diseases

• Agranulocytosis
• Leukaemia

Other causes

• Aphthous ulcer
• Behcet's syndrome
• AIDS