Tonsillitis (infection of the tonsils) is amongst the most common conditions seen in both ENT and General Practice. It is most commonly bacterial in origin with the most common pathogens being: B haemolytic Streptococcus, Pneumococcus and Haemophilus influenzae. It can occur following a viral infection.
The diagnosis of tonsillitis is made from the history and clinical findings.
A throat swab often gives misleading results, growing a surface organism rather than reflecting true bacterial activity.
Tonsillitis is treated using antibiotics. Oral penicillin V or ampicillin are appropriate. N.B: Ampicillin or amoxicillin should be avoided if glandular fever is suspected as this may cause a florid skin rash. Erythromycin should be used in patients with an allergy to penicillin. Give paracetamol for analgesia.
Hospital admission only required if:
In hospital, treatment includes: rehydration, analgesia and intravenous antibiotics
This is the most commonly performed operation in ENT. It involves removing the tonsils via various methods, under general anaesthetic.
The indications for tonsillectomy may be absolute or relative.
A quinsy is a collection of pus forming outside the capsule of the tonsil. It is more common in adults than in children and is almost always unilateral.
The patient already suffering from acute tonsillitis becomes more ill, has a peak temperature and develops severe dysphagia with referred otalgia.
The major clinical feature is trismus. Further the buccal mucosa is furred and there is foetor. The quinsy will push the tonsil downwards and medially.
Treatment is intravenous antibiotics and drainage of the abscess. The relief is immediate and dramatic.
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