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Tonsillitis

Aetiology:

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.

Clinical Features:

  • Sore throat
  • Enlargement of the tonsils
  • Difficulty in swallowing
  • General Malaise
  • Exudative inflammation
  • Pyrexia
  • Lymphadenopathy
  • Bad breath
  • Ear ache

Diagnosis

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.

Management

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:

  • Patient cannot take fluid orally
  • Risk of airway obstruction
  • A quinsy abscess develops  

In hospital, treatment includes: rehydration, analgesia and intravenous antibiotics

Tonsillectomy

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.

Absolute indications:

  • Suspected malignancy
  • Children with obstructive sleep apnoea

Relative indications:

  • Recurrent acute tonsillitis
  • Chronic tonsillitis
  • More than one quinsy
  • Febrile convulsions

Complications of tonsillitis (rare)

  • Febrile convulsions may occur in children
  • Infection may spread to produce abscesses such as quinsy (paratonsillar abscess) and parapharyngeal abscess
  • Airway Obstruction (may occur in tonsillitis due to glandular fever)

Quinsy (peritonsillar abscess)

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.  

Further Reading

  • Burton M, Leighton S, Robson A, Russell J (2000).  Hall and Colman’s Diseases of the Ear, Nose and Throat. Churchill Livingstone. Chapter 26 pp. 177-181
  • Drake-Lee A (1996) Clinical Otorhinolaryngology. Churchill Livingstone. Chapter 22 pp. 246-249
  • Lissauer T, Clayden G (2007). Illustrated Textbook of Paediatrics. Mosby Elsevier.  Chapter 16 pp.262-263
  • Roland N.J, McRae R.D.R, McCombe A.W (2001). Key topics in Otolaryngology Second Edition. BIOS Scientific Publishers Limited. pp 330-335
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