[8] Tonsillitis Flashcards
What is tonsillitis?
A form of pharyngitis where there is intense inflammation of the tonsils
What often accompanies tonsillitis?
Purulent exudate
What are the two main types of tonsillitis?
Bacterial and Viral
What is the main cause of bacterial tonsillitis?
Group A beta-haemolytic streptococci
What is a cause of viral tonsillitis?
EBV
What are the risk factors for tonsillitis?
Smoking - second hand in younger and personal in older
What are the potnetial symptoms of tonsillitis?
- Sore throat
- Fever
- Dysphagia/odynophagia
- Halitosis
What are the possible signs seen on examination?
- Enlargement of tonsils
- Enlarged cervical lymph nodes
- Red, inflamed tonsils
- White exudate spots on the tonsils
What are the differentials for tonsillitis?
- Quinsy
- Pharyngitis
- Glandular fever
- Tonsillar malignancy e.g. lymphoma
- Epiglottitis
What is the first step for determining management?
Distinguishing between viral and bacterial tonsillitis
How does the causative organism affect management?
Bacterial tonsillitis is an indication for antibiotic therapy
What criteria can be used to distinguish between viral and bacterial tonsillitis?
Centor criteria
How does the Centor criteria work?
A series of symptoms (or absence of) should be looked for with each symptom (or absence of) scoring +1 point.
What score suggests bacterial infection?
3+ is highly suggestive of a bacterial infection
What are the symptoms screened for in the Centor criteria?
- Tonsillar exudate
- Tender anterior cervical lymphadenopathy
- Fever, or history of fever
- Absence of cough
What is the typical antibiotic used in tonsillitis if the patient requires IV?
Benzylpenicillin
How is benzylpenicillin dosed in children?
According to weight
How long are antibiotics typically given for in tonsillitis?
7-10 days
What should happen if or when the child is able to tolerate oral antibiotics?
Switch to penicillin V
What antibiotic is often avoided in tonsillitis?
Co-amoxiclav
Why is co-amoxiclav avoided?
There is a risk leaving a permanent skin rash if the tonsillitis is due to glandular fever
What are the indications for hospital admission with tonsillitis?
- Respiratory compromise
- Inability to eat or drink
- Failure to respond to community antibiotics
What may show respiratory compromise in tonsillitis?
- Tachypnoea
- Low sats
- Use of accessory muscles
- Apnoeic episodes
What does inability to eat or drink risk?
Dehydration
What types of analgesia may be useful in tonsillitis?
- Paracetamol
- Ibuprofen
- Topical treatments
What topical treatments are available in tonsillitis?
Difflam spray/mouthwash
Why are topical analgesics particularly useful?
They can reduce pain enough for the child to take oral analgesics
What other medication (besides antibiotics and analgesics) can sometimes be used in tonsillitis?
Oral steroids
Why are steroids sometimes helpful?
They can accelerate the resolution of pain and inflammation
Is tonsillectomy routinely performed?
No, there are set criteria reserved for children with recurrent episodes
What criteria are used to determine if tonsillitis is indicated?
SIGN criteria
When do the S|GN criteria indicate tonsillitis?
- 7 or more episodes in 1 year
- 5 or more per year for 2 years
- 3 or more per year for 3 years
What are the potential complications of tonsillitis?
- Quinsy
- Deep neck space abscess
How can tonsillitis become quinsy?
Infection can spread into the peritonsillar space and form an abscess
How can tonsillitis lead to a deep neck space abscess?
Spread into the retropharyngeal or parapharyngeal space
How is a deep neck abscess treated?
Prolonged IV antibiotics and sometimes surgical drainage
