9: Tonsils Flashcards
go back over the 1st half of this
What are the symptoms and duration of viral tonsilitis?
Malaisae
Sore throat
Mild fever
Lymphadenopathy
Lasts 3-4 days
What are the symptoms and duration of bacterial tonsilitis?
Much more severe:
Systemic upset
Fever
Odynophagia
Halitosis
Lymphadenopathy
Reduced capability to do daily activities
+ 1 week
Which criteria are used to decide if a sore throat requires antibiotics?
Centor criteria
Which infection is indicated by 4 or 5 Centor points?
GAS infection
What does tonsilitis look like?
Inflamed throat
Enlarged tonsils
Exudate
What is the supportive treatment for tonsilitis?
Fluids
Rest
Analgesia
What antibiotics are given for severe tonsilitis?
For how long?
Penicillin / Clarithromycin
10 days
If tonsilitis is to be managed in hospital, what treatments are given?
IV fluids
IV antibiotics
IV steroids
If tonsilitis is persistent and recurrent, what is done?
Tonsilectomy
What are the durations of tonsilitis required for tonsilectomy?
Why is this so strictly follow?
7 episodes in one year
5 episodes a year for 2 years
3 episodes a year for 3 years
Surgery is incredibly painful
What analgesia is required following tonsillectomy?
Strong opioids e.g morphine
What is a local complication of untreated acute tonsilitis?
Peritonsilar abscess / Quinsy
What is a peritonsilar abscess?
Stretching of tonsil by pus produced by bacteria
What are the symptoms of peritonsillar abscess?
UNILATERAL throat pain, odynophagia
Trismus (lockjaw)
What does a peritonsilar abscess look like?
Swelling over tonsil
Uvula deviates away from abscess
How is a peritonsilar abscess treated?
Aspiration
Antibiotics
Which disease, caused by EBV, produces a severe tonsilitis, lymphadenopathy and hepatosplenomegaly?
Infectious mononucleosis
How is glandular fever diagnosed?
Atypical lymphocytes on blood film
Positive antibody test (Monospot or Paul-Bunnell)
How is glandular fever treated?
Supportive
NO AMOXICILLIN (amoxicillin causes rash with EBV) - penicillin and steroids PRN
Which antibiotic should not be given to someone with tonsilitis?
Amoxicillin
may produce a macular rash
What pathology of the tonsils may cause stertor or sleep apnoea?
Hyperplasia of palatine tonsils
What pathology of the tonsils may cause otitis media or a hyponasal voice?
Hyperplasia of adenoid tonsils
What should your suspicion be if a patient has unilateral tonsilar enlargement?
Neoplasia
What is the difference between acute otitis media and glue ear?
OME caused by fluid buildup e.g blockage of Eustachian tube
Both involve acute inflammation of middle ear
In which variant of otitis media is pain, fever and irritability seen?
Acute otitis media
NOT a feature with effusion
What group is glue ear common in?
Children
(Boys / girls) are more likely to develop glue ear.
Boys
What is thought to cause glue ear?
Eustachian tube blockage
How does glue ear present in children?
Hearing loss but they won’t tell you that
No earache because that’s not seen in OME
Misbehaviour
School performance is poor
SPEECH AND LANGUAGE DEVELOPMENTAL DELAY
How is glue ear investigated?
Ear examination - bulging TM, possibly rupture
Tuning fork tests
Audiogram
What kind of hearing loss does glue ear cause?
Conductive
When should you refer a patient with glue ear?
Persistent symptoms for 3 months
What is the treatment for severe bilateral glue ear?
Grommets
What may be done in addition to inserting grommets in patients with severe bilateral glue ear?
Removal of adenoids
to unblock Eustachian tube
Is there any evidence that children with developmental delay due to OME catch up once grommets have been inserted?
No
What are some complications of grommets?
Need reinserted
Infection
Perforation
Problems bathing / swimming
tm retrudes because outer pressure > inner pressure, due to eustachian tube blockage, pushing it in
