Acute Tonsillitis Flashcards
What is a peritonsillar abscess?
A peritonsillar abscess typically develops as a complication of bacterial tonsillitis.
What are the features of a peritonsillar abscess?
Features include: severe throat pain, which lateralises to one side; deviation of the uvula to the unaffected side; trismus (difficulty opening the mouth); reduced neck mobility.
Who should review patients with a peritonsillar abscess?
Patients need urgent review by an ENT specialist.
What is the management for a peritonsillar abscess?
Management includes needle aspiration or incision & drainage + intravenous antibiotics.
What should be considered to prevent recurrence of a peritonsillar abscess?
Tonsillectomy should be considered to prevent recurrence.
What is a common post-operative complication of tonsillectomy?
Pain may increase for up to 6 days following a tonsillectomy.
What is a feared complication following tonsillectomy?
Haemorrhage is a feared complication following tonsillectomy. All post-tonsillectomy haemorrhages should be assessed by ENT.
When does primary or reactionary haemorrhage most commonly occur after tonsillectomy?
Primary, or reactionary haemorrhage most commonly occurs in the first 6-8 hours following surgery.
It is managed by immediate return to theatre.
When does secondary haemorrhage occur after tonsillectomy?
Secondary haemorrhage occurs between 5 and 10 days after surgery and is often associated with a wound infection.
Treatment is usually with admission and antibiotics. Severe bleeding may require surgery.
What percentage of tonsillectomies experience secondary haemorrhage?
Secondary haemorrhage occurs in around 1-2% of all tonsillectomies.
What are the complications of tonsillitis?
Complications of tonsillitis include: otitis media, quinsy (peritonsillar abscess), and very rarely, rheumatic fever and glomerulonephritis.
What criteria does NICE recommend for considering tonsillectomy?
Surgery should be considered if: sore throats are due to tonsillitis (not recurrent upper respiratory tract infections), the person has 7 episodes per year for one year, 5 per year for 2 years, or 3 per year for 3 years with no other explanation for recurrent symptoms, and the episodes of sore throat are disabling and prevent normal functioning.
What are other established indications for tonsillectomy?
Other indications include: recurrent febrile convulsions secondary to episodes of tonsillitis, obstructive sleep apnoea, stridor or dysphagia secondary to enlarged tonsils, and peritonsillar abscess (quinsy) if unresponsive to standard treatment.
What are the primary complications of tonsillectomy?
Primary complications (< 24 hours) include haemorrhage in 2-3% (most commonly due to inadequate haemostasis) and pain.
What are the secondary complications of tonsillectomy?
Secondary complications (24 hours to 10 days) include haemorrhage (most commonly due to infection) and pain.
