Adenotonsillar disease and OME Flashcards
What is the main function of the adenoids and tonsils?
Trap viruses and bacteria on inhalation and expose to the immune system: “prime” the immune system and prevent subsequent infection
What is Waldeyer’s ring?
Ring of lymphoid aggregation in the sub-epithelial layer of oropharynx and nasopharynx
What comprises Waldeyer’s ring?
Tonsils (palatine tonsil)
Adenoids (pharyngeal tonsil)
Lingual tonsil
Describe the aetiology of acute tonsillitis.
Mainly viral; 5-30% bacterial
Which viruses are often responsible for acute tonsillitis?
EBV, rhinoviruses, influenza, enterovirus
Why is strep pyogenes an important bacterial pathogen?
Potential sequelae- rheumatic fever, glomerulonephritis
What are the most common bacterial causes of chronic tonsillitis?
Group A strep
H. influenziae
S. aureus
Strep pneumoniae
What should be considered in the DDx of acute tonsillitis?
Viral URTI Diphtheria Glandular fever Peritonsillar abscess Malignancy
How do the symptoms of bacterial tonsillitis differ from viral?
Bacterial- more of a systemic upset- fever, odynophagia, usually unable to work/school, lymphadenopathy, lasts around a week (compared to 4 days), halitosis, requires antibiotics to settle
What is the purpose of the Centor criteria?
Help distinguish bacterial from viral tonsillitis
What is the empirical antibiotic treatment regimen for bacterial tonsillitis?
Penicillin 500mg qid for 10 days (clarithryomycin if allergic)
What are the SIGN guidelines for tonsillectomy?
Tonsillectomy should only be considered if:
a) 7 or more episodes in previous year
b) 5 or more episodes in each of two previous years
c) 3 or more episodes in each of three previous years
What is the classic history of a peritonsillar abscess?
Unilateral throat pain, trouble swallowing and trismus (unable to open mouth properly) and preceding case of acute tonsilitis
How is quinsy treated?
Aspiration of abscess and antibiotics
What do the tonsils look like in glandular fever?
Grossly enlarged with membranous exudate
