ENT - Tonsillitis Flashcards
What is the most common cause of tonsilitis?
Viral infection
What are the most common causes of bacterial tonsilitis?
Streptococcus pyogenes (group A streptococcus)
Most common cause of otitis media + rhinosinusitis + tonsilitis streptococcus pneumoniae
What is Waldeyer’s ring?
Tonsillar ring of lymphoid tissues
What tonsil is most commonly infected in tonsilitis?
Palatine tonsils
Label the image
What are the features of tonsillitis?
Fever
Sore throat
Painful swallowing
Peak of children 5-10
Peak between 15-20
How does tonsillitis present in younger children?
Fever
Poor oral intake
Headache
Vomiting
Abdominal pain potentially
What must you always examine in tonsillitis apart from the throat?
Otoscopy to visualise the tympanic membrane and palpate for any cervical lymphadenopathy
What is the centor criteria for tonsillitis?
Fever over 38
Tonsillar exudate
No cough
Tender anterior cervical lymph nodes
What is the FeverPAIN score criteria?
2-3 = 34-40% probability
4-5 = 62-65% probability
Of bacterial tonsillitis
FEVER during last 24 hours
Purulence
Attended within 3 days of symptoms
Inflamed tonsils
No cough
How is tonsillitis managed?
Exclude other pathology e.g. meningitis, epiglottitis and peritonsillar abscess
Calculate centor or FeverPAIN score
Safety net viral
Simple analgesia, paracetamol + ibuprofen
Delayed prescription if symptoms do not improve in 3 days
When should antibiotics be considered?
If Centor score is 3 or more
FeverPAIN 4 or more
Immunocompromised
Significant co-morbidity
History of rheumatic fever
When should admission for tonsillitis be considered?
Immunocompromised
Systemically unwell
Dehydrated
Stridor
Respiratory distress
Peritonsillar abscess
Cellulitis
What is the first-line antibiotic for bacterial tonsillitis?
Penicillin V for 10 days
Clarithromycin if allergic
Why can kids struggle to take Penicillin V?
Bad taste, younger children who can’t swallow tablets and need syrups are reluctant to take
Amoxicillin sometimes used instead (not in guidelines)
