tonsilitis Flashcards
what is the most common cause of viral tonsilitis?
rhinovirus
what is the most common cause of bacterial tonsilitis?
group A beta haemolytic streptococcus
what might be the cause of reccurent tonsilitis?
s.aureus, because it can be resisitant to abx
how does tonsilitis present?
- sudden onset sore throat
- pyrexial >38degrees
- fever
- anterior cervical lymphadenopathy
- reduced oral intake (skin turgor and dry mucous membranes)
which investigations can you do for tonsilitis?
- throat culture- gold standard but takes >48 hrs to get back
- group A streptococcus antigen test- is less acurate but faster, good for vulnerable immunosupressed people
what are the 2 scoring systems used for tonsilitis?
- CENTOR
2. Fever PAIN
what makes up the centor criteria?
- fever >38
- tonsilar exudate
- absence of cough
- tender cervical lymphadenopathy
3 or more–> give abx
what makes up the Fever PAIN score?
- fever in past 24 hours
-P- pus on tonsil
A- attended within 3 days of sxs
I- inflamed tonsils
N- no cough or coryza
4 or more—> consider abx
when would you arrange hospital admission for patient with tonsilitis?
hospital admission is rare, but would consider for…
- inabillity to swallow
- breathing difficulty
- clinical dehydration
- peri-tonsillar abcess
- retropharangeal abcess
- sepsis
- may give IV/IM steroid for throat swelling
what is the abx of choice for tonsilitis?
10 day course of PenV-
if allergic clarythromycin
what are complciations of tonsilitis?
Acute otitis media: the most common complication, generally benign and self-limiting
Peri-tonsillar abscess (quinsy): local abscess formation due to bacterial tonsillitis; associated with ‘hot potato’ voice, trismus (‘lockjaw’), and uvula displacement to the unaffected side
Parapharyngeal abscess
Acute rheumatic fever: a very rare complication but should be considered as an indication for rapid antigen testing in at-risk groups
Acute post-streptococcal glomerulonephritis: also a very rare complication
what are indications for tonsilectomy?
Recurrent tonsillitis or its complications (e.g. quinsy) in children <16 years and in adults
Obstructive sleep-disordered breathing in children <16 years
what is considered reccurent tonsilitis for tonsilectomy?
- 7 or more clinically significant episodes in the last year
- 5 or more in each of the precedeing 2 years
- 3 or more in each of the preceding 3 years
which tonsils are removed in tonsilectomy?
adenoid tonsils–> adenectomy
what should you consider for diagnostic uncertainty of sleep apneoa?
overnigh pulse oximetry
what is a complication of tonsilectomy?
Post-tonsillectomy haemorrhage is considered a surgical emergency
- primary haemorrhage (<24hrs ) occurs in approx 2%
- secondary haemorrhage (>24hrs) occurs in approx 4%
which factors increase risk of tonsilitis?
> 5 yrs
asprin before op
chronic tonsilitis
what are symptoms of quincy?
Trismus, which refers to when the patient is unable to open their mouth
Change in voice due to the pharyngeal swelling, described in textbooks as a “hot potato voice”
Swelling and erythema in the area beside the tonsils on examination
what causes quincy?
- group A strep
- haemophillus influenza
how is quincy managed?
Patients should be referred into hospital under the care of the ENT team for incision and drainage of the abscess under general anaesthetic
