Tonsilitis Flashcards
What is tonsilitis?
Inflammation and infection of the palatine tonsils. Note the same organisms can also cause acute pharyngitis which is simply inflammation of the oropharynx and is what we call a common cold if viral.
What causes tonsilitis?
Viral 70% - Adenovirus, Coronavirus, Rhinovirus, Parainfluenza virus, Influenza type A and B, herpes simplex virus and Epstein-barr virus (glandular fever).
Bacterial 30% – Group A beta haemolytic strep, Haemophilus influenza, staphylococci and Escherichia coli. Strep pyogenes is most common and can also cause scarlet fever if it produces erythrogenic toxins.
Describe the signs and symptoms of tonsilitis
If cold like symptoms, then likely viral (dry cough, runny nose etc.)
If puss, lymphadenopathy (jugulodigastric lymph node) and lack of URTI symptoms, then likely bacterial
Dysphagia and odynophagia
Otalgia as a referred pain
If tonsillar enlargement is unilateral think quinsy or cancer
How should suspected tonsilitis be investigated?
Throat swab and Rapid strep test but neither are routine
Describe the centor criteria
One point for each criterion met – the more points the more likely it is bacteria
- Cough absent (can’t cough)
- Tonsillar Exudate
- Tender cervical lymphadenopathy
- Temperature
Describe the Fever PAIN criteria
- Fever over 38
- Purulence (pharyngeal or tonsillar exudate)
- Attend rapidly (3 days or less)
- Severely inflamed tonsils
- Cough or coryza
How should tonsilitis be managed?
Paracetamol and ibuprofen
Warm salt water gargles
If viral then usually self-limiting
If bacterial (Centor 3-4 or FeverPAIN 4 to 5) may need antibiotics – Phenoxymethylpenicillin or clarithromycin/erythromycin if penicillin allergic. Can give delayed antibiotics if unsure.
What management can be offered to chronic tonsillitis sufferers?
In chronic cases a tonsillectomy may be indicated if all of these criteria are met.
Must be certain that the recurrent infections are due to tonsillitis, that they are disabling and prevent normal function, 7 events in last year or 5 per year for 2 years or 3 per year for 3 years.
What complications can occur from tonsillitis?
Quinsy – sore throat, dysphagia, peritonsillar bulge, uvular deviation, trismus (hot potato moth open) and muffled voice. Antibiotics and aspiration by ENT specialist is needed.
Parapharyngeal abscess – serious but rare, diffuse swelling in the neck. US to identify then incise and drain under GA
Lemierre syndrome – acute sepsis and jugular vein thrombosis due to infection with fusobacterium species and a septic embolus.
Otitis media
What is quinsy?
Quinsy (Peritonsillar abscess)
Definition – rare and dangerous side effect of tonsillitis resulting in an abscess that forms between one of your tonsils and the wall of your throat.
What causes quinsy?
Usually because of severe strep pyogenes Tonsillitis. Can also be staph aureus and Haemophilus Influenza.
What are the signs and symptoms of quinsy?
Deviated uvula away from lesion Drooling due to dysphagia Unilateral Hot potatoe voice Referred ear pain Trismus (inability to open mouth)
How should quinsy be investigated?
Medical imaging to rule our complications such as CT and MRI
Complications
Retropharyngeal abscess
Mediastinitis
Sepsis
How are quinsy’s managed?
Drainage by ENT surgeon due to internal carotid artery proximity
IV Antibiotics
Steroids sometimes useful
What is adenoiditis?
Infection and inflammation of the pharyngeal tonsils. Children mostly as the adenoids are prominent in children and atrophy after puberty.
What are the causes of infection in adenoiditis?
If viral recedes within 48 hours – adenovirus, rhinovirus and paramyxovirus
Bacteria – strep pyogenes, strep pneumoniae, Moraxella Catarrhalis and many staphylococcus types
What are the signs and symptoms of adenoiditis?
Mouth breathing
Nasal tone to speech
May result in middle ear infections due to blockage of pharyngotympanic canal
Fever, runny nose
What investigations can be done for adenoiditis if uncertain?
If uncertain can use optical fibre endoscopy to visualise inflammation
What management should be offered for adenoiditis?
If viral then analgesics and antipyretics
If bacterial then antibiotics
What complications can occur from adenoiditis?
Due to drainage of these nodes to the retropharyngeal lymph nodes this can lead to a retropharyngeal abscess and spread to the mediastinum
What is the management for acute airway obstruction in adults?
- Give oxygen – Heliox is preferred as it contained helium and so is less dense requiring less work to breath with
- Nebulised adrenaline with saline
- Take standard obs
- Call on call ENT registrar and anaesthetist to help
Endotracheal intubation – first line intervention, move on quickly if this doesn’t work
In emergency – cricothyroidotomy – temporary measures pending formal tracheostomy. A wide bore cannula is inserted through the cricothyroid membrane and can sustain life for 30-45 mins
Discuss hemorrhages as a post tonsillectomy complications and how they should be managed?
ENT should assess all post-tonsillectomy haemorrhages.
Primary, or reactionary haemorrhage most commonly occurs in the first 6-8 hours following surgery. It is managed by immediate return to theatre.
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. Secondary haemorrhage occurs in around 1-2% of all tonsillectomies.
What pain is normal post tonsillectomy?
The pain may increase for up to 6 days following a tonsillectomy.
