Tonsilitis & quinsy's

Question 1

What are the symptoms of tonsillitis?

Answer 1

Typical symptoms include:
Sore throat
Cough
Coryzal prodrome
Dysphonia 
Pyrexia
Pain and malaise

Less common symptoms include:
Dysphagia
Halitosis

Question 2

What may be found on clinical examination?

Answer 2

Swollen, erythematous palatine tonsils
Exudates covering tonsils
Cervical lymphadenopathy

Question 3

What criteria is useful in determining the appropriateness of abx in tonsillitis?

Answer 3

The centor criteria

One point is given for each of the following:
Fever >38 degrees
Tonsillar exudates
Absence of cough
Tender anterior cervical lymph nodes (lymphadenopathy)

Score of <3 = unlikely to benefit from abx
Score >=3 = chance of bacterial tonsillitis and can give abx

Question 4

What differentials need to be considered with tonsillitis?

Answer 4

Epiglottitis:
Acute and severe onset
Muffled voice
Drooling
Stridor

Glandular fever:
Triad of fever, sore throat and swollen gland
Pharyngitis of longer duration
Splenomegaly

Squamous cell carcinoma:
Unilateral tonsillar enlargement
Dysphonia
Ulcers

Question 5

What complications can arise from tonsillitis?

Answer 5

Quinsy’s - peritonsillar abscess
Otitis media
Rheumatic fever and glomerulonephritis (rarely)

Question 6

What are the features of quinsy’s?

Answer 6

Sore throat
Dysphagia
Trismus
Hot potato voice
Unilateral bulge above tonsils
Deviated uvula to unaffected side

Question 7

What is the treatment for tonsillitis?

Answer 7

Viral:
Self-limiting

Bacterial:
1st line = Penicillin V (phenoxymethylpenicillin) for 10days
2nd line = erythromycin (if penicillin allergy), co-amoxiclav, clarithromycin, doxycycline

If >7 episodes in last year, or >5 episodes each year for 2 years, or >3 episodes for last 3 years = tonsillectomy

Question 8

What are the post-operative complications of tonsillectomy?

Answer 8

Pain:
May increase for up to 6 days post tonsillectomy

Haemorrhage (bleeding):
All post-tonsillectomy haemorrhage should be assessed by ENT

Primary, or reactionary haemorrhage commonly occurs in the 1st 6-8 hours following surgery
Managed by immediate return to theatre

Secondary haemorrhage occurs 5-10 days after surgery and is often associated with a wound infection
Treatment is with admission and abx. Severe bleeding may require surgery.

Question 9

What is the management for quinsy?

Answer 9

Needle aspiration or incision and drainage + IV abx

May need tonsillectomy to prevent recurrence