Tonsillitis

Question 1

What is the definition of tonsillitis?

Answer 1

Inflammation of the tonsils that frequently occurs with pharyngitis

Question 2

What is the aetiology of tonsillitis?

Answer 2

Mostly viral- EBV, rhinovirus, influenza, parainfluenza, enterovirus, adenovirus
5-30% bacterial- most common strep pyogenes but others include h. influenza, s. aureus, strep. pneumoniae

Question 3

What is the clinical presentation of viral tonsillitis?

Answer 3

Malaise
Sore throat, mild analgesia required
Temperature
Able to undertake normal activity
Possible lymphadenopathy
Lasts 3-4 days

Question 4

What is the clinical presentation of bacterial tonsillitis?

Answer 4

Dysphagia, odynophagia, dysphonia
Systemic upset
Fever
Halitosis
Unable to work/school
Lymphadenopathy
Lasts ~1 week, requires antibiotics to settle
Soft palate and tonsils may be inflamed and tender

Question 5

What investigations are done for tonsillitis?

Answer 5

Clinical diagnosis
Swabs not helpful

Question 6

What scoring systems are used for tonsillitis?

Answer 6

Centor - 1 point for each of: tonsillar exudate, tender anterior cervical lymph nodes, history of fever, absence of cough
FeverPAIN - 1 point for each of: Purulence, Attend rapidly (within 3 days), very Inflamed tonsils, No cough

Question 7

What is the management of tonsillitis?

Answer 7

Self limiting and most resolve within 3 days, consider glandular fever if aged 15-25 and persisting beyond 2 weeks

Self care advice: eat and drink, rest, regular analgesia, medicated lozenges

FeverPAIN score 4-5 prescribe penicillin (clarithromycin if allergic)
Consider delayed prescription for FeverPAIN score 2-3

Question 8

When should tonsillitis be admitted to secondary care?

Answer 8

Refer immediately if stridor, breathing difficulty, clinical dehydration, systemically unwell

Investigate for throat cancer if neck mass and persistent sore throat

Patients with sore/painful throat lasting 3-4 weeks with dysphagia

Red/white patches or ulceration/swelling persisting for 3+ weeks

Question 9

What is the acute management of tonsillitis in secondary care?

Answer 9

IV fluids
Antibiotics
Steroids
Infection control measures- isolation first 48 hours and standard measures

Question 10

What are some complications of tonsillitis?

Answer 10

Otitis media (most common)
Peritonsillar abscess (quinsy)
Parapharyngeal abscess
Epiglottitis
Lemierre syndrome (suppurative thrombophlebitis of jugular vein)

Late complications of strep pyogenes (3 weeks) - rheumatic fever, glomerulonephritis