Tonsillitis Flashcards
What are the common bacterial causes for tonsillitis?
Group A strep - Strep. pyogenes Staphs Moraxella catarrhalis Mycolasma Chlamydia Haemophilus
What is the treatment for tonsillitis?
Paracetamol +/i difflam gargle
Most cases viral
Antibiotics if >/= 3 centaur criteria:
- PENV (Clarithromycin if allergic)
What are the Centaur criteria used in tonsillitis?
Tonsillar exudate
Tender anterior cervical lymphadenopathy
Fever >38.0
Absence of cough
What are the complications of tonsillitis?
Retropharyngeal abscess
Peritonsillar abscess (quincy)
Pharyngeal and Laryngeal abscess
Lemierre’s disease
How does a retropharyngeal abscess present?
Ill child
Stiff extended neck
Fails to eat or drink
Lateral x-ray shows soft tissue swelling
How is a retropharyngeal abscess treated?
Incise and drain pus under GA
How does a peritonsillar abscess present?
Sore throat Dysphagia Peritonsillar bulge Uvular devation Trismus (spasm of jaw muscles causing mouth to remain shut Muffled voice
What is the treatment for a peritonsillar abscess?
Antibiotics and aspiration
Steroids reduce morbidity
How are haryngeal and laryngeal abscesses treated?
Medical therapy alone esp. in children
What is Lemierre’s disease?
Pharyngotonsillitis, internal jugular vein thrombophlebitis + septic emboli around body
What causes Lemierre’s disease?
Fusobacterium necrophorum
How do you treat Lemierre’s disease?
IV benylpenicillin, clindamycin and metronidazole
Debridements
What is the DDx of unilateral tonsillar enlargement?
True asymmetry - excision biopsy if malignancy possible
Apparent enlargement = pharyngeal mass/peritonsillar abscess
Tumours - Squamous (70%)
What is the typical presentation of someone with a tonsillar Ca?
Elderly
Sore throat
Dysphagia
+/- otalgia
How is tonsillar Ca treated?
XRT, surgery, cytotoxics
