Tonsillitis Flashcards
What is tonsillitis?
Inflammation of the tonsils
What are the tonsils?
Collections of lymphoid tissue facing into the aerodigestive tract
What is Waldeyer’s ring?
A set of lymphatic tissues (tonsils)
What does Waldeyer’s ring consist of?
- Adenoid tonsils
- Tubal tonsils
- Palatine tonsils
- Lingual tonsil
What is the most common cause of tonsillitis?
Viral infection
What are the viral causes of tonsillitis?
- Adenovirus
- Rhinovirus
- Influenza
- Coronavirus
- RSV
What is the second most common cause of tonsillitis?
Bacterial infection
What is the most common causative bacteria in tonsillitis?
Group A bet-haemolytic strep
What are the less common causative bacteria in tonsillitis?
- Staph. aureus
- Strep. pneumoniae
- Mycoplasma pneumoniae
- Chlamydia pneumoniae
- Bordatella pertussis
What are the risk factors for tonsillitis?
- Immunodeficiency
- Family history of tonsillitis
- Family history of atopy
What are the symptoms of tonsillitis?
- Sore throat
- Odynophagia
- Pain in ears
- Headache
- Loss of voice
What are the signs of tonsillitis?
- Tonsillar erythema
- White flecks of pus (potentially)
- Swollen tonsils
- Pyrexia
- Swollen regional lymph nodes
How is tonsillitis diagnosed?
Clinically
Should throat swabs be performed routinely?
No
What are the differentials of tonsillitis?
- Glandular fever
- HSV
- Coxsackie infection
- Malignancy
How will a patient with glandular fever present?
Quite unwell with very large purulent tonsils and lethargy
How will a patient with coxsackie infection present?
Small blisters on tonsils and roof of mouth
What happens to the blisters in coxsackie infection?
They rupture after a few days and form scabs
How can tonsillitis be differentiated from a malignancy usually?
The enlargement in malignancy is unilateral
What does self-care for tonsillitis include?
- Plenty of rest
- Gargling with warm salt water
- Avoiding social contact
- Antipyretics and analgesia
Are antibiotics helpful in the majority of cases of tonsillitis?
No
What are the indications for antibiotics in tonsillitis?
- Features of marked systemic illness
- Unilateral peri-tonsillitis
- History of rheumatic fever
- Increased risk of infection
- 3 or more of Centor criteria
What are the Centor criteria for tonsillitis?
- History of fever
- Tonsillar exudate
- No cough
- Tender anterior cervical lymphadenopathy
What is the antibiotic of choice in tonsillitis?
Phenoxymethylpenicillin
How long should antibiotics be prescribed in tonsillitis?
10 days
What antibiotic therapy is used in tonsillitis with penicillin allergy?
10 days of clarithromycin
What is the aim of a tonsillectomy?
To reduce recurrence
When is a tonsillectomy indicated?
- Recurrent streptococcal tonsillitis
- Enlarge tonsils obstructing the airway
- Possible malignant disease of tonsils
What are the potential complications of tonsillitis?
- Peritonsillar abscess
- Acute otitis media
- Obstructive sleep apnoea
- Streptococcal infection may cause guttate psoriasis
