Tonsillitis Flashcards
What is Waldeyer’s ring?
Collection of lymphatic tissue in pharynx
–> pharyngeal tonsil, 2x tubal tonsils, 2x palatine tonsils, lingual tonsil
What is tonsillitis?
Inflammation of palatine tonsils
What are the viral and bacterial causes of tonsillitis?
Viral: adenovirus, rhinovirus, influenza, parainfluenza
Bacterial (approx 1/3): S. pyogenes (group A strep - most common), S. aureus, M. catarrhalis
What are the symptoms of tonsillitis?
Sore throat Odynophagia (painful swallowing) Dysphagia Earache Fever Malaise Headache Halitosis
What are the signs of tonsillitis?
Swollen, erythematous tonsils +/- purulent exudate
Thick or ‘hot potato’ voice
Trismus (quinsy)
Bilateral cervical lymphadenopathy
What is the Centor criteria used for?
In GP to assess for likelihood of bacterial infection
What are the features of the Centor criteria?
Consider antibiotics if 2 or more of:
- history of pyrexia
- tonsillar exudate
- no cough
- tender anterior cervical lymphadenopathy
How is tonsillitis diagnosed?
Clinically
Only do investigations if complications suspected
How is uncomplicated tonsillitis managed?
Analgesia –> topical Difflam spray + paracetamol +/- NSAIDs
Hydration –> may need admitted for IV fluids if cannot swallow
Antibiotics if indicated
Which antibiotics are given for a suspected bacterial tonsillitis?
Penicillin 5-7 days
Which antibiotics should be avoided in tonsillitis and why?
Amoxicillin
–> causes a rash if patient has glandular fever
What are the indications for a tonsillectomy?
- episodes that are disabling + prevent normal functioning
- 7 or more episodes in last year, 5 or more episodes in each of last 2 years, 3 or more episodes in each of last 3 years
- suspected malignancy
- presence of sleep apnoea
- previous quinsy
How is a tonsillectomy performed?
Cold steel excision or diathermy
What is the main complication after a tonsillectomy?
Bleeding
–> primary (first 24 hours) or secondary (day 4-7)
How is bleeding post tonsillectomy managed?
Usually conservatively with antibiotics and hydrogen peroxide mouthwash
Which two serious complications are associated with bacterial tonsillitis?
Peritonsillar abscess (quinsy) Deep neck space infection
What are the clinical features of quinsy?
Severe sore throat --> worse on one side Severe odynophagia May be stertor + trismus Examination difficult due to trismus --> extensive erythema + soft palate swelling --> uvula deviated to opposite side
How is quinsy managed?
Admit
IV antibiotics
Regular analgesia + topical analgesic throat sprays
Needle aspiration or incision + drainage
What is a deep neck space infection?
Infection spreads from tonsils into surrounding potential spaces between fascial planes of the neck
What are the two different types of deep neck space infection?
Parapharyngeal abscess –> space posterolateral to nasopharynx (most common)
Retropharyngeal abscess –> space anterior to prevertebral fascia (from necrotising lymph nodes in children)
How does deep neck space infection present?
Similar to quinsy but with associated:
- reduced neck movement
- cervical pain
- torticollis in children (asymmetrical head/neck position)
Which investigations should be done for deep neck space infection?
CT with IV contrast (gold standard)
Bloods + cultures
How is a deep neck space infection managed?
Manage airway if compromised
IV antibiotics + surgical drainage
