Tonsillitis and Peritonsillar Abscess

Question 1

Causes

Answer 1

• Most commonly viral caused by rhinovirus, coronavirus or adenovirus
• Group A Streptococcus, mainly streptococcus pyogenes is the most common bacterial cause
• Streptococcus pneumoniae
• Haemophilus influenzae
• Morazella catarrhalis
• Staphylococcus aureus

Question 2

Centor criteria

Answer 2

• Used to estimate the probability that tonsillitis is due to bacterial infection
• A score of <3 indicates unlikely to benefit from antibiotics
• One point for each of:
  
  • Fever >38^oC
  • Tonsillar exudates
  • Absence of cough
  • Tender anterior cervical lymph nodes (lymphadenopathy)

Question 3

Management

Answer 3

• Penecilin V for 10 days if first line
• Can also use co-amoxiclav, clarithromycin and doxycycline

Question 4

Waldeyer’s Tonsillar Ring

Answer 4

Question 5

Features of tonsillitis

Answer 5

• Sore throat
• Fever
• Painful swallowing

Question 6

Peritonsillar abscess (Quinsy)

Answer 6

• Trismus - decreased mouth opening
• Change in voice due to pharyngeal swelling
• Drain abscess (LA, aspirate or I&D)
• Admit for IV antibiotics +/- dexamethasone
• Consider tonsillectomy if more than one episode

Question 7

Tonsillectomy

Answer 7

• Indications
  
  • Recurrent tonsillitis
    
    • 7 or more episodes in 1 year
    • 5 per year to 2 years
    • 3 per year for 3 years
  • Recurrent tonsillar abscesses (2 episodes)
  • Enlarged tonsils causing breathing difficulty, swallowing or snoring
• Complications
  
  • Pain
  • Damage to teeth
  • Infection
  • Post-tonsillectomy bleeding
  • Risks of GA

Question 8

Post-tonsillectomy bleeding

Answer 8

• Can be life threatening
• Call ENT
• Get IV access and bloods (FBC, clotting screen, G&S, crossmatch)
• Keep patient calm
• Sit them up and encourage to spit blood rather than swallow
• NBM
• IV fluids for maintenance and resuscitation as required
• Prior to theatre can use hydrogen peroxide gargle and adrenaline soaked swabs