Tonsillitus

Question 1

Definition

Answer 1

Inflammation of the tonsils (pharyngeal), part of Waldeyer’s lymphoid tissue ring

Question 2

Aetiology

Answer 2

BACTERIAL
-B-haemolytic streptococcus*, S. pneumoniae, H. Influenzae

VIRAL
-influenza, parainfluenza, adenovirus

Question 3

Clinical Features

Answer 3

Malaise
Sore thoat w/ odynophagia (pain on swallowing)
Otalgia

Fever
Inflamed tonsils w/ exudate
Cervical lymphadenopathy

Mimics Mononucleosis infection caused by EBV

Question 4

Investigations

Answer 4

Monspot test for glandular fever

CENTOR CRITERIA FOR ANTIBIOTICS (3 out of 4)

• presence of tonsillar exudate
• tender anterior cervical lymphadenopathy or lymphadenitis
• history of fever
• absence of cough

Question 5

Management

Answer 5

MEDICAL
-Antibiotics (Phenoxymethylpenicillin incase EBV as rash with amoxicillin)

SURGICAL
Tonsillectomy if meet criteria

Question 6

Complications

Answer 6

• otitis media
• quinsy - peritonsillar abscess
• rheumatic fever and glomerulonephritis very rarely
• Respiratory obstruction

Question 7

Tonsillectomy criteria

Answer 7

1. sore throats are due to tonsillitis (i.e. not recurrent upper respiratory tract infections)
2. the person has five or more episodes of sore throat per year
3. symptoms have been occurring for at least a year
4. the episodes of sore throat are disabling and prevent normal functioning

Question 8

Tonsillectomy complications

Answer 8

primary (< 24 hours): haemorrhage in 2-3% (most commonly due to inadequate haemostasis), pain
secondary (24 hours to 10 days): haemorrhage (most commonly due to infection), pain