Tonsillitis
- Acute bacterial or viral infection causing inflammation of the palatine tonsils. Infection may also affect the pharyngeal tonsils or adenoids
- There are 4 types of tonsillar disease: acute tonsillitis, recurrent acute tonsillitis, chronic tonsillitis, and obstructive tonsillar hyperplasia
- Diagnosis is clinical. On examination, ensure that the airway is not obstructed by tonsils. A gray exudate may indicate diphtheria, an important differential diagnosis
- Treatment for streptococcal tonsillitis is penicillin V, or erythromycin in penicillin-allergic patients
- Other complications of untreated tonsillitis include rheumatic fever
- If breathing is severely affected by possible obstruction or if epiglottitis is suspected
- If fever exceeds 104°F (40°C)
- If gray exudate is present and points to diphtheria, hospitalization, isolation, and notification of public health officials is required
- Urgent surgical drainage is indicated if peritonsillar abscess (ie, quinsy) or parapharyngeal abscess is diagnosed
- Severe infections require hospitalization and intravenous antibiotics
- Inability to swallow can lead to dehydration; treat with intravenous fluid
Description
- Acute bacterial or viral infection causing inflammation of the palatine tonsils. The tonsils are large, fleshy, oval masses of tissue that lie in the lateral wall of the oral pharynx
- Infection may also affect the pharyngeal tonsils or adenoids, similar masses of tissue located between the back of the nose and the throat
- Four types of tonsillar disease exist: acute tonsillitis, recurrent acute tonsillitis, chronic tonsillitis, and obstructive tonsillar hyperplasia
- Features:
- Fever that can be as high as 104°F (40°C)
- Sore throat that may impair swallowing
- Patients with acute tonsillitis often have sore throat, fever, dysphagia, tender cervical lymphadenopathy, and erythematous/exudative tonsils
- Patients may also report otalgia, headache, and vomiting
- Tonsillitis and pharyngitis can occur simultaneously
Epidemiology
Incidence- Peaks in winter and early spring
Age:
- Most common in children aged 6 to 12 years; however, all ages are affected
- Tonsillitis in children aged less than 3 years is rare and usually of viral etiology
- Affects male and female population equally
- Further spread of infection may occur from cramped living, traveling, or working conditions
Causes and risk factors
Causes:- Influenza A and B viruses
- Respiratory syncytial virus (RSV)
- Adenovirus
- Streptococcus groups A and G, group A ß-hemolytic streptococci
- Epstein-Barr virus
- Herpes simplex
- Neisseria gonorrhoeae
- Serious causes:
- Epstein-Barr virus and Neisseria gonorrhoeae
- Staphylococcus aureus
- Mycoplasma pneumoniae
- Chlamydia pneumoniae
- Enhanced spread of infection due to cramped living, traveling, or working conditions
- Repeat attacks are often caused by reinfection by family members or close contacts
- Also common in school populations; viral tonsillitis is common in the military and closed communities
Associated disorders
- Acute pharyngitis
- Acute adenoiditis
- Acute laryngitis
- Infectious mononucleosis
- Thyroiditis
- Otitis media
Screening
Not applicable.Primary prevention
Summary approach
Tonsillectomy eliminates risk of recurrent infections.Preventive measures
- Smoking cessation reduces the risk of tonsillitis and may help reduce severity of throat infections
- Excessive alcohol intake should be discontinued
- Inappropriate or ineffective antibiotic use may increase resistance
