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Tonsillitis

Causes

  • Viral

  • Bacterial - Group A Strep (strep pyogenes), S. pneumoniae, H. influenzae, M. catarrhalis


Presentation

  • Sore throat

  • Dysphagia/odynophagia

  • Fever

  • O/E

    • Red, inflamed tonsils +/- white exudates

    • Anterior cervical lymphadenopathy


Viral tonsillitis is more associated with headache, apathy and abdominal pain, whilst Bacterial tonsillitis is more associated with purulent discharge and cervical lymphadenopathy.

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“A case of strep throat, culture positive.” © James Heilman, MD CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0/)

N.B. Waldeyer’s Tonsillar Ring is the ring of lymphoid tissue, which includes the nasopharyngeal, tubal, palatine, and lingual tonsils.


Centor Criteria

This is used to assess likelihood of a sore throat being due to bacterial infection.

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Management

Viral:

  • Safety netting i.e. seek medical attention if temp spike, new exudates, new lymphadenopathy

  • Simple analgesia (paracetamol, ibuprofen)


Bacterial (Centor > 3):

  • Phenoxymethylpenicillin (Pen V) 500mg QDS for 5-10 days

    • Clarithromycin if pen allergic/intolerant


Complications

  • Recurrent tonsillitis - Most common complication

  • Peritonsillar abscess (Quinsy) - Presents with peritonsillar bulge, uvular deviation, trismus and muffled voice - Managed with abx and aspiration

  • Retropharyngeal abscess - Rare complication caused by soft tissue swelling, presenting with a stiff and extended neck

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“A right sided peritonsilar abscess” © James Heilman,MD CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0/)


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