Tonsillitis

Overview

• Definition: Inflammation of the palatine tonsils located at the back of the throat.

Classification

• Acute Tonsillitis: Sudden onset, typically resolving within a few days to a week.
• Chronic Tonsillitis: Recurrent episodes over a prolonged period.

Aetiology/ Causes

• Viral: Adenovirus, rhinovirus, Epstein-Barr virus (EBV), influenza virus.
• Bacterial: Most commonly Group A beta-haemolytic Streptococcus (GABHS or Streptococcus pyogenes).

Clinical Features

• Throat: Sore throat, dysphagia, odynophagia.
• General: Fever, malaise, headache.
• Enlarged and erythematous tonsils, possibly with exudate.
• Cervical lymphadenopathy.
• Bad breath (halitosis).

Investigations

• Not usually required but can include:
  • Monospot Test: If infectious mononucleosis (caused by EBV) is suspected.
  • Full blood count (can show raised white cell count in bacterial infections).

Management

• Conservative: hydration.
• Medical:
  • Analgesia (e.g, paracetamol, ibuprofen).
  • Antibiotics (e.g, penicillin) if bacterial cause confirmed or highly suspected. Important for preventing complications such as rheumatic fever.
• Surgical: Tonsillectomy may be considered in recurrent or chronic tonsillitis.

Complications

• Peritonsillar abscess (quinsy).
• Spread of infection to nearby tissues (e.g., retropharyngeal abscess).
• Rheumatic fever (following GABHS infections).
• Glomerulonephritis.

Key Points

• Tonsillitis can be caused by both viruses and bacteria, with the latter often requiring antibiotic treatment.
• It’s crucial to differentiate bacterial from viral causes to guide treatment.
• Chronic or recurrent tonsillitis may necessitate a tonsillectomy.