[8] Tonsillitis

Question 1

What is tonsillitis?

Answer 1

A form of pharyngitis where there is intense inflammation of the tonsils

Question 2

What often accompanies tonsillitis?

Answer 2

Purulent exudate

Question 3

What are the two main types of tonsillitis?

Answer 3

Bacterial and Viral

Question 4

What is the main cause of bacterial tonsillitis?

Answer 4

Group A beta-haemolytic streptococci

Question 5

What is a cause of viral tonsillitis?

Answer 5

EBV

Question 6

What are the risk factors for tonsillitis?

Answer 6

Smoking - second hand in younger and personal in older

Question 7

What are the potnetial symptoms of tonsillitis?

Answer 7

• Sore throat
• Fever
• Dysphagia/odynophagia
• Halitosis

Question 8

What are the possible signs seen on examination?

Answer 8

• Enlargement of tonsils
• Enlarged cervical lymph nodes
• Red, inflamed tonsils
• White exudate spots on the tonsils

Question 9

What are the differentials for tonsillitis?

Answer 9

• Quinsy
• Pharyngitis
• Glandular fever
• Tonsillar malignancy e.g. lymphoma
• Epiglottitis

Question 10

What is the first step for determining management?

Answer 10

Distinguishing between viral and bacterial tonsillitis

Question 11

How does the causative organism affect management?

Answer 11

Bacterial tonsillitis is an indication for antibiotic therapy

Question 12

What criteria can be used to distinguish between viral and bacterial tonsillitis?

Answer 12

Centor criteria

Question 13

How does the Centor criteria work?

Answer 13

A series of symptoms (or absence of) should be looked for with each symptom (or absence of) scoring +1 point.

Question 14

What score suggests bacterial infection?

Answer 14

3+ is highly suggestive of a bacterial infection

Question 15

What are the symptoms screened for in the Centor criteria?

Answer 15

• Tonsillar exudate
• Tender anterior cervical lymphadenopathy
• Fever, or history of fever
• Absence of cough

Question 16

What is the typical antibiotic used in tonsillitis if the patient requires IV?

Answer 16

Benzylpenicillin

Question 17

How is benzylpenicillin dosed in children?

Answer 17

According to weight

Question 18

How long are antibiotics typically given for in tonsillitis?

Answer 18

7-10 days

Question 19

What should happen if or when the child is able to tolerate oral antibiotics?

Answer 19

Switch to penicillin V

Question 20

What antibiotic is often avoided in tonsillitis?

Answer 20

Co-amoxiclav

Question 21

Why is co-amoxiclav avoided?

Answer 21

There is a risk leaving a permanent skin rash if the tonsillitis is due to glandular fever

Question 22

What are the indications for hospital admission with tonsillitis?

Answer 22

• Respiratory compromise
• Inability to eat or drink
• Failure to respond to community antibiotics

Question 23

What may show respiratory compromise in tonsillitis?

Answer 23

• Tachypnoea
• Low sats
• Use of accessory muscles
• Apnoeic episodes

Question 24

What does inability to eat or drink risk?

Answer 24

Dehydration

Question 25

What types of analgesia may be useful in tonsillitis?

Answer 25

- Paracetamol - Ibuprofen - Topical treatments

Question 26

What topical treatments are available in tonsillitis?

Answer 26

Difflam spray/mouthwash

Question 27

Why are topical analgesics particularly useful?

Answer 27

They can reduce pain enough for the child to take oral analgesics

Question 28

What other medication (besides antibiotics and analgesics) can sometimes be used in tonsillitis?

Answer 28

Oral steroids

Question 29

Why are steroids sometimes helpful?

Answer 29

They can accelerate the resolution of pain and inflammation

Question 30

Is tonsillectomy routinely performed?

Answer 30

No, there are set criteria reserved for children with recurrent episodes

Question 31

What criteria are used to determine if tonsillitis is indicated?

Answer 31

SIGN criteria

Question 32

When do the S|GN criteria indicate tonsillitis?

Answer 32

- 7 or more episodes in 1 year - 5 or more per year for 2 years - 3 or more per year for 3 years

Question 33

What are the potential complications of tonsillitis?

Answer 33

- Quinsy | - Deep neck space abscess

Question 34

How can tonsillitis become quinsy?

Answer 34

Infection can spread into the peritonsillar space and form an abscess

Question 35

How can tonsillitis lead to a deep neck space abscess?

Answer 35

Spread into the retropharyngeal or parapharyngeal space

Question 36

How is a deep neck abscess treated?

Answer 36

Prolonged IV antibiotics and sometimes surgical drainage