Tonsilitis

Question 1

What are the symptoms for tonsilitis?

Answer 1

• Intermittent sore throats but absence of a cough
• Fever
• Difficulty swallowing
• Tender anterior cervical lymphadenopathy

Question 2

What is the treatment for tonsilitis?

Answer 2

• Antibiotic treatment (CENTOR criteria) - usually caused by strep A infections
• Usually give phenoxymethylpenicillin (amoxicillin won’t cover strep A) for 10 days
• If penicillin allergy, give erythromycin
• If they get >7 episodes within a year, or >5 episodes each year for last 2 years, or >3 episodes each year for last 3 years, then recommend tonsillectomy
• Dexamethasone recommended in children to prevent postoperative vomiting in children undergoing a tonsillectomy

Question 3

How would tonsillitis present in different age groups?

Answer 3

• In children: suspect bacterial infection
• In older children/young adults: suspect infectious mononucleosis (glandular fever/kissing disease)
• In adults 40+ with recurrent tonsillitis: suspect cancer in oropharyngeal area

Question 4

What is quinsy?

Answer 4

Peritonsillar abscess which can occur as a complication of severe bacterial acute tonsilitis.
- Patients with bacterial infections of pharynx can also develop abscesses in parapharyngeal space and retropharyngeal space.

Question 5

How would quinsy present?

Answer 5

• Uvula deviated away from swelling
• Bulging palate
• Anterior palate pushed medially
• Erythema
• Unilateral
• Odynophagia/can’t really swallow
• Dysphonia

Question 6

What are the signs for tonsilitis?

Answer 6

• Exudate on tonsils
• Bilateral
• Can still swallow
• Usually teenagers

Question 7

What is the treatment for quinsy?

Answer 7

• Normally need IV abx AND drainage
• Drainage done via local anaesthetic via aspiration of pus or by incision and drainage with a knife. It is not pleasant but patient feels almost immediate relief.

Question 8

What is the epidemiology of epiglottitis?

Answer 8

• Common in children/teenagers
• Causes: haemophilius influenzae B (worldwide) and Strep (Britain)

Question 9

What are the symptoms of epiglottitis?

Answer 9

• Sore throat
• Vocal changes (dysphonic/may not be able to talk) - rapid onset hoarse/croaky voice
• Rapid onset aphagia/severe dysphagia
• Septic - pyrexia, tachycardia, tachypnoea
• Stridor (late sign, URT obstruction) - hear it loud after every word

Question 10

What is the management of epiglottitis?

Answer 10

• Don’t look at throat as in children can make them more distressed and close it even more
• A-E
• Steroids (to decrease inflammation)
• Oxygen
• Adrenaline (to decrease inflammation by causing vasoconstriction) - nebulised
• Abx IV and fluids
• Potentially need to intubate, if not possible then tracheostomy

Question 11

What is the CENTOR criteria for tonsilitis?

Answer 11

• Presence of tonsillar exudate
• History of fever
• Absence of cough
• Tender anterior cervical lymphadenopathy
  >3 paracetamol and abx