What is tonsillitis?
inflammation of the tonsils in the throat.
What are the two types of tonsillitis?
- Acute
- Chronic
What is the incidence rate of acute tonsillitis?
A general practitioner (GP) typically sees around 120 people in a 2,000-patient population with an acute sore throat every year.
What is the incidence rate of chronic tonsillitis?
chronic tonsillitis generally has an incidence of 100 per 1,000-patient population in the UK
What age demographic has the highest incidence rate?
children and young adults, aged 5 to 24 years old, have the highest incidence, representing 50% of total cases
What is the ring-shaped lymphoid tissue on the oropharynx?
Waldeyer’s ring
How many groups of tonsils are there in the waldeyer’s ring?
4
What are the 4 main groups of tonsils called?
- Adenoid
- Tubal
- Palatine
- Lingual
What are the 3 types of infection that can cause tonsillitis?
- Viral
- Bacterial
- Non-infectious
What are the most common viral causes of tonsillitis?
- Rhinovirus (most common)
- Coronavirus
- Parainfluenza
- Epstein Barr Virus (EBV)
What are the most common bacterial causes of tonsillitis?
- Group A beta-haemolytic Streptococcus (GABHS; most common)
- Haemophilus influenzae
- Moraxella catarrhalis
What are some non-infectious causes of tonsillitis?
- Gastro-oesophageal reflux disease
- irritation (e.g. from nasogastric tubes
What are the typical symptoms of tonsillitis?
- Sore throat
- Cough
- Coryzal prodrome
- Dysphonia
- Pyrexia
- Pain and malaise
What are 2 less common symptoms of tonsillitis?
- Dysphagia
- Halitosis
Upon examination, what are the typical clinical findings of tonsillitis?
- Fever
- Swollen erythematous palatine tonsils
- Cervical lymphadenopathy
- Tonsils covered with exudate
What is a less common finding of tonsillitis?
Peritonsillar abscess (usually a complication of acute tonsillitis)
What is a Peritonsillar abscess?
unilateral bulge above tonsils, accompanied by symptoms such as a sore throat, dysphagia, trismus and a classical hot potato voice.
What are the 3 differential diagnosis’ for tonsillitis?
- Epiglottis
- Infection mononucleosis (glandular fever) due to Epstein Barr Virus
- Squamous cell carcinoma
What are 4 features differentiating epiglottitis from tonsillitis?
Acute and severe onset
Muffled voice
Drooling
Stridor
What are 4 features differentiating glandular fever from tonsillitis?
Pharyngitis of longer duration
Splenomegaly
FBC – raised WBC count with lymphocytosis
Positive Monospot test (in patients > 4 years old)
What are 3 features differentiating squamous cell carcinoma from tonsillitis?
Unilateral tonsillar enlargement
Dysphonia
Ulcers
What does bleeding 5-10 after a tonsillectomy indicate?
Haemorrhage 5-10 days after tonsillectomy is commonly associated with a wound infection and should therefore be treated with antibiotics
