What is tonsillitis?
Inflammation of the tonsils
What are the tonsils?
Collections of lymphoid tissue facing into the aerodigestive tract
What is Waldeyer’s ring?
A set of lymphatic tissues (tonsils)
What does Waldeyer’s ring consist of?
- Adenoid tonsils
- Tubal tonsils
- Palatine tonsils
- Lingual tonsil
What is the most common cause of tonsillitis?
Viral infection
What are the viral causes of tonsillitis?
- Adenovirus
- Rhinovirus
- Influenza
- Coronavirus
- RSV
What is the second most common cause of tonsillitis?
Bacterial infection
What is the most common causative bacteria in tonsillitis?
Group A bet-haemolytic strep
What are the less common causative bacteria in tonsillitis?
- Staph. aureus
- Strep. pneumoniae
- Mycoplasma pneumoniae
- Chlamydia pneumoniae
- Bordatella pertussis
What are the risk factors for tonsillitis?
- Immunodeficiency
- Family history of tonsillitis
- Family history of atopy
What are the symptoms of tonsillitis?
- Sore throat
- Odynophagia
- Pain in ears
- Headache
- Loss of voice
What are the signs of tonsillitis?
- Tonsillar erythema
- White flecks of pus (potentially)
- Swollen tonsils
- Pyrexia
- Swollen regional lymph nodes
How is tonsillitis diagnosed?
Clinically
Should throat swabs be performed routinely?
No
What are the differentials of tonsillitis?
- Glandular fever
- HSV
- Coxsackie infection
- Malignancy
How will a patient with glandular fever present?
Quite unwell with very large purulent tonsils and lethargy
How will a patient with coxsackie infection present?
Small blisters on tonsils and roof of mouth
What happens to the blisters in coxsackie infection?
They rupture after a few days and form scabs
How can tonsillitis be differentiated from a malignancy usually?
The enlargement in malignancy is unilateral
What does self-care for tonsillitis include?
- Plenty of rest
- Gargling with warm salt water
- Avoiding social contact
- Antipyretics and analgesia
Are antibiotics helpful in the majority of cases of tonsillitis?
No
What are the indications for antibiotics in tonsillitis?
- Features of marked systemic illness
- Unilateral peri-tonsillitis
- History of rheumatic fever
- Increased risk of infection
- 3 or more of Centor criteria
What are the Centor criteria for tonsillitis?
- History of fever
- Tonsillar exudate
- No cough
- Tender anterior cervical lymphadenopathy
What is the antibiotic of choice in tonsillitis?
Phenoxymethylpenicillin
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Epistaxis55
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Neck Lumps36
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Parapharyngeal Abscess28
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Sialolithiasis30
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Ludwig's Angina28
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Epiglottitis27
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Sjögren’s syndrome34
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Acute Rhinosinusitis41
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Chronic Rhinosinusitis23
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Retropharyngeal Abscess35
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Otitis Externa48
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Acute Otitis Media31
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Chronic Suppurative Otitis Media41
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Otitis Media with Effusion36
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Otosclerosis29
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Vertigo31
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Allergic Rhinitis43
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Tonsillitis29
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Obstructive Sleep Apnoea Syndrome58
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Auricular Haematoma25
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Tympanic Membrane Perforation20
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Sialadenitis20
