This article is on Tonsillitis, a condition frequently experience by patients and seen by General Practitioners/Otolaryngologists. It is intended to help inform patients, relatives of patients and health professionals. The information in the grey boxes is more technical and intended more for Health professionals that are reading this article.

 

What are the Tonsils?

Tonsils are found at the back of the mouth and are part of the immune system. We have two tonsils, one on each side.

 

What is Tonsillitis?

Tonsillitis is the swelling and infection of the tonsils.

Bacterial cause:
-Strep. pyogenes (Most Common)
-Cornybacterium diphtheria
-Neisseria gonorrhoeae
-Chlamydia trachomatis

Viral Cause:
-EBV
-Rhinovirus
-Enterovirus
-Influenza
-Adenovirus

 

Who gets Tonsillitis?

Tonsillitis most commonly occur in children but can also affect adults.

 

What are the causes?

Tonsillitis is caused by a virus most of the time. It can also be caused by a bacteria.

Brodsky Tonsil Grade
– Grade 0 – Tonsils within tonsillar fossa (not visible)
– Grade 1 – Tonsils visible and occupy <25% oropharyngeal width
– Grade 2 – 25-50% oropharyngeal width
– Grade 3 – 50-75% oropharyngeal width
– Grade 4: >75% oropharyngeal width

 

What are the symptoms?

Common symptoms include sore throat, fevers, difficulty swallowing and bad breath. The tonsils may look enlarged, red or have while spots on them.

 

How is it diagnosed?

Diagnosis is made through clinical assessment. Throat swabs should be taken to exclude group A Streptococcal infections, especially in high risk patient groups for endocarditis

 

What are the potential complications?

While most cases will improve after 7-10 days, some patients will experience worse symptoms than others despite the medical treatment. If you have persistent high fevers, are struggling to open your mouth, have difficulty breathing or drinking water please seek medical attention.

Patients with severe symptoms may require a short admission to hospital.

Complications:
– Peritonsillar Abscess (Quinsy)
– Peritonsillar Cellulitis
– Retropharyngeal abscess
– Airway obstruction
– Rheumatic Fever
– Glomerulonephritis

Differentials:
– Mononucleosis
– Scarlet Fever

 

What are the treatment options?

Supportive care and time are the main form of treatment for Tonsillitis. This includes rest and plenty of fluid intake. Paracetamol and Ibuprofen are useful medication to manage pain and fevers.

Antibiotics:
– Oral Penicillin

Penicillin Allergy:
– Erythromycin
– Cephalosporin

Antibiotics should be taken to treat bacterial tonsillitis. Patients who have recurrent episodes of Tonsillitis or other complications may benefit from a discussion with an ENT Surgeon regarding a Tonsillectomy.

 

Can you prevent Tonsillitis?

Tonsillitis cannot be prevented. Some people are more prone to having tonsillitis than others.

Generally, keeping children up to date with immunization, staying home when unwell and practicing good hygiene are important.

 

What is the prognosis?

Most cases improve with supportive care (fluids/pain relief) after 7-10days.

Recurrent episodes may occur, but having one episode does not increase the chance of another infection.

 

What are the day to day impacts?

The severity of symptoms vary from person to person. Expect to take around 1 week off work or school. There is usually no long term effects from having Tonsillitis.

 

Further reading:

Tonsillitis – Mayoclinic.org

 

References:
1. Windfuhr J, Toepfner N, Steffen G et al. Clinical practice guideline: tonsillitis I. Diagnostics and nonsurgical management. 2016. Eur Arch Otorhinolaryngol. 273:973–987
2. Sidell D, Shapiro N. Acute Tonsillitis. 2012. Infectious Disorders – Drug Targets, 12, 271-276
3. Brodsky L. Modern assessment of tonsils and adenoids. 1989. Pediatr Clin North Am. 36(6):1551-69

 

Author + Affiliation:
Dr Johnny Wu, Department of Otolaryngology, Waikato Hospital.
Reviewed by Dr , Otolaryngologist, Waikato Hospital

Date of Publication +/- Review:
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