Tonsillitis overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]}
Overview
Tonsillitis is an infection of the tonsils and will often, but not necessarily, cause a sore throat and fever.
Classification
There are 3 main types of tonsillitis: acute, subacute and chronic. Acute tonsillitis can either be bacterial or viral (75%) in origin. Subacute tonsillitis (which can last between 3 weeks and 3 months) is caused by the bacterium Actinomyces. Chronic tonsillitis, which can last for long periods if not treated, is almost always bacterial.
Pathophysiology
Tonsillitis is associated with infection, it is currently unknown if the swelling and other symptoms are caused by the infectious agents themselves, or by the host immune response to these agents. Tonsillitis may be a result of aberrant immune responses to the normal bacterial flora of the nasopharynx.
Causes
The most common causes of tonsillitis are adenovirus, rhinovirus, influenza, coronavirus, and respiratory syncytial virus. It can also be caused by Epstein-Barr virus, herpes simplex virus, cytomegalovirus, or HIV. The second most common causes are bacterial.
Diagnosis
History and Symptoms
Symptoms of tonsillitis include a severe sore throat (which may be experienced as referred pain to the ears), painful/difficult swallowing, headache, fever and chills, and change in voice causing a "hot potato" voice.
Physical Examination
Tonsillitis is characterized by signs of red, swollen tonsils which may have a purulent exudative coating of white patches (i.e. pus). In addition, there may be enlarged and tender neck cervical lymph nodes.
Laboratory Findings
The diagnosis of GABHS tonsillitis can be confirmed by culture. Samples are obtained by swabbing both tonsillar surfaces and the posterior pharyngeal wall are plated on sheep blood agar medium. The isolation rate can be increased by incubating the cultures under anaerobic conditions and using selective media.
Treatment
Medical Therapy
Treatment of tonsillitis consists of pain management medications[1] and lozenges.[2] If the tonsillitis is caused by bacteria, then antibiotics are prescribed, with penicillin being most commonly used.[3] Erythromycin is used for patients allergic to penicillin. In many cases of tonsillitis, the pain caused by the inflamed tonsils warrants the prescription of topical anesthetics for temporary relief. Viscous lidocaine solutions are often prescribed for this purpose. Ibuprofen or other analgesics can help to decrease the edema and inflammation, which will ease the pain and allow the patient to swallow liquids sooner.[1] When tonsillitis is caused by a virus, the length of illness depends on which virus is involved. Usually, a complete recovery is made within one week; however, some rare infections may last for up to two weeks. Additionally, gargling with a solution of warm water and salt may reduce pain and swelling.
Surgery
Chronic cases may indicate tonsillectomy (surgical removal of tonsils) as a choice for treatment.[4]
References
- ↑ 1.0 1.1 Boureau, F.; et al. "Evaluation of Ibuprofen vs Paracetamol Analgesic Activity Using a Sore Throat Pain Model". Clinical Drug Investigation. 17 year=1999: 1–8. - Boureau studied 113 patients who saw 19 physicians in France. Patients were give Ibuprofen 400mg or Paracetamol 1000mg randomly. Pain intensity, difficulty swallowing, and global pain relief were use to measure in hourly increments until 6 hours after patients first dose. The results showed that Ibuprofen better than Paracetamol in all three categories
- ↑ Praskash, T.; et al. (2001). "Koflet lozenges in the Treatment of Sore Throat". The Antiseptic. 98: 124–127. - The efficacy of Koflet Lozenges was evaluated by symptomatic relief of pain. The 48 patients were examined by the Physicians and given a scale rating from 0-3. 0 stating no signs and symptoms and 3 being the worse. The results showed patients with pharyngitis 95% of the patient with positive feedbacks. Tonsillitis patients and patients with both symptoms gave 100% positive feedbacks
- ↑ Touw-Otten FW, Johansen KS (1992). "Diagnosis, antibiotic treatment and outcome of acute tonsillitis: report of a WHO Regional Office for Europe study in 17 European countries". Fam Pract. 9 (3): 255–62. doi:10.1093/fampra/9.3.255. PMID 1459378. - 17 European Countries had a minimum of 10 physicians each that participated in a studied that involved 4094 patients that they had seen from Nov 1989 to May 1990. Sore throat, redness and swelling of tonsils, pus on tonsils, enlarge regional lymph nodes, or fever. Bacterial and serology test were performed to determined antibiotics usage. Antibiotics results had 2334 out of 3646 patient using penicillin. 343 out of the 3646 used amoxicillin and 554 out of 3646 used macrolides
- ↑ Paradise JL, Bluestone CD, Bachman RZ; et al. (1984). "Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and nonrandomized clinical trials". N. Engl. J. Med. 310 (11): 674–83. PMID 6700642. - Paradise studied 187 children with tonsillectomy or tonsillectomy and adenoidectomy. 91 children were randomly put in surgical and non-surgical groups. The other 96 were place by parent’s choice. The results favored the surgical group on reoccurrence of throat infections during their initial and second year follow-up where the data was collected. While non-surgical groups did better in the long run. 13 out of the 95 surgical group encountered surgical complications after their second year follow up