Acute tonsillitis is an acute inflammation of the palatine tonsils. It is commonly caused by viruses.
It peaks between 6 and 15 years of age.
Classification of tonsillitis
| Classification | Description |
|---|---|
| Acute catarrhal tonsillitis (superficial) | The tonsillitis is part of a generalized pharyngitis. It is commonly viral in origin. |
| Acute follicular tonsillitis | The infection spreads into the crypts, which get filled with pus. It appears as yellowish spots. |
| Acute parenchymatous tonsillitis | The infection spreads to the parenchyma. The tonsils appear enlarged and red. |
| Acute membranous tonsillitis | Exudates from the crypts coalesce and form a membrane over the tonsils |
Grading of Tonsillar enlargement
| Grade | Definition | Description |
|---|---|---|
| 1 | < 25% | Tonsils fill less than 25% of the transverse oropharyngeal space measured |
| 2 | 25-49% | Tonsils fill less than 50% of the transverse oropharyngeal space |
| 3 | 50-74% | Tonsils fill less than 75% of the transverse oropharyngeal space |
| 4 | > 75% | Tonsils fill 75% or more of the oropharyngeal space |
- Causative organisms
- Viruses
- Herpes simplex virus
- Epstein-Barr virus
- Cytomegalovirus
- Adenovirus
- Measles virus
- Bacteria
- Streptococcus pyogenes
- Haemophilus influenzae
- Streptococcus pneumoniae
- Staphylococcus aureus
- Viruses
- Risk factors
- Children and adolescents
- Close contact with infected individuals
- Crowded environments such as schools and day-care centres
- Poor hygiene
- Immunodeficiency
- Allergies
- Tobacco smoke exposure
- Gastroesophageal reflux disease
- Signs and symptoms
- Throat pain (sore throat)
- Foul breath
- Difficulty swallowing (dysphagia)
- Pain on swallowing (odynophagia)
- Fever
- May be associated with chills and rigors
- Ear pain
- Either referred from the tonsils, or due to acute otitis media
- Airway obstruction
- Mouth breathing
- Snoring
- Sleep-disordered breathing (sleep apnea)
- Headache, malaise
- Constipation
- Abdominal pain due to mesenteric lymphadenitis
- Physical examination
- Fetid breath
- Open mouth breathing
- Subtle voice change (Thicker voice)
- Hyperemia of the pillars, soft palate, and uvula
- Tonsils are red and swollen
- Yellowish spots of pus (acute follicular tonsillitis)
- Whitish membrane over the medial surface of the tonsils (acute membranous tonsilitis; can be wiped with a swab)
- Tonsils are enlarged and almost meet in the midline
- Odema of the uvula and soft palate (acute parenchymatous tonsillitis)
- Jugulodigastric lymphadenitis
- Stiff neck
- Differentials
- Peritonsillar abscess
- Infectious mononucleosis
- Viral pharyngitis
- Membranous tonsillitis
- Diphtheria
- Vincent angina
- Candidiasis of the tonsils
- Infectious mononucleosis
- Agranulocytosis
- Leukemia
- Aphthous ulcers
- Malignant tonsil
- Traumatic ulcer
- Investigations
- Complete blood count
- Peripheral blood film
- Throat swab and culture
- Rapid antigen detection test
- Serum testing for anti-streptococcal antibodies
- Treatment
- Reassurance
- Symptoms usually last for around 1 week
- Bed rest
- Plenty of fluids
- Analgesia and antipyretics
- Antibiotics (phenoxymethylpenicillin or erythromycin)
- Antihistamines and decongestants
- Antiseptic gargle
- For airway obstruction
- Nasal airway device
- Intravenous corticosteroids
- Humidified oxygen
- Tonsillectomy is the definitive treatment
- Reassurance
- Complications
- Chronic tonsillitis with recurrent attacks due to incomplete resolution of acute infection
- Peritonsillar abscess (Quinsy)
- Parapharyngeal abscess
- Retropharyngeal abscess
- Cervical abscess following suppuration of jugulodigastric nodes
- Acute otitis media
- Sinusitis
- Cervical lymphadenitis
- Mastoiditis
- Internal jugular vein thrombophlebitis
- Rheumatic fever
- Acute post-streptococcal glomerulonephritis
- Subacute bacterial endocarditis in patients with valvular heart disease
- Septicemia