Tonsillitis

Tonsil infection – tonsillitis

Tonsillitis refers to inflammation of the pharyngeal tonsils – glands at the back of the throat, visible through the mouth

The inflammation may involve other areas of the back of the throat, including the adenoids and the lingual tonsils (tonsil tissue at the back of the tongue)
There are several types of tonsillitis: acute, recurrent, and chronic tonsillitis, and peritonsillar abscess (quinsy)
Viral or bacterial infections and immunologic factors lead to tonsillitis and its complications
Nearly all children experience at least one episode of tonsillitis
Due to improvements in medical and surgical treatments, complications associated with tonsillitis, including mortality, are rare

Tonsillitis most often occurs in children, but rarely in those younger than two years old
Tonsillitis caused by bacteria (streptococcus species) Streptococcus species typically occurs in children aged 5 to 15 years, while viral tonsillitis is more common in younger children
A peritonsillar abscess is usually found in young adults but can occur occasionally in children
The history often helps identify the type of tonsillitis present (i.e., acute, recurrent, chronic)

Most cases of acute pharyngitis and acute tonsillitis are due to the following infections

Patients have a fever, sore throat, foul breath, dysphagia (difficulty swallowing), odynophagia (painful swallowing), and tender cervical lymph nodes
Airway obstruction due to swollen tonsils may cause mouth breathing, snoring, nocturnal breathing pauses, or sleep apnoea
Lethargy and malaise are common
These symptoms usually resolve in three to four days, but may last up to two weeks despite therapy

This diagnosis is made when an individual has multiple episodes of acute tonsillitis in a year

Individuals often have chronic sore throat, halitosis, tonsillitis, and persistently tender cervical nodes

Individuals often have severe throat pain, fever, drooling, foul breath, trismus (difficulty opening the mouth), and muffled voice quality, such as the “hot potato” voice (as if talking with a hot potato in his or her mouth)

Fever and enlarged inflamed tonsils covered by pus
Group A beta-hemolytic Streptococcus pyogenes (GABHS) can cause tonsillitis (“strep throat”) associated with the presence of palatal petechiae (tiny hemorrhagic spots, of pinpoint to pinhead size, on the soft palate)
Neck nodes may be enlarged. A fine red rash over the body suggests scarlet fever
GABHS pharyngitis usually occurs in children 5-15 years old
Open-mouth breathing and muffled voice resulting from obstructive tonsillar enlargement
The voice change with acute tonsillitis usually is not as severe as that associated with peritonsillar abscess
Tender cervical lymph nodes and neck stiffness are often found in acute tonsillitis
Signs of dehydration found by examination of skin and mucosa
Red swollen tonsils that may have small ulcers on their surfaces in individuals with herpes simplex virus (HSV) tonsillitis

The possibility of infectious mononucleosis (glandular fever) due to EBV in an adolescent or younger child with acute throat infection, particularly when cervical, axillary, and/or groin nodes are tender
Severe lethargy, malaise, and low-grade fever accompany acute tonsillitis
A grey membrane covering tonsils that are inflamed from an EBV infection – this membrane can be removed without bleeding
Palatal petechiae (pinpoint spots on the soft palate) may also be seen with an EBV infection

Unilateral bulging above and to the side of one of the tonsils when quinsy (peritonsillar abscess) exists
A stiff jaw, difficulty opening the mouth and pain referred to the ear may be present in varying severity

Tonsillitis is usually treated with a regimen of antibiotics
Fluid replacement and pain control are important
Hospitalization may be required in severe cases, particularly when there is airway obstruction
When the condition is chronic or recurrent, tonsillectomy – a surgical procedure to remove the tonsils is often recommended
Peritonsillar abscess may need more urgent treatment to drain the abscess