Tonsillitis is of two types:

1. Acute tonsillitis
2. Chronic tonsillitis

Acute Tonsillitis:

Aetiology:

• Streptococci, Pneumococci and Hemophilus influenzae.
• Haemolytic streptococcus- most common organism.
• Mainly seen in school-going children but also affects children.

Symptoms:

• Sore throat
• Difficulty in swallowing
• Fever
• Ear ache

Signs:

• Often breath is foetid and tongue is coasted
• Hyperaemia of pillars, soft palate and uvula

Examination:

• Endoscopy
• Culture test

Clinical management:

• Pt should take bed rest.
• Plenty of fluids must be taken.
• PCM-650 must be taken thrice a day for pain relief & fever.
• Gargle with warm salt water or betadine solution (1:3 dilution).

Antimicrobial therapy:

Adult dosage:

• Penicillin V 500mg PO BD for 10 days or 250mg PO QID for 10 days.
• Benzathine penicillin G 1.2 million units IM once or
• Amoxicillin 500-875mg PO q12h or 250-500mg PO q8h for 10 days
• Cefuroxime axetil 500mg PO BD for 5 days

Paediatric dosage:

• Penicillin V 25-50mg/kg/day divided q6h for 10 days or
• Benzathine penicillin G 25,000 units/kg IM once or
• Amoxicillin 50mg/kg/day PO in 2 or 3 divided doses for 10 days or
• Amoxillin clavulanate 500-875mg PO q12h for 10 days
• Cefuroxime axetil 10mg/kg PO BD for 7 days

Differential diagnosis:

• Diphtheria, Pharyngitis

Chronic Tonsillitis:

• Complication of acute tonsillitis.
• Mostly affects children & young adults.
• Rarely occurs after 50 years.
• Caused by chronic infection in tooth or sinuses.

Signs:

• Enlarged tonsils
• Yellowish beads of pus

Complications:

• Peritonsillar abscess
• Parapharyngeal abscess
• Intratonsillar abscess
• Tonsilloliths
• Tonsillar cyst

Clinical management:

• Tonsillectomy

Preventive measures:

• The best way to prevent tonsillitis is by washing hands and good hygienic practices.
• Good oral care must be maintained.
• Avoid sharing food, dishes, water bottles or utensils.
• Replace tooth brushes after infection.
• Avoid having low quality ice creams and juices.

Red flags:

• Teeth and skeletal abnormalities of teeth

Pit falls:

• Confused with Ricketts

Pearls:

• Defluorination of water & fluoride paste

References:

• PL Dhingra, Shruti Dhingra (7^th edition) Diseases of Ear, Nose and Throat & Head and Neck Surgery, Elsevier publications.
• Tonsillitis and Diphtheria- Centres for Disease Control and prevention (CDC)