Tonsillitis is defined as an infectious disease characterized by the inflammation of tonsils.
Tonsillitis is of two types:
- Acute tonsillitis
- 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 (7th edition) Diseases of Ear, Nose and Throat & Head and Neck Surgery, Elsevier publications.
- Tonsillitis and Diphtheria- Centres for Disease Control and prevention (CDC)