MARCH 8TH, 2023
Acute Tonsillitis: inflammation of the tonsils
Presenting Symptoms: Erythematous (possibly exudative) tonsils, odynophagia, trismus, earache, fever, coughing, headache, halitosis
Epidemiology: Tonsillitis can affect people of all ages, but most commonly ages 5-15.
Etiology/Pathophysiology: Viral infection accounts for 70% of tonsillitis cases and often leads to subsequent bacterial superinfection.
Most common viral causes: Rhinovirus, Adenovirus, Coronavirus, Epstein-Barr Virus
Most common bacterial causes: Group A Streptococcus, Moraxella, H. influenza
Diagnosis:
Physical exam (direct visualization of the oral cavity/oropharynx)
Rapid Strep, Antistreptolysin-O, bacterial culture, or Monospot tests to determine bacterial/viral etiology
Treatment:
Tonsillitis with suspected or confirmed bacterial etiology can be treated with oral antibiotics targeting specific antigen, such as penicillin or clindamycin.
For viral tonsillitis (e.g. EBV), rest, hydration, over-the-counter pain relievers, and throat lozenges are recommended.
If a patient is experiencing chronic or recurrent tonsillitis, a tonsillectomy should be considered.
Major indications for tonsillectomy (recurrent or chronic tonsillitis) are defined by the Paradise criteria
Paradise criteria:
7 infections in 1 year, 5 infections/year in 2 years, 3 infections/year in 3 years
Infection = sore throat with 1 + of following:
>38.3C
Cervical adenopathy
Tonsillar exudate
Positive strep-testing
Recurrent tonsillitis not meeting above criteria with antibiotic allergy, PFAPA, or previous peritonsillar abscess
Inflamed tonsils
Functions of Tonsils. News Medical Life Sciences. Accessed 5 March 2023.
StatPearls - Tonsillitis NIH National Library of Medicine. Accessed 5 March 2023.
Further Reading:
Tonsilitis
Clinical Guidelines (2019) for pediatric tonsillectomy
Tonsillectomy Trends
Written by: Phuong (Alexandria) Bao
