Tonsillitis Related Terms

Adenoid Hypertrophy Adenotonsillitis Infective Adenoiditis Infective Tonsillitis Pharyngotonsillitis Septic Adenoiditis Septic Tonsillitis Suppurative Adenoiditis Suppurative Tonsillitis Tonsillar Hypertrophy Viral Tonsillitis

Differential Diagnoses

Adenoid hypertrophy Lymphoma Pharyngitis Strep throat Infectious mononucleosis Epiglottitis Peri-tonsillar abscess Retropharyngeal abscess Gonococcal pharyngitis Diphtheria HIV infection

Specialists

Family Physician General Surgeon Internal Medicine Physician Otolaryngologist Pediatrician

Comorbid Conditions

Chronic sinusitis Pharyngitis Severe nasal obstruction English Village, Gulan Street, Erbil, Kurdistan Region of Iraq www.bcm-medical.com

Factors Influencing Duration Length of disability may be influenced by the underlying cause (bacterial or viral infection), method of treatment (antibiotics or surgery), response to treatment, or the presence of complications (presence of other infections).

Definition Tonsillitis is an inflammation of the fleshy tissues that lie on either side of the back of the mouth at the top of the throat (pharyngeal or palatine tonsils). These tissues contain cells that are useful in fighting infection. Inflammation of the tonsils can be caused by many contagious bacteria or viruses, including strains of streptococcus bacteria, adenovirus, influenza virus, Epstein-Barr virus, enterovirus, and the herpes simplex virus. One of the most frequent causes of tonsillitis is group A beta hemolytic Streptococcus pyogenes (GABHS), which is also the cause of strep throat; it is responsible for 30% of childhood tonsillitis and 10% of adult cases (Lauro). Adenoiditis is an inflammation of the lymphoid tissue at the back of the roof of the mouth (the adenoids). Adenoiditis, or enlarged adenoids (adenoid hypertrophy), is unusual in adults because the adenoids normally shrink and almost disappear as the individual reaches adolescence. Hypertrophy of the adenoids occurs naturally or is caused by chronic inflammation. Chronic adenoid inflammation may cause nosebreathing problems due to their location. Tonsillitis and adenoiditis may occur at the same time in children. Risk: Children are at a greater risk for both tonsillitis and adenoiditis. The risk is higher in those with a family history of tonsillectomy; in adults, the risk is variable and unspecified. Incidence and Prevalence: Tonsillitis is a common condition, with nearly all children becoming infected at least once (Shah). Carrier status of GABHS is found in 2.5% to 10.9% of school-age children (Shah). Tonsillitis Symptoms Symptoms of tonsillitis include: Sore throat English Village, Gulan Street, Erbil, Kurdistan Region of Iraq www.bcm-medical.com

Difficulty feeding (in babies) Pain with swallowing Fever Headache Abdominal pain Nausea and vomiting Cough Hoarseness Runny nose Redness of the tonsils and throat Tenderness in the glands of the neck (swollen lymph glands) White patches on the tonsils Redness of the eyes Rash Ear pain (caused by nerves that go to the back of the throat also go to the ear)

Diagnosis History: Individuals with tonsillitis may report a sudden onset of a sore throat, painful swallowing, and fever. In addition, the individual may experience headache, loss of appetite, chills, malaise, and swollen lymph nodes in the neck and jaw area. Individuals with adenoiditis may report chronic or acute pus-like nasal discharge and chronic mouth breathing due to nasal blockage (obstruction). The individual may also experience painful swallowing, snoring, sleep disturbances (sleep apnea and restlessness), and ear infections (otitis media). A history of prior bouts of tonsillitis may be reported (chronic tonsillitis). Physical exam: Examination of the neck and throat of an individual with tonsillitis reveals swollen, red tonsils, often coated with white areas of exudate if tonsillitis is caused by Streptococcus pyogenes. In some cases, grayish-white membranes and red spots (petechiae) may be seen if tonsillitis is caused by Epstein-Barr virus. The lymph nodes in the neck and jaw area may be swollen and tender, and the neck may be stiff. Signs of dehydration may be seen in the skin and mucosa. Ulcerated areas may be found on the tonsils, suggestive of herpes simplex virus. A physical exam of an individual with adenoiditis reveals enlarged adenoids and nasal discharge. A rhinoscopy (examination of the nose with a speculum) may be performed. Tests: A swab of the tonsils may be cultured to determine if the tonsillitis is caused by English Village, Gulan Street, Erbil, Kurdistan Region of Iraq www.bcm-medical.com

streptococcal bacteria. An x-ray of the side view of the throat may be taken in individuals who may have adenoiditis.

Treatment Tonsillitis that is caused by a bacterial infection is usually treated with a 10- to 14-day course of antibiotics, given either as a one-time injection or orally. Penicillin is the drug of choice for tonsillitis; for people allergic to penicillin, erythromycin or clindamycin may be prescribed. Supportive treatment includes drinking plenty of fluids, rest, use of a humidifier, and use of over-the-counter medications to relieve pain and/or fever. Tonsillitis that is caused by a viral infection is not treated with antibiotics but may be treated with antiviral medications. Adenoiditis may be treated with antibiotics if symptoms do not improve after 10 to 12 days. Surgical removal of the tonsils (tonsillectomy) and adenoids (adenoidectomy) is usually recommended if the tonsils and/or adenoids become chronically infected, if there is an obstruction of the airway, or if the individual experiences excessive snoring or sleep apnea (when breathing momentarily and episodically stops during sleep). These procedures, particularly in adults, can cause severe pain.

Prognosis Most cases of tonsillitis heal well and go away in 7 to 10 days. Bacterial infections usually respond favorably to antibiotic therapy. Symptoms of tonsillitis usually lessen 2 to 3 days after treatment begins. If infections recur frequently, surgical removal of the tonsils and adenoids (tonsillectomy and adenoidectomy) may be advised. This surgery is usually successful.

Rehabilitation Rehabilitation therapy is not necessary. The individual should get adequate rest and drink plenty of fluids until the infection clears.

Complications Complications of tonsillitis are rare primarily because of advances in medical and surgical treatment. If left untreated, tonsillitis associated with Streptococcus pyogenes can lead to more serious conditions such as rheumatic fever and possible accompanying English Village, Gulan Street, Erbil, Kurdistan Region of Iraq www.bcm-medical.com

cardiovascular disorders, or kidney complications (post-streptococcal glomerulonephritis) that can lead to kidney failure. Other complications of untreated tonsillitis include viral or bacterial throat infections (pharyngitis), dehydration due to difficulty swallowing fluids, difficulty breathing (airway obstruction), and abscesses in other parts of the throat (quinsy or peritonsillar abscess). Complications of adenoiditis include right-sided heart failure (cor pulmonale), chronic ear infections (otitis media), airway obstruction, and obstructive sleep apnea, in which an individual periodically stops breathing while sleeping.

Return to Work (Restrictions / Accommodations) Work restrictions or accommodations are not usually associated with this condition unless a tonsillectomy/adenoidectomy has been performed. These procedures are usually done on an outpatient basis, and recovery from surgery usually requires 1 to 2 weeks. A person can return to work 24 hours after starting antibiotic treatment.

Failure to Recover If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:

Did individual experience symptoms of sore throat, fever, malaise, and/or purulent nasal discharge, ear infections or snoring? Has a culture and sensitivity been performed to identify the causative organisms and most appropriate antimicrobial therapy? Has diagnosis of tonsillitis and/or adenoiditis been confirmed? If not, have other conditions with similar symptoms, such as strep throat, lymphoma, or other cancers, been ruled out?

Regarding treatment:

Has any underlying bacterial infection been treated with the appropriate antibiotics (according to a culture and sensitivity)? If the infection was viral, were antiviral medications warranted? Has the prescribed medication been taken according to instructions? Has surgical intervention been considered (i.e., for chronic infection, or associated snoring or sleep apnea)? With adenoiditis, have symptoms persisted longer than 10 to 12 days? If so, English Village, Gulan Street, Erbil, Kurdistan Region of Iraq www.bcm-medical.com

were antibiotics prescribed? Regarding prognosis:

Has the infection persisted despite treatment? If so, has culture and sensitivity been done to identify the causative organism, determine the most effective antibiotic, and to rule out antibiotic-resistant organisms? Would extended therapy or a change in antibiotics be warranted at this time? Was surgery indicated? Did individual experience any complications associated with the infection, such as rheumatic fever, glomerulonephritis, cor pulmonale, or throat abscesses, that could affect recovery and prognosis? Have these complications been addressed in the treatment plan? Does individual have a comorbid condition that may affect recovery, such as severe nasal obstruction or chronic sinusitis?

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