Tonsillitis

1. Introduction

  • Definition: Tonsillitis is the inflammation of the tonsils, which are lymphoid tissues located at the back of the throat. It can be caused by infections or other irritants.
  • Epidemiology: Common in children and young adults, though it can affect people of all ages. Viral tonsillitis is more prevalent than bacterial.
  • Significance: While most cases are mild, recurrent or untreated bacterial tonsillitis can lead to complications like abscesses or rheumatic fever.

2. Causes and Risk Factors

  • Causes:
    • Infectious:
      • Viral (most common): Adenovirus, rhinovirus, Epstein-Barr virus (mononucleosis).
      • Bacterial: Group A Streptococcus pyogenes (strep throat), less commonly Staphylococcus aureus.
    • Non-infectious: Irritants like smoking or environmental pollutants.
  • Risk Factors:
    • Close contact with infected individuals.
    • Age (more common in children aged 5–15).
    • Seasonal factors (higher prevalence in winter and early spring).

3. Pathophysiology

  • Tonsillitis occurs when infectious agents or irritants trigger inflammation of the tonsils. This leads to swelling, redness, and the production of pus. In bacterial cases, toxins produced by Group A Streptococcus exacerbate the immune response, causing systemic symptoms like fever.

4. Symptoms and Features

  • Common Symptoms:
    • Sore throat and painful swallowing (odynophagia).
    • Red, swollen tonsils, sometimes with white patches or exudates.
    • Fever, fatigue, and bad breath (halitosis).
  • Specific Signs:
    • Viral tonsillitis: Accompanied by cough, runny nose, and hoarseness.
    • Bacterial tonsillitis: Fever >38°C, swollen cervical lymph nodes, absence of cough.

5. Complications

  • Local Complications:
    • Peritonsillar abscess (quinsy).
    • Airway obstruction due to severe swelling.
  • Systemic Complications:
    • Rheumatic fever.
    • Post-streptococcal glomerulonephritis.
    • Septicaemia (rare).

6. Diagnosis

  • Clinical Features: Diagnosis is based on history and physical examination, including throat redness, exudates, and lymph node swelling.
  • Diagnostic Tests:
    • Rapid antigen detection test (RADT) for Group A Streptococcus.
    • Throat culture for confirmation in suspected bacterial cases.
    • Blood tests (e.g., monospot test) for Epstein-Barr virus in suspected mononucleosis.

7. Management Overview

  • Goals: Relieve symptoms, eradicate infection (if bacterial), and prevent complications.
  • Approach: Supportive care for viral tonsillitis, antibiotics for bacterial causes, and surgical intervention for recurrent or chronic cases.

8. Treatment Options with Cost (USD)

  • Supportive Care:
    • Pain relievers (e.g., paracetamol, ibuprofen): ~$5–$10 per pack.
    • Saltwater gargles: Minimal cost.
    • Lozenges or sprays (e.g., benzocaine): ~$5–$15 per pack.
  • Antibiotics (if bacterial):
    • Penicillin V or amoxicillin: ~$10–$20 per course.
    • Azithromycin (for penicillin-allergic patients): ~$15–$30 per course.

9. Advanced Treatment Options with Cost (USD)

  • Surgical Interventions:
    • Tonsillectomy for recurrent or chronic tonsillitis: ~$3,000–$10,000.
  • Hospitalisation:
    • For complications like peritonsillar abscess drainage: ~$5,000–$15,000.

10. Pharmacological Treatment

  • First-line: Penicillin V or amoxicillin for confirmed bacterial tonsillitis.
  • Adjunctive: NSAIDs or paracetamol for pain and fever relief.
  • Refractory Cases: Clindamycin or cefuroxime for resistant infections.

11. Medication Tables

Table 1: Doses and Side Effects

DrugIndicationDoseCommon Side Effects
Penicillin VBacterial tonsillitis250 mg 2–3 times daily for 10 daysGI upset, rash
AmoxicillinBacterial tonsillitis500 mg twice daily for 10 daysDiarrhoea, rash
AzithromycinPenicillin allergy500 mg on day 1, then 250 mg daily for 4 daysNausea, headache
IbuprofenPain and fever relief200–400 mg every 6–8 hoursStomach upset, dizziness
Benzocaine lozengesSymptom reliefAs neededNumbness, throat irritation

Table 2: Brand Names and Approximate Costs (USD)

DrugBrand NamesApprox. Cost
Penicillin VPen VK$10–$15 per course
AmoxicillinAmoxil$10–$20 per course
AzithromycinZithromax$15–$30 per course
IbuprofenAdvil, Motrin$5–$10 per pack
Benzocaine lozengesCepacol, Chloraseptic$5–$15 per pack

12. Lifestyle Interventions

  • Rest and stay hydrated to support recovery.
  • Avoid irritants like smoking or alcohol.
  • Use a humidifier to keep air moist and ease throat discomfort.
  • Consume soothing foods and drinks, such as warm broths or teas.

13. Monitoring Parameters

  • Symptom resolution within 7–10 days for viral tonsillitis and 24–48 hours for bacterial cases on antibiotics.
  • Monitor for complications such as difficulty swallowing, abscess formation, or systemic symptoms.
  • Assess for recurrent or chronic tonsillitis, which may require surgical evaluation.

14. Patient Counseling Points

  • Educate that most cases of tonsillitis are viral and self-limiting, requiring supportive care only.
  • Stress the importance of completing antibiotics for bacterial infections to prevent complications.
  • Avoid sharing utensils or close contact with infected individuals to prevent spread.
  • Seek medical attention if symptoms worsen, include breathing difficulty, or last longer than 10 days.

15. Special Populations

  • In Children: Use weight-based dosing for medications; consider tonsillectomy for recurrent infections (>7 episodes/year).
  • In Pregnancy: Penicillin or amoxicillin are safe; avoid NSAIDs.
  • In Immunocompromised Individuals: Higher risk of severe infections; require early diagnosis and treatment.

16. Prevention

  • Practice good hand hygiene and avoid close contact with sick individuals.
  • Treat allergies or chronic nasal congestion to reduce throat irritation.
  • Ensure children are up to date with vaccinations to prevent infections like diphtheria.
  • Avoid smoking or exposure to second-hand smoke.

17. FAQs

  1. What is tonsillitis?
    Answer: Inflammation of the tonsils, often caused by infections.
  2. What causes tonsillitis?
    Answer: Viral or bacterial infections, with viruses being more common.
  3. How is tonsillitis treated?
    Answer: Supportive care for viral cases; antibiotics for bacterial infections.
  4. Is tonsillitis contagious?
    Answer: Yes, especially if caused by infectious agents like viruses or bacteria.
  5. How long does tonsillitis last?
    Answer: Viral tonsillitis resolves in 5–7 days; bacterial improves within 24–48 hours of antibiotics.
  6. When should a tonsillectomy be considered?
    Answer: For recurrent infections or complications like abscesses.
  7. Can tonsillitis cause complications?
    Answer: Yes, including abscesses, rheumatic fever, and kidney inflammation.
  8. What is quinsy?
    Answer: A peritonsillar abscess causing severe throat pain and difficulty swallowing.
  9. Can adults get tonsillitis?
    Answer: Yes, though it is more common in children.
  10. What foods help with tonsillitis?
    Answer: Soft, soothing foods like broths, yoghurts, and ice cream.
  11. Are lozenges effective for tonsillitis?
    Answer: They provide temporary relief for pain and irritation.
  12. Can tonsillitis recur?
    Answer: Yes, especially if caused by chronic bacterial infections or irritants.
  13. Is strep throat the same as tonsillitis?
    Answer: Strep throat is a type of bacterial tonsillitis caused by Group A Streptococcus.
  14. How can I prevent spreading tonsillitis?
    Answer: Avoid sharing utensils, maintain good hygiene, and stay home while symptomatic.
  15. Is gargling with salt water effective?
    Answer: Yes, it can reduce swelling and discomfort.