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.
- Infectious:
- 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
Drug | Indication | Dose | Common Side Effects |
---|---|---|---|
Penicillin V | Bacterial tonsillitis | 250 mg 2–3 times daily for 10 days | GI upset, rash |
Amoxicillin | Bacterial tonsillitis | 500 mg twice daily for 10 days | Diarrhoea, rash |
Azithromycin | Penicillin allergy | 500 mg on day 1, then 250 mg daily for 4 days | Nausea, headache |
Ibuprofen | Pain and fever relief | 200–400 mg every 6–8 hours | Stomach upset, dizziness |
Benzocaine lozenges | Symptom relief | As needed | Numbness, throat irritation |
Table 2: Brand Names and Approximate Costs (USD)
Drug | Brand Names | Approx. Cost |
---|---|---|
Penicillin V | Pen VK | $10–$15 per course |
Amoxicillin | Amoxil | $10–$20 per course |
Azithromycin | Zithromax | $15–$30 per course |
Ibuprofen | Advil, Motrin | $5–$10 per pack |
Benzocaine lozenges | Cepacol, 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
- What is tonsillitis?
Answer: Inflammation of the tonsils, often caused by infections. - What causes tonsillitis?
Answer: Viral or bacterial infections, with viruses being more common. - How is tonsillitis treated?
Answer: Supportive care for viral cases; antibiotics for bacterial infections. - Is tonsillitis contagious?
Answer: Yes, especially if caused by infectious agents like viruses or bacteria. - How long does tonsillitis last?
Answer: Viral tonsillitis resolves in 5–7 days; bacterial improves within 24–48 hours of antibiotics. - When should a tonsillectomy be considered?
Answer: For recurrent infections or complications like abscesses. - Can tonsillitis cause complications?
Answer: Yes, including abscesses, rheumatic fever, and kidney inflammation. - What is quinsy?
Answer: A peritonsillar abscess causing severe throat pain and difficulty swallowing. - Can adults get tonsillitis?
Answer: Yes, though it is more common in children. - What foods help with tonsillitis?
Answer: Soft, soothing foods like broths, yoghurts, and ice cream. - Are lozenges effective for tonsillitis?
Answer: They provide temporary relief for pain and irritation. - Can tonsillitis recur?
Answer: Yes, especially if caused by chronic bacterial infections or irritants. - Is strep throat the same as tonsillitis?
Answer: Strep throat is a type of bacterial tonsillitis caused by Group A Streptococcus. - How can I prevent spreading tonsillitis?
Answer: Avoid sharing utensils, maintain good hygiene, and stay home while symptomatic. - Is gargling with salt water effective?
Answer: Yes, it can reduce swelling and discomfort.