Tonsillitis I: Introduction

Tonsillitis is inflammation of the tonsils, which are two lymphoid tissue masses at the back of the throat. This condition can cause discomfort and irritation in the throat.

Etiology

Three primary contributing factors have been identified.

• Viruses: Viral infections are the most common cause of tonsillitis. Common viruses responsible for tonsillitis include rhinovirus, influenza, parainfluenza, Epstein-Barr virus, and adenovirus.

• Bacteria: The predominant bacterium responsible for tonsillitis is Streptococcus pyogenes. Other bacteria like Staphylococcus aureus, Haemophilus influenza, and Moraxella catarrhalis can also lead to tonsillitis.

• Other Causes: Tonsillitis can rarely be caused by different pathogens such as fungi (especially in people with weakened immune systems) or parasites.

Classifications

Tonsillitis can be categorized into three types.

• Acute tonsillitis is a sudden onset inflammation and swelling of the tonsils caused by bacterial or viral infections. Symptoms usually resolve within a few days with appropriate treatment.

• Recurrent Tonsillitis refers to multiple episodes of acute tonsillitis in a year. Patients with recurrent tonsillitis may consider a tonsillectomy if the condition significantly impacts their quality of life.

• Chronic Tonsillitis is an ongoing infection of the tonsils. Symptoms may include chronic sore throat, bad breath, difficulty swallowing, and tender lymph nodes in the neck.

Clinical manifestations

The main symptoms of tonsillitis are fever, tonsillar exudate, sore throat, tender cervical lymph nodes, and neck stiffness. Patients may also note odynophagia (pain when swallowing) and dysphagia (difficulty swallowing) secondary to tonsillar swelling.

Complications

Untreated or inadequately managed tonsillitis can result in various complications.

• Peritonsillar Abscess is the most common complication of tonsillitis. It occurs when pus forms a pocket around the tonsils due to the bacterial infection.

• Middle Ear Infections (Otitis media): The bacteria or viruses causing tonsillitis can potentially spread to the middle ear, leading to infection.

• Obstructive Sleep Apnea: Chronic or recurrent tonsillitis can cause the tonsils to become enlarged. This can interfere with breathing during sleep, leading to obstructive sleep apnea.

• Difficulty Breathing: Enlarged tonsils can block the airways, making breathing difficult.

• Scarlet Fever: Bacterial tonsillitis caused by certain strains of group A streptococcus bacteria can lead to scarlet fever.

• Rheumatic Fever and Poststreptococcal Glomerulonephritis: These are rare but serious complications that can occur after a strep throat infection, which sometimes presents as tonsillitis. Rheumatic fever can permanently damage the heart, while post-streptococcal glomerulonephritis affects the kidneys.

Diagnostic evaluation

The diagnostic evaluation for tonsillitis involves the following.

• Physical Examination includes looking for signs of redness, swelling, white patches, or pus on the tonsils and swollen lymph nodes.

• Throat Swab involves gently swabbing the back of the patient's throat with a sterile swab to obtain a sample of secretions.

• Rapid Antigen Detection Test (RADT) can detect streptococcal bacteria in minutes by identifying antigens on the surface of the bacteria. A positive test indicates a streptococcal infection.

• Throat Culture may be performed if the RADT test is negative.