tonsillitis

File:Blausen 0860 Tonsils&Throat Anatomy.png

Those with tonsillitis usually experience sore throat, painful swallowing, malaise, and fever.{{cite journal |vauthors=De M, Anari S |title=Infections and foreign bodies in ENT |journal=Surgery (Oxf) |volume=36 |issue=10 |pages=555–556 |date=October 2018 |pmid=32336859 |pmc=7172438 |doi=10.1016/j.mpsur.2018.08.008 |type= Review }} Their tonsils – and often the back of the throat – appear red and swollen, and sometimes give off a white discharge.{{cite journal |vauthors=Stelter K |title=Tonsillitis and sore throat in children |journal=GMS Curr Top Otorhinolaryngol Head Neck Surg |volume=13 |page=3 |date=2014 |pmid=25587367 |pmc=4273168 |doi=10.3205/cto000110 |type= Review}} Some also have tender swelling of the cervical lymph nodes.{{cite journal |vauthors=Bird JH, Biggs TC, King EV |title=Controversies in the management of acute tonsillitis: an evidence-based review |journal=Clin Otolaryngol |volume=39 |issue=6 |pages=368–74 |date=December 2014 |pmid=25418818 |pmc=7162355 |doi=10.1111/coa.12299 |type= Review}}

Many viral infections that cause tonsillitis will also cause cough, runny nose, hoarse voice, or blistering in the mouth or throat.{{cite journal |vauthors=Bochner RE, Gangar M, Belamarich PF |title=A Clinical Approach to Tonsillitis, Tonsillar Hypertrophy, and Peritonsillar and Retropharyngeal Abscesses |journal=Pediatr Rev |volume=38 |issue=2 |page=82 |date=February 2017 |pmid=28148705 |doi=10.1542/pir.2016-0072|s2cid=31192934 |type= Review}} Infectious mononucleosis can cause the tonsils to swell with red spots or white discharge that may extend to the tongue.{{cite journal |vauthors=Fugl A, Andersen CL |title=Epstein-Barr virus and its association with disease - a review of relevance to general practice |journal=BMC Fam Pract |volume=20 |issue=1 |pages=62 |date=May 2019 |pmid=31088382 |pmc=6518816 |doi=10.1186/s12875-019-0954-3 |type= Review |doi-access=free }} This can be accompanied by fever, sore throat, cervical lymph node swelling, and enlargement of the liver and spleen. Bacterial infections that cause tonsillitis can also cause a distinct "scarletiniform" rash, vomiting, and tonsillar spots or discharge.

Tonsilloliths occur in up to 10% of the population frequently due to episodes of tonsillitis.{{clarify|reason= What is this sentence trying to say ?|date=November 2020}}Nour p. ???.

File:Tonsillitis cause.jpg

Viral infections cause 40 to 60% of cases of tonsillitis. Many viruses can cause inflammation of the tonsils (and the rest of throat) including adenovirus, rhinovirus, coronavirus, influenza virus, parainfluenza virus, coxsackievirus, measles virus, Epstein-Barr virus, cytomegalovirus, respiratory syncytial virus, and herpes simplex virus. Tonsillitis can also be part of the initial reaction to HIV infection. An estimated 1 to 10% of the cases are caused by Epstein-Barr virus.

Tonsillitis can also stem from infection with bacteria, predominantly Group A β-hemolytic streptococci (GABHS), which causes strep throat. Bacterial infection of the tonsils usually follows the initial viral infection. When tonsillitis recurs after antibiotic treatment for streptococcus bacteria, it is usually due to the same bacteria as the first time, which suggests that the antibiotic treatment was not fully effective.{{cite journal |vauthors=Gollan B, Grabe G, Michaux C, Helaine S |title=Bacterial Persisters and Infection: Past, Present, and Progressing |journal=Annu Rev Microbiol |volume=73 |pages=359–385 |date=September 2019 |pmid=31500532 |doi=10.1146/annurev-micro-020518-115650 |s2cid=202405991 |type= Review|doi-access=free }} Less common bacterial causes include: Streptococcus pneumoniae, Mycoplasma pneumoniae, Chlamydia pneumoniae, Bordetella pertussis, Fusobacterium sp., Corynebacterium diphtheriae, Treponema pallidum, and Neisseria gonorrhoeae.{{MerckManual|08|090|i||Tonsillopharyngitis}}Wetmore 2007, pp. 756–57.Thuma 2001, p. ???Simon 2005, p. ????

Anaerobic bacteria have been implicated in tonsillitis, and a possible role in the acute inflammatory process is supported by several clinical and scientific observations.{{cite journal |vauthors=Brook I |title=The role of anaerobic bacteria in tonsillitis |journal=Int J Pediatr Otorhinolaryngol |volume=69 |issue=1 |pages=9–19 |date=January 2005 |pmid=15627441 |doi=10.1016/j.ijporl.2004.08.007 |type=Review}}

Sometimes tonsillitis is caused by an infection of spirochaeta and treponema, which is called Vincent's angina or Plaut-Vincent angina.{{primary source inline|date=November 2020}}{{primary source inline|date=November 2020}} {{cite journal |vauthors=Van Cauwenberge P |title=[Significance of the fusospirillum complex (Plaut-Vincent angina)] |language=nl |journal=Acta Otorhinolaryngol Belg |volume=30 |issue=3 |pages=334–45 |year=1976 |pmid=1015288 }} — fusospirillum complex (Plaut-Vincent angina) Van Cauwenberge studied the tonsils of 126 patients using direct microscope observation. The results showed that 40% of acute tonsillitis was caused by Vincent's angina and 27% of chronic tonsillitis was caused by Spirochaeta

Within the tonsils, white blood cells of the immune system destroy the viruses or bacteria by producing inflammatory cytokines like phospholipase A2,{{primary source inline|date=November 2020}}{{primary source inline|date=November 2020}} {{cite journal |vauthors=Ezzeddini R, Darabi M, Ghasemi B, Jabbari Moghaddam Y, Jabbari Y, Abdollahi S, etal | title=Circulating phospholipase-A2 activity in obstructive sleep apnea and recurrent tonsillitis. | journal=Int J Pediatr Otorhinolaryngol | year= 2012 | volume= 76 | issue= 4 | pages= 471–4 | pmid=22297210 | doi=10.1016/j.ijporl.2011.12.026 }} which also lead to fever.{{cite journal |vauthors=van Kempen MJ, Rijkers GT, Van Cauwenberge PB |s2cid=33290556 |title=The immune response in adenoids and tonsils |journal=Int. Arch. Allergy Immunol. |volume=122 |issue=1 |pages=8–19 |date=May 2000 |pmid=10859465 |doi= 10.1159/000024354|type= Review}}{{cite journal |vauthors=Perry M, Whyte A |title=Immunology of the tonsils |journal=Immunology Today |volume=19 |issue=9 |pages=414–21 |date=September 1998 |pmid=9745205 |doi= 10.1016/S0167-5699(98)01307-3|type= Review}} The infection may also be present in the throat and surrounding areas, causing inflammation of the pharynx.{{MedlinePlusEncyclopedia|001043|Tonsillitis}}

There is no firm distinction between a sore throat that is specifically tonsillitis and a sore throat caused by inflammation in both the tonsils and also nearby tissues.{{Cite web|date=22 August 2019|title=Tonsillitis - Symptoms, diagnosis and treatment|url=https://bestpractice.bmj.com/topics/en-gb/598|access-date=2020-11-04|website=BMJ Best Practice}} An acute sore throat may be diagnosed as tonsillitis, pharyngitis, or tonsillopharyngitis (also called pharyngotonsillitis), depending upon the clinical findings.

File:Throat Culture.png

In primary care settings, the Centor criteria are used to determine the likelihood of group A beta-hemolytic streptococcus (GABHS) infection in an acute tonsillitis and the need of antibiotics for tonsillitis treatment. However, the Centor criteria have their weaknesses in making precise diagnosis for adults. The Centor criteria are also ineffective in diagnosis for tonsillitis in children and in secondary care settings (hospitals). A modified version of the Centor criteria, which modified the original Centor criteria in 1998, is often used to aid in diagnosis. The original Centor criteria had four major criteria but the modified Centor criteria have five. The five major criteria of the modified Centor score are:

1. Presence of tonsillar exudate
2. Painful neck lymph nodes
3. History of fever
4. Age between five and fifteen years
5. Absence of cough

The possibility of GABHS infection increases with increasing score. The probability for getting GABHS is 2 to 23% for the score of 1, and 25 to 85% for the score of 4.

The diagnosis of GABHS tonsillitis can be confirmed by culture of samples obtained by swabbing the throat and plating them on blood agar medium. This small percentage of false-negative results are part of the characteristics of the tests used but are also possible if the person has received antibiotics prior to testing. Identification requires 24 to 48 hours by culture but rapid screening tests (10–60 minutes), which have a sensitivity of 85–90%, are available. In 40% of the people without any symptoms, the throat culture can be positive. Therefore, throat culture is not routinely used in clinical practice for the detection of GABHS.

Centor and McIsaac scores are equally ineffective at identifying patients who need antibiotics presenting with pharyngitis at hospitals. Too many true positive cases are missed and too many false positives are treated, leading to the over prescription of antibiotics.{{Cite journal |last=Kanagasabai |first=Atchchuthan |last2=Evans |first2=Callum |last3=Jones |first3=Hayley E. |last4=Hay |first4=Alastair D. |last5=Dawson |first5=Sarah |last6=Savović |first6=Jelena |last7=Elwenspoek |first7=Martha M.C. |date=April 2024 |title=Systematic review and meta-analysis of the accuracy of McIsaac and Centor score in patients presenting to secondary care with pharyngitis |url=https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(23)00633-X/fulltext |journal=Clinical Microbiology and Infection |language=English |volume=30 |issue=4 |pages=445–452 |doi=10.1016/j.cmi.2023.12.025 |issn=1198-743X |archive-url=http://web.archive.org/web/20240113054208/https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(23)00633-X/fulltext |archive-date=2024-01-13|doi-access=free }}

Bacterial culture may need to be performed in cases of a negative rapid streptococcal test.{{cite journal |vauthors=Leung AK, Newman R, Kumar A, Davies HD | s2cid = 35041911 | year = 2006 | title = Rapid antigen detection testing in diagnosing group A beta-hemolytic streptococcal pharyngitis | journal = Expert Rev Mol Diagn | volume = 6 | issue = 5| pages = 761–6 | doi = 10.1586/14737159.6.5.761 | pmid = 17009909 |type= Review}} An increase in antistreptolysin O (ASO) streptococcal antibody titer following the acute infection can provide retrospective evidence of GABHS infection and is considered definitive proof of GABHS infection, but not necessarily of the tonsils.{{cite journal |vauthors=Sen ES, Ramanan AV |title=How to use antistreptolysin O titre |journal=Archives of Disease in Childhood: Education and Practice Edition |volume=99 |issue=6 |date=December 2014 |pages=231–8 |pmid=24482289 |doi=10.1136/archdischild-2013-304884|s2cid=37309363 |type= Review}}

Epstein Barr virus serology can be tested for those who may have infectious mononucleosis with a typical lymphocyte count in full blood count result. Blood investigations are only required for those with hospital admission requiring intravenous antibiotics.

Nasoendoscopy can be used for those with severe neck pain and inability to swallow any fluids to rule out masked epiglotitis and supraglotitis. Routine nasoendscopy is not recommended for children.

Treatments to reduce the discomfort from tonsillitis include:

• pain and fever reducing medications such as paracetamol (acetaminophen) and ibuprofen
• warm salt water gargle, lozenges, honey, or warm liquids

There are no antiviral medical treatments for virally caused tonsillitis.{{Cite web|title=Tonsillitis|url=https://medlineplus.gov/tonsillitis.html|access-date=2020-12-03|website=medlineplus.gov}}

If the tonsillitis is caused by group A streptococcus, then antibiotics are useful, with penicillin or amoxicillin being primary choices. Cephalosporins and macrolides are considered good alternatives to penicillin in the acute care setting.{{cite journal |vauthors=Casey JR, Pichichero ME | year = 2004 | title = Meta-analysis of cephalosporin versus penicillin treatment of group A streptococcal tonsillopharyngitis in children | journal = Pediatrics | volume = 113 | issue = 4| pages = 866–882 | doi = 10.1542/peds.113.4.866 | pmid = 15060239 |type= Meta-analysis}} A macrolide, such as azithromycin or erythromycin, is used for people allergic to penicillin. If penicillin therapy fails, bacterial tonsillitis may respond to treatment effective against beta-lactamase producing bacteria such as clindamycin or amoxicillin-clavulanate.{{cite journal |vauthors=Brook I |title=The role of beta-lactamase-producing-bacteria in mixed infections |journal=BMC Infect Dis |volume=9 |pages=202 |year=2009 |pmid=20003454 |pmc=2804585 |doi=10.1186/1471-2334-9-202|type= Review |doi-access=free }} Aerobic and anaerobic beta lactamase producing bacteria that reside in the tonsillar tissues can "shield" group A streptococcus from penicillins.{{cite journal |vauthors=Brook I |title=Microbiology and principles of antimicrobial therapy for head and neck infections |journal=Infect Dis Clin North Am |volume=21 |pages=355–91 |year=2007 |pmid=17561074 |doi=10.1016/j.idc.2007.03.014 |issue=2 |type= Review }} There is no significant difference in efficacy of various groups of antibiotics for treating tonsillitis. Intravenous antibiotics can be for those who are hospitalized with inability to swallow and presented with complications.{{Citation needed|date=November 2020}} Oral antibiotics can be resumed immediately if the person is clinically improved and able to swallow orally. Antibiotic treatment is usually taken for seven to ten days.

Paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) can be used to treat throat pain in children and adults. Codeine is avoided in children under 12 years of age to treat throat pain or following tonsilectomy.{{Cite press release|publisher=US Food and Drug Administration|date=2013|title=Safety review update of codeine use in children; new Boxed Warning and Contraindication on use after tonsillectomy or adenoidectomy: Safety announcement|url=https://www.fda.gov/media/85072/download|access-date=November 9, 2020}}{{Cite journal|vauthors= Jenco M|date=2020-10-29|title=Do not use codeine, tramadol in children: FDA|url=https://www.aappublications.org/news/2017/04/20/Codeine042017|journal=AAP News}} NSAIDs (such as ibuprofen) and opioids (such as codeine and tramadol) are equally effective at relieving pain, however, precautions should be taken with these pain medications. NSAIDs can cause peptic ulcer disease and kidney damage.{{Citation needed|date=November 2020}} Opioids can cause respiratory depression in those who are vulnerable. Anaesthetic mouthwash can also be used for symptomatic relief.

Corticosteroids reduce tonsillitis pain and improve symptoms in 24 to 48 hours. Oral corticosteroids are recommended unless the person is unable to swallow medications.

{{Main|Tonsillectomy}}

When tonsillitis recurs frequently, often arbitrarily defined as at least five episodes of tonsillitis in a year,{{cite journal |vauthors=Georgalas CC, Tolley NS, Narula PA |title=Tonsillitis |journal=BMJ Clin Evid |volume=2014|date=July 2014 |pmid=25051184 |pmc=4106232 |type= Review}} or when the palatine tonsils become so swollen that swallowing is difficult as well as painful, a tonsillectomy can be performed to surgically remove the tonsils. A randomised controlled trial of tonsillectomy versus medical treatment (antibiotics and pain killers) in adults with frequent tonsillitis found that tonsillectomy was more effective and cost effective. It resulted in fewer days with sore throat.{{Cite journal |last1=Wilson |first1=Janet A |last2=O'Hara |first2=James |last3=Fouweather |first3=Tony |last4=Homer |first4=Tara |last5=Stocken |first5=Deborah D |last6=Vale |first6=Luke |last7=Haighton |first7=Catherine |last8=Rousseau |first8=Nikki |last9=Wilson |first9=Rebecca |last10=McSweeney |first10=Lorraine |last11=Wilkes |first11=Scott |last12=Morrison |first12=Jill |last13=MacKenzie |first13=Kenneth |last14=Ah-See |first14=Kim |last15=Carrie |first15=Sean |date=2023-06-17 |title=Conservative management versus tonsillectomy in adults with recurrent acute tonsillitis in the UK (NATTINA): a multicentre, open-label, randomised controlled trial |journal=The Lancet |volume=401 |issue=10393 |pages=2051–2059 |doi=10.1016/S0140-6736(23)00519-6 |pmid=37209706 |s2cid=258745995 |issn=0140-6736|doi-access=free |hdl=10023/27774 |hdl-access=free }}{{Cite journal |date=5 September 2023 |title=Removing tonsils is effective and cost-effective for adults with frequent tonsillitis |url=https://evidence.nihr.ac.uk/alert/removing-tonsils-is-effective-and-cost-effective-for-adults-with-frequent-tonsillitis/ |journal=NIHR Evidence|doi=10.3310/nihrevidence_59646 |s2cid=261565310 }}

Children have had only a modest benefit from tonsillectomy for repeated cases of tonsillitis.{{cite journal |vauthors=Burton MJ, Glasziou PP, Chong LY, Venekamp RP |title=Tonsillectomy or adenotonsillectomy versus non-surgical treatment for chronic/recurrent acute tonsillitis |journal=Cochrane Database Syst Rev |issue=11 |pages=CD001802 |date=November 2014 |volume=2014 |pmid=25407135 |pmc=7075105 |doi=10.1002/14651858.CD001802.pub3 |type= Review}}

Since the advent of penicillin in the 1940s, a major preoccupation in the treatment of streptococcal tonsillitis has been the prevention of rheumatic fever, and its major effects on the nervous system and heart.

Complications may rarely include dehydration and kidney failure due to difficulty swallowing, blocked airways due to inflammation, and pharyngitis due to the spread of infection.

An abscess may develop lateral to the tonsil during an infection, typically several days after the onset of tonsillitis.{{Citation needed|date=November 2020}} This is termed a peritonsillar abscess (or quinsy).

Rarely, the infection may spread beyond the tonsil resulting in inflammation and infection of the internal jugular vein giving rise to a spreading infectious thrombophlebitis (Lemierre's syndrome).{{Citation needed|date=November 2020}}

In strep throat, diseases like post-streptococcal glomerulonephritis{{primary source inline|date=November 2020}}{{primary source inline|date=November 2020}} {{cite journal |vauthors=Zoch-Zwierz W, Wasilewska A, Biernacka A, etal |title=[The course of post-streptococcal glomerulonephritis depending on methods of treatment for the preceding respiratory tract infection] |language=pl |journal=Wiad. Lek. |volume=54 |issue=1–2 |pages=56–63 |year=2001 |pmid=11344703 }} can occur. These complications are extremely rare in developed nations but remain a significant problem in poorer nations.{{cite journal |vauthors=Ohlsson A, Clark K |title=Antibiotics for sore throat to prevent rheumatic fever: yes or no? How the Cochrane Library can help |journal=CMAJ |volume=171 |issue=7 |pages=721–3 |date=September 2004 |pmid=15451830 |pmc=517851 |doi=10.1503/cmaj.1041275 }}{{cite journal | title=Treatment of sore throat in light of the Cochrane verdict: is the jury still out? | journal=Medical Journal of Australia | year=2002 | volume=177 | issue=9 | pages=512–5 | url=http://www.mja.com.au/public/issues/177_09_041102/dan10028_fm.html | pmid=12405896 | last1=Danchin | first1=MH | last2=Curtis | first2=N | last3=Nolan | first3=TM | last4=Carapetis | first4=JR | url-status=live | archive-url=https://web.archive.org/web/20080724093118/http://mja.com.au/public/issues/177_09_041102/dan10028_fm.html | archive-date=2008-07-24 | doi=10.5694/j.1326-5377.2002.tb04925.x | s2cid=1957427 }} — Medical Journal of Australia commentary on Cochrane analysis

Tonsillitis occurs throughout the world, without racial or ethnic differences.Sommers 2015, p. 1078. Most children have tonsillitis at least once during their childhood,Sommers 2015, p. 1077. although it rarely occurs before the age of two. It most typically occurs between the ages of four and five; bacterial infections most typically occur at a later age.

Tonsillitis is described in the ancient Greek Hippocratic Corpus.Dean-Jones 2013

Recurrent tonsillitis can interfere with vocal function and the ability to perform among people who use their voices professionally.Sataloff & Hawkshaw 2019.Stadelman-Cohen 2019, pp. 30–52.

{{Reflist}}

• [https://velbehagklinikk.no/Blogg/hovne-mandler-symptomer-og-behandlinger/ Tonsillitt] Velbehagklinikk 26 July 2022

{{commons category}}

• {{Cite book|vauthors=Dean-Jones L|url=http://oxfordhandbooks.com/view/10.1093/oxfordhb/9780199781546.001.0001/oxfordhb-9780199781546-e-005|chapter=The Child Patient of the Hippocratics: Early Pediatrics?|date=2013|isbn= 9780199781546 |title= The Oxford Handbook of Childhood and Education in the Classical World| publisher=Oxford University Press|doi=10.1093/oxfordhb/9780199781546.013.005|veditors= Grubbs JE, Parkin T}}
• {{cite book|vauthors=Ferri FF|title=Ferri's Clinical Advisor 2016: 5 Books in 1|date=2015|publisher=Elsevier Health Sciences|isbn=978-0323280471|edition= first}}
• {{cite book|vauthors=Jones R|title=Oxford Textbook of Primary Medical Care|date=2005|publisher=Oxford University Press|isbn=9780198567820}}
• {{cite book|vauthors=Lang F|title=Encyclopedia of Molecular Mechanisms of Disease|date=2009|publisher=Springer Science & Business Media|isbn=9783540671367}}
• {{cite book |vauthors=Nour SG, Mafee MR, Valvassori GE, Valbasson GE, Becker M|title=Imaging of the head and neck |publisher=Thieme |location=Stuttgart |year=2005 |page= 716 |isbn=978-1-58890-009-8 }}
• {{Cite book|vauthors=Sataloff RT, Hawkshaw MJ |title=The Oxford Handbook of Voice Studies|isbn=978-0-19-998229-5|veditors=Eidsheim NS, Meisel K|location=New York, NY|chapter=Medical Care of Voice Disorders|doi=10.1093/oxfordhb/9780199982295.013.11|oclc=1076410526|year= 2019 |pages=54–75|publisher= Oxford University Press}}
• {{cite book |vauthors=Simon HB |chapter=Bacterial infections of the upper respiratory tract |veditors =Dale DC, Federman DD |title=ACP Medicine, 2006 Edition (Two Volume Set)|edition= Second |publisher=WebMD Professional Publishing |year=2005 |isbn=978-0-9748327-6-0 }}
• {{cite book|vauthors= Sommers M, Fannin E|title= Diseases & Disorders: A Nursing Therapeutics Manual |year= 2015 |edition= 5th |publisher= F.A. Davis Company|isbn= 978-0803638556}}
• {{cite book|vauthors=Stadelman-Cohen TK, Hillman RE|chapter=Voice Dysfunction and Recovery|date=2019|title=The Oxford Handbook of Singing |pages=30–52|veditors=Welch GF, Howard DM, Nix J|publisher=Oxford University Press |doi=10.1093/oxfordhb/9780199660773.013.018 |isbn= 978-0-19-966077-3}}
• {{cite book |vauthors=Thuma P |chapter=Pharyngitis and tonsillitis |veditors =Hoekelman RA, Adam HM, Nelson NM, Weitzman ML |title=Primary pediatric care |publisher=Mosby |location=St. Louis |year=2001 |edition= 4th|isbn=978-0-323-00831-0 }}
• {{cite book |vauthors=Wetmore RF|chapter=Tonsils and adenoids |veditors = Kliegman RM, Behrman RE, Jenson HB, Stanton BF |title=Nelson textbook of pediatrics |publisher=Saunders |location=Philadelphia |edition= 18th|year=2007 |isbn=978-1-4160-2450-7 }}

{{Medical condition classification and resources

| DiseasesDB = 13165

| ICD10 = {{ICD10|J|03||j|00}}, {{ICD10|J|35|0|j|30}}

| ICD9 = {{ICD9|463}}

| ICDO =

| OMIM =

| MedlinePlus = 001043

| eMedicineSubj = article

| eMedicineTopic = 871977

| MeshID = D014069

}}

{{Respiratory pathology}}

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Category:Inflammations

Category:Acute upper respiratory infections

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Category:Otorhinolaryngology