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==Treatment==
==Treatment==
Treatments to reduce the discomfort from tonsillitis symptoms include:<ref name=merck/><ref name=wetmore/><ref name=thuma/><ref name=simon/><ref name=medline>Medline Plus, http://www.nlm.nih.gov/medlineplus/ency/article/001043.htm</ref><ref name="Boureau">{{cite journal |doi=10.2165/00044011-199917010-00001 |author=Boureau, F. ''et al.'' |title=Evaluation of Ibuprofen vs Paracetamol Analgesic Activity Using a Sore Throat Pain Model |journal=Clinical Drug Investigation| volume=17 | year=1999 |pages=1–8}}</ref><ref>{{cite journal |author=Praskash, T. ''et al.''|title=Koflet lozenges in the Treatment of Sore Throat |journal=The Antiseptic |volume=98 |year=2001 |pages=124–127}}</ref>
Treatments to reduce the discomfort from tonsillitis symptoms include: Driving back up from your boring house to manor bank, getting trolleyed on red wine are steaming off to the cut for a massive night filled with millions of muckers! <ref name=merck/><ref name=wetmore/><ref name=thuma/><ref name=simon/><ref name=medline>Medline Plus, http://www.nlm.nih.gov/medlineplus/ency/article/001043.htm</ref><ref name="Boureau">{{cite journal |doi=10.2165/00044011-199917010-00001 |author=Boureau, F. ''et al.'' |title=Evaluation of Ibuprofen vs Paracetamol Analgesic Activity Using a Sore Throat Pain Model |journal=Clinical Drug Investigation| volume=17 | year=1999 |pages=1–8}}</ref><ref>{{cite journal |author=Praskash, T. ''et al.''|title=Koflet lozenges in the Treatment of Sore Throat |journal=The Antiseptic |volume=98 |year=2001 |pages=124–127}}</ref>
*pain relief, anti-inflammatory, fever reducing medications (acetaminophen, ibuprofen)
*pain relief, anti-inflammatory, fever reducing medications (acetaminophen, ibuprofen)
*sore throat relief (salt water gargle, lozenges, warm liquids)
*sore throat relief (salt water gargle, lozenges, warm liquids)

Revision as of 15:49, 27 January 2011

Tonsillitis
SpecialtyFamily medicine, infectious diseases, otorhinolaryngology Edit this on Wikidata

Tonsillitis (also pharyngotonsillitis or tonsillopharyngitis) is an inflammation of the tonsils most commonly caused by viral or bacterial infection. It is a type of pharyngitis.[1] Symptoms of tonsillitis include sore throat and fever. While no treatment has been found to shorten the duration of viral tonsillitis, bacterial causes may be treatable with antibiotics.

Symptoms

Common symptoms of tonsillitis include:[2][3][4][5]

  • red and/or swollen tonsils
  • white or yellow patches on the tonsils
  • tender, stiff, and/or swollen neck
  • sore throat
  • painful or difficult swallowing
  • cough
  • headache
  • sore eyes
  • body aches
  • otalgia
  • fever
  • chills
  • nasal congestions

Acute tonsillitis is caused by both bacteria and viruses and will be accompanied by symptoms of ear pain when swallowing, bad breath, and drooling along with sore throat and fever. In this case, the surface of the tonsil may be bright red or have a grayish-white coating, while the lymph nodes in the neck may be swollen. [6]

Causes

The most common causes of tonsillitis are the common cold viruses (adenovirus, rhinovirus, influenza, coronavirus, respiratory syncytial virus).[2][3][4][5] It can also be caused by Epstein-Barr virus, herpes simplex virus, cytomegalovirus, or HIV.[2][3][4][5] The second most common causes are bacterial. The most common bacterial cause is Group A β-hemolytic streptococcus (GABHS), which causes strep throat.[2][3][4][5] Less common bacterial causes include: Staphylococcus aureus, Streptococcus pneumoniae, Mycoplasma pneumoniae, Chlamydia pneumoniae, pertussis, Fusobacterium, diphtheria, syphilis, and gonorrhea.[2][3][4][5]

Under normal circumstances, as viruses and bacteria enter the body through the nose and mouth, they are filtered in the tonsils.[7][8] Within the tonsils, white blood cells of the immune system mount an attack that helps destroy the viruses or bacteria, and also causes inflammation and fever.[7][8] The infection may also be present in the throat and surrounding areas, causing inflammation of the pharynx.[9] This is the area in the back of the throat that lies between the voice box and the tonsils.

Tonsillitis may be caused by Group A streptococcal bacteria,[10] resulting in strep throat.[10] Viral tonsillitis may be caused by numerous viruses[10] such as the Epstein-Barr virus[10] (the cause of infectious mononucleosis)[11] or adenovirus.[10]

Sometimes, tonsillitis is caused by an infection of spirochaeta and treponema, in this case called Vincent's angina or Plaut-Vincent angina.[12]

Treatment

Treatments to reduce the discomfort from tonsillitis symptoms include: Driving back up from your boring house to manor bank, getting trolleyed on red wine are steaming off to the cut for a massive night filled with millions of muckers! [2][3][4][5][13][14][15]

  • pain relief, anti-inflammatory, fever reducing medications (acetaminophen, ibuprofen)
  • sore throat relief (salt water gargle, lozenges, warm liquids)

If the tonsillitis is caused by group A streptococus, then antibiotics are useful with penicillin or amoxicillin being first line.[16] A macrolide such as erythromycin is used for patients allergic to penicillin. When tonsillitis is caused by a virus, the length of illness depends on which virus is involved. Usually, a complete recovery is made within one week; however may last for up to two weeks. Chronic cases may be treated with tonsillectomy (surgical removal of tonsils) as a choice for treatment.[17]

Complications

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.[2][3][4][5][13]

An abscess may develop lateral to the tonsil during an infection, typically several days after the onset of tonsillitis. 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 septicaemia infection (Lemierre's syndrome).

In chronic/recurrent cases (generally defined as seven episodes of tonsillitis in the preceding year, five episodes in each of the preceding two years or three episodes in each of the preceding three years),[18][19][20] or in acute cases where the palatine tonsils become so swollen that swallowing is impaired, a tonsillectomy can be performed to remove the tonsils. Patients whose tonsils have been removed are still protected from infection by the rest of their immune system.

In very rare cases of strep throat, diseases like rheumatic fever[21] or glomerulonephritis[22] can occur. These complications are extremely rare in developed nations but remain a significant problem in poorer nations.[23][24] Tonsillitis associated with strep throat, if untreated, can also lead to pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS).[25]

Tonsilloliths occur in up to 10% of the population frequently due to episodes of tonsillitis.[26]

References

  1. ^ Rafei K, Lichenstein R (2006). "Airway infectious disease emergencies". Pediatr. Clin. North Am. 53 (2): 215–42. doi:10.1016/j.pcl.2005.10.001. PMID 16574523. {{cite journal}}: Unknown parameter |month= ignored (help)
  2. ^ a b c d e f g Tonsillopharyngitis. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec08/ch090/ch090i.html. Accessed July 26, 2010.
  3. ^ a b c d e f g Wetmore RF. Tonsils and adenoids. In:Bonita F. Stanton; Kliegman, Robert; Nelson, Waldo E.; Behrman, Richard E.; Jenson, Hal B. (2007). Nelson textbook of pediatrics Robert M. Kliegman, Richard E. Behrman, Hal B. Jenson, Bonita F. Stanton. Philadelphia: Saunders. ISBN 1-4160-2450-6.{{cite book}}: CS1 maint: multiple names: authors list (link)
  4. ^ a b c d e f g Thuma P (2001). Pharyngitis and tonsillitis. In:Hoekelman, Robert A. (2001). Primary pediatric care. St. Louis: Mosby. ISBN 0-323-00831-3.
  5. ^ a b c d e f g Simon HB (2006). Bacterial infections of the upper respiratory tract. In: Dale, David (2005). ACP Medicine, 2006 Edition (Two Volume Set) (Webmd Acp Medicine). WebMD Professional Publishing. ISBN 0-9748327-6-6.
  6. ^ Tonsillitis and Adenoid Infection MedicineNet. Retrieved on 2010-01-25
  7. ^ a b van Kempen MJ, Rijkers GT, Van Cauwenberge PB (2000). "The immune response in adenoids and tonsils". Int. Arch. Allergy Immunol. 122 (1): 8–19. doi:10.1159/000024354. PMID 10859465. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  8. ^ a b Perry M, Whyte A (1998). "Immunology of the tonsils". Immunology Today. 19 (9): 414–21. doi:10.1016/S0167-5699(98)01307-3. PMID 9745205. {{cite journal}}: Unknown parameter |month= ignored (help)
  9. ^ Tonsillitis Overview Medline Plus. Retrieved on 2010-01-25
  10. ^ a b c d e Putto A (1987). "Febrile exudative tonsillitis: viral or streptococcal?". Pediatrics. 80 (1): 6–12. PMID 3601520.
  11. ^ Renn CN, Straff W, Dorfmüller A, Al-Masaoudi T, Merk HF, Sachs B (2002). "Amoxicillin-induced exanthema in young adults with infectious mononucleosis: demonstration of drug-specific lymphocyte reactivity". Br. J. Dermatol. 147 (6): 1166–70. doi:10.1046/j.1365-2133.2002.05021.x. PMID 12452866.{{cite journal}}: CS1 maint: multiple names: authors list (link) -Renn studied 4 patients who where treated amoxicillin for throat infection and lymphadenopathy. Infectious mononucleosis was present in the patient’s blood due to trace of Epstein-Barr antibodies. The three tests performed where the patched test, intracutaneous test, and lymphocyte transformation test. The results of the patched test assas the caused of their rash were 1 out of 4 patients. The intracutaneous showed 2 out of 4 patients with positive results that pointed to amoxicillin. The LTT results showed 3 out of 4 that pointed to amoxicillin
  12. ^ Van Cauwenberge P (1976). "[Significance of the fusospirillum complex (Plaut-Vincent angina)]". Acta Otorhinolaryngol Belg (in Dutch; Flemish). 30 (3): 334–45. PMID 1015288.{{cite journal}}: CS1 maint: unrecognized language (link) - 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
  13. ^ a b Medline Plus, http://www.nlm.nih.gov/medlineplus/ency/article/001043.htm
  14. ^ Boureau, F.; et al. (1999). "Evaluation of Ibuprofen vs Paracetamol Analgesic Activity Using a Sore Throat Pain Model". Clinical Drug Investigation. 17: 1–8. doi:10.2165/00044011-199917010-00001. {{cite journal}}: Explicit use of et al. in: |author= (help)
  15. ^ Praskash, T.; et al. (2001). "Koflet lozenges in the Treatment of Sore Throat". The Antiseptic. 98: 124–127. {{cite journal}}: Explicit use of et al. in: |author= (help)
  16. ^ Touw-Otten FW, Johansen KS (1992). "Diagnosis, antibiotic treatment and outcome of acute tonsillitis: report of a WHO Regional Office for Europe study in 17 European countries". Fam Pract. 9 (3): 255–62. doi:10.1093/fampra/9.3.255. PMID 1459378.
  17. ^ Paradise JL, Bluestone CD, Bachman RZ; et al. (1984). "Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and nonrandomized clinical trials". N. Engl. J. Med. 310 (11): 674–83. doi:10.1056/NEJM198403153101102. PMID 6700642. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  18. ^ Scottish Intercollegiate Guidelines Network. (1999). "6.3 Referral Criteria for Tonsillectomy". Management of Sore Throat and Indications for Tonsillectomy. Scottish Intercollegiate Guidelines Network. ISBN 1-899893-66-0. {{cite book}}: External link in |chapterurl= and |publisher= (help); Unknown parameter |chapterurl= ignored (|chapter-url= suggested) (help); Unknown parameter |month= ignored (help) - notes though that these criteria "have been arrived at arbitrarily" from:
    Paradise JL, Bluestone CD, Bachman RZ; et al. (1984). "Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and nonrandomized clinical trials". N. Engl. J. Med. 310 (11): 674–83. doi:10.1056/NEJM198403153101102. PMID 6700642. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  19. ^ Paradise JL, Bluestone CD, Colborn DK, Bernard BS, Rockette HE, Kurs-Lasky M (2002). "Tonsillectomy and adenotonsillectomy for recurrent throat infection in moderately affected children". Pediatrics. 110 (1 Pt 1): 7–15. doi:10.1542/peds.110.1.7. PMID 12093941.{{cite journal}}: CS1 maint: multiple names: authors list (link) - this later study by the same team looked at less severely affected children and concluded "modest benefit conferred by tonsillectomy or adenotonsillectomy in children moderately affected with recurrent throat infection seems not to justify the inherent risks, morbidity, and cost of the operations"
  20. ^ Wolfensberger M, Mund MT (2004). "[Evidence based indications for tonsillectomy]". Ther Umsch (in German). 61 (5): 325–8. PMID 15195718. - review of literature of the past 25 years concludes "No consensus has yet been reached, however, about the number of annual episodes that justify tonsillectomy"
  21. ^ Del Mar CB, Glasziou PP, Spinks AB (2004). "Antibiotics for sore throat". Cochrane Database Syst Rev (2): CD000023. doi:10.1002/14651858.CD000023.pub2. PMID 15106140.{{cite journal}}: CS1 maint: multiple names: authors list (link) - Meta-analysis of published research
  22. ^ Zoch-Zwierz W, Wasilewska A, Biernacka A; et al. (2001). "[The course of post-streptococcal glomerulonephritis depending on methods of treatment for the preceding respiratory tract infection]". Wiad. Lek. (in Polish). 54 (1–2): 56–63. PMID 11344703. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  23. ^ Ohlsson, A.; Clark, K (2004). "Antibiotics for sore throat to prevent rheumatic fever: Yes or No? How the Cochrane Library can help". CMAJ. 171 (7): 721–3. doi:10.1503/cmaj.1041275. PMC 517851. PMID 15451830. {{cite journal}}: Unknown parameter |month= ignored (help) - Canadian Medical Association Journal commentary on Cochrane analysis
  24. ^ Danchin, MH; Curtis, N; Nolan, TM; Carapetis, JR (2002). "Treatment of sore throat in light of the Cochrane verdict: is the jury still out?". MJA. 177 (9): 512–515. PMID 12405896. - Medical Journal of Australia commentary on Cochrane analysis
  25. ^ American Academy of Pediatrics (2006). Group A streptococcal infections. In: Pickering, Larry K. (2006). Red Book: 2006 Report of the Committee on Infectious Diseases (Red Book Report of the Committee on Infectious Diseases). Amer Academy of Pediatrics. ISBN 1-58110-194-5.
  26. ^ S. G. Nour; Mafee, Mahmood F.; Valvassori, Galdino E.; Galdino E. Valbasson; Minerva Becker (2005). Imaging of the head and neck. Stuttgart: Thieme. p. 716. ISBN 1-58890-009-6.{{cite book}}: CS1 maint: multiple names: authors list (link)
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