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| {{Tonsilitis}} | | {{Tonsilitis}} |
| {{CMG}} | | {{CMG}} |
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| '''Tonsillitis''' is an [[infection]] of the [[tonsil]]s and will often, but not necessarily, cause a [[sore throat]] and [[fever]].
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| ==Types==
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| There are 3 main types of tonsillitis: '''[[Acute (medical)|acute]]''', '''[[subacute]]''' and '''[[Chronic (medicine)|chronic]]'''. Acute tonsillitis can either be [[bacterial]] or [[viral]] (75%) in origin. Subacute tonsillitis (which can last between 3 weeks and 3 months) is caused by the bacterium ''[[Actinomyces]]''. Chronic tonsillitis, which can last for long periods if not treated, is almost always bacterial.
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| ==Symptoms==
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| Symptoms of tonsillitis include a severe sore throat (which may be experienced as [[referred pain]] to the ears), painful/difficult swallowing, headache, fever and chills, and change in voice causing a "hot potato" voice. Tonsillitis is characterized by signs of red, swollen tonsils which may have a [[exudate|purulent exudative]] coating of white patches (i.e. [[pus]]). In addition, there may be enlarged and tender neck [[cervical lymph nodes]].
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| ==Causes==
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| Bacterial tonsillitis may be caused by ''[[Group A streptococcal infection|Group A streptococcal bacteria]]'',<ref name="pmid3601520">{{cite journal |author=Putto A |title=Febrile exudative tonsillitis: viral or streptococcal? |journal=[[Pediatrics]] |volume=80 |issue=1 |pages=6–12 |year=1987 |pmid=3601520 |doi= |issn=}}</ref> resulting in [[strep throat]].<ref name="pmid3601520">{{cite journal |author=Putto A |title=Febrile exudative tonsillitis: viral or streptococcal? |journal=[[Pediatrics]] |volume=80 |issue=1 |pages=6–12 |year=1987 |pmid=3601520 |doi= |issn=}}</ref> Viral tonsillitis may be caused by numerous viruses<ref name="pmid3601520">{{cite journal |author=Putto A |title=Febrile exudative tonsillitis: viral or streptococcal? |journal=[[Pediatrics]] |volume=80 |issue=1 |pages=6–12 |year=1987 |pmid=3601520 |doi= |issn=}}</ref> such as the [[Epstein-Barr virus]]<ref name="pmid3601520">{{cite journal |author=Putto A |title=Febrile exudative tonsillitis: viral or streptococcal? |journal=[[Pediatrics]] |volume=80 |issue=1 |pages=6–12 |year=1987 |pmid=3601520 |doi= |issn=}}</ref> (the cause of [[infectious mononucleosis]])<ref name="pmid12452866">{{cite journal |author=Renn CN, Straff W, Dorfmüller A, Al-Masaoudi T, Merk HF, Sachs B |title=Amoxicillin-induced exanthema in young adults with infectious mononucleosis: demonstration of drug-specific lymphocyte reactivity |journal=Br. J. Dermatol. |volume=147 |issue=6 |pages=1166–70 |year=2002 |pmid=12452866 |doi=10.1046/j.1365-2133.2002.05021.x}} -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 that pointed to amoxicillin as 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</ref> or the [[Adenovirus]].<ref name="pmid3601520">{{cite journal |author=Putto A |title=Febrile exudative tonsillitis: viral or streptococcal? |journal=[[Pediatrics]] |volume=80 |issue=1 |pages=6–12 |year=1987 |pmid=3601520 |doi= |issn=}}</ref>
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| Sometimes, tonsillitis is caused by a [[superinfection]] of [[spirochaeta]] and [[treponema]], in this case called [[Trench mouth|Vincent's angina]] or Plaut-Vincent angina.<ref name="pmid1015288">{{cite journal |author=Van Cauwenberge P |title=[Significance of the fusospirillum complex (Plaut-Vincent angina)] |language=Dutch; Flemish |journal=Acta Otorhinolaryngol Belg |volume=30 |issue=3 |pages=334–45 |year=1976 |pmid=1015288 |doi=}} - 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 agina and 27% of chronic tonsillitis was caused by Spirochaeta</ref>
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| Although tonsillitis is associated with infection, it is currently unknown if the swelling and other symptoms are caused by the infectious agents themselves, or by the host immune response to these agents. Tonsillitis may be a result of aberrant immune responses to the normal bacterial flora of the [[nasopharynx]].
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| ==Treatment==
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| Treatments of tonsillitis consist of pain management medications<ref name="Boureau">{{cite journal |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}} - Boureau studied 113 patients who saw 19 physicians in France. Patients were give Ibuprofen 400mg or Paracetamol 1000mg randomly. Pain intensity, difficulty swallowing, and global pain relief were use to measure in hourly increments until 6 hours after patients first dose. The results showed that Ibuprofen better than Paracetamol in all three categories</ref> and [[Throat lozenge|lozenges]].<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}} - The efficacy of Koflet Lozenges was evaluated by symptomatic relief of pain. The 48 patients were examined by the Physicians and given a scale rating from 0-3. 0 stating no signs and symptoms and 3 being the worse. The results showed patients with pharyngitis 95% of the patient with positive feedbacks. Tonsillitis patients and patients with both symptoms gave 100% positive feedbacks</ref> If the tonsillitis is caused by [[bacteria]], then [[antibiotics]] are prescribed, with [[penicillin]] being most commonly used.<ref name="pmid1459378">{{cite journal |author=Touw-Otten FW, Johansen KS |title=Diagnosis, antibiotic treatment and outcome of acute tonsillitis: report of a WHO Regional Office for Europe study in 17 European countries |journal=Fam Pract |volume=9 |issue=3 |pages=255–62 |year=1992 |pmid=1459378 |doi=10.1093/fampra/9.3.255}} - 17 European Countries had a minimum of 10 physicians each that participated in a studied that involved 4094 patients that they had seen from Nov 1989 to May 1990. Sore throat, redness and swelling of tonsils, pus on tonsils, enlarge regional lymph nodes, or fever. Bacterial and serology test were performed to determined antibiotics usage. Antibiotics results had 2334 out of 3646 patient using penicillin. 343 out of the 3646 used amoxicillin and 554 out of 3646 used macrolides</ref> [[Erythromycin]] is used for patients allergic to penicillin.
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| In many cases of tonsillitis, the pain caused by the inflamed tonsils warrants the prescription of topical [[anesthetics]] for temporary relief. Viscous [[lidocaine]] solutions are often prescribed for this purpose.
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| [[Ibuprofen]] or other [[analgesic]]s can help to decrease the [[edema]] and inflammation, which will ease the pain and allow the patient to swallow liquids sooner.<ref name="Boureau" />
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| 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, some rare infections may last for up to two weeks.
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| [[Chronic (medicine)|Chronic]] cases may indicate [[tonsillectomy]] (surgical removal of tonsils) as a choice for treatment<ref name="pmid6700642">{{cite journal |author=Paradise JL, Bluestone CD, Bachman RZ, ''et al'' |title=Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and nonrandomized clinical trials |journal=N. Engl. J. Med. |volume=310 |issue=11 |pages=674–83 |year=1984 |pmid=6700642 |doi=}} - Paradise studied 187 children with tonsillectomy or tonsillectomy and adenoidectomy. 91 children were randomly put in surgical and non-surgical groups. The other 96 were place by parent’s choice. The results favored the surgical group on reoccurrence of throat infections during their initial and second year follow-up where the data was collected. While non-surgical groups did better in the long run. 13 out of the 95 surgical group encountered surgical complications after their second year follow up</ref>
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| Additionally, gargling with a solution of warm water and salt may reduce pain and swelling.<ref>[http://www.mayoclinic.com/health/tonsillitis/DS00273/DSECTION=10 Tonsillitis: Self-care - MayoClinic.com<!-- Bot generated title -->]</ref>
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| ==Complications==
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| 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]]).
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| 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]]).
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| 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),<ref>{{cite book | title=Management of Sore Throat and Indications for Tonsillectomy | url=http://www.sign.ac.uk/guidelines/fulltext/34/index.html | chapter=6.3 Referral Criteria for Tonsillectomy | chapterurl=http://www.sign.ac.uk/guidelines/fulltext/34/section6.html | publisher=[http://www.sign.ac.uk Scottish Intercollegiate Guidelines Network] | id=ISBN 1-899893-66-0 | year=1999 | month=January}} - notes though that these criteria "have been arrived at arbitrarily" from:<br>{{cite journal |author=Paradise JL, Bluestone CD, Bachman RZ, ''et al'' |title=Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and nonrandomized clinical trials |journal=N. Engl. J. Med. |volume=310 |issue=11 |pages=674–83 |year=1984 |pmid=6700642 |doi=}}</ref><ref name="pmid12093941">{{cite journal |author=Paradise JL, Bluestone CD, Colborn DK, Bernard BS, Rockette HE, Kurs-Lasky M |title=Tonsillectomy and adenotonsillectomy for recurrent throat infection in moderately affected children |journal=Pediatrics |volume=110 |issue=1 Pt 1 |pages=7–15 |year=2002 |pmid=12093941 |doi=10.1542/peds.110.1.7}} - 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"</ref><ref name="pmid15195718">{{cite journal |author=Wolfensberger M, Mund MT |title=[Evidence based indications for tonsillectomy] |language=German |journal=Ther Umsch |volume=61 |issue=5 |pages=325–8 |year=2004 |pmid=15195718 |doi=}} - 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"</ref> 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 certainly still protected from infection by the rest of their immune system.
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| [[Bacteria]] feeding on [[mucus]] which accumulates in pits (referred to as "crypts") in the tonsils may produce whitish-yellow deposits known as [[tonsillolith]]s. These may emit an odour due to the presence of [[Volatility (chemistry)|volatile]] [[sulfur]] compounds.
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| [[Organ hypertrophy|Hypertrophy]] of the tonsils can result in snoring, mouth breathing, disturbed sleep, and [[obstructive sleep apnea]], during which the patient stops breathing and experiences a drop in the oxygen content in the bloodstream. A [[tonsillectomy]] can be curative.
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| In very rare cases, diseases like [[rheumatic fever]]<ref name="pharyngitis-cochrane">{{cite journal |author=Del Mar CB, Glasziou PP, Spinks AB |title=Antibiotics for sore throat |journal=[[Cochrane Library|Cochrane Database Syst Rev]] |volume= |issue=2 |pages=CD000023 |year=2004 |pmid=15106140 |doi=10.1002/14651858.CD000023.pub2 |url=http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD000023/frame.html}} - Meta-analysis of published research</ref> or [[glomerulonephritis]]<ref name="pmid11344703">{{cite journal |author=Zoch-Zwierz W, Wasilewska A, Biernacka A, ''et al'' |title=[The course of post-streptococcal glomerulonephritis depending on methods of treatment for the preceding respiratory tract infection] |language=Polish |journal=Wiad. Lek. |volume=54 |issue=1-2 |pages=56–63 |year=2001 |pmid=11344703 |doi=}}</ref> can occur. These complications are extremely rare in developed nations but remain a significant problem in poorer nations.<ref>{{cite journal | title=Antibiotics for sore throat to prevent rheumatic fever: Yes or No? How the Cochrane Library can help | journal=CMAJ | month=September 28 | year=2004 | volume=171 | issue=7 | id={{doi|10.1503/cmaj.1041275}} | url=http://www.cmaj.ca/cgi/content/full/171/7/721 | author=Ohlsson, A. | pages=721}} - Canadian Medical Association Journal commentary on Cochrane analysis</ref><ref>{{cite journal | title=Treatment of sore throat in light of the Cochrane verdict: is the jury still out? | journal=MJA | year=2002 | volume=177 | issue=9 | pages=512-515| url=http://www.mja.com.au/public/issues/177_09_041102/dan10028_fm.html}} - Medical Journal of Australia commentary on Cochrane analysis</ref>
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| ==References==
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| {{Reflist|2}}
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| {{Respiratory pathology}} | | {{Respiratory pathology}} |
