In this section : Ear, Nose and Throat
Management of Epistaxis
Sore Throat Differential Diagnosis
Dizziness Differential Diagnosis
Peritonsillar Abscess/Quinsy
Acute Tonsillitis
Acute Mastoiditis
Otitis Media
Otitis Externa
WoS Paediatric Drooling and Aspiration Guideline
Voice clinic
Ear Wax
Admitting Patients with Tracheostomy/Laryngectomy to DGRI
Emergency Laryngectomy Management
Emergency Tracheostomy Management
Safe Transfer of Patients with Tracheostomy/Laryngectomy within DGRI
Other Tracheostomy Documents
Home | Articles | Ear, Nose and Throat |
Acute Tonsillitis
Last updated 10th October 2023
- An acute sore throat can be due to acute pharyngitis (inflammation of the oropharynx) or tonsillitis. It is commonly caused by a viral or bacterial infection and is generally self-limiting.
Causes
- Viral: rhinovirus, coronavirus, parainfluenza virus, influenza type A and B, adenovirus, herpes simplex virus and EBV (glandular fever)
- Bacterial: Group A beta haemolytic Streptococcus-is the most common bacterial cause of sore throat and may cause pharyngitis, tonsillitis, or scarlet fever.
Examination Findings
- Examine the patient’s throat and neck:
- Pharyngitis is often associated with pharyngeal exudate and cervical lymphadenopathy.
- Tonsillitis is associated with tonsillar exudate with enlargement and erythema of the tonsils.
- There may be anterior cervical lymphadenopathy.
- The FeverPAIN criteria: score 1 point for each (maximum score of 5).
- Fever (during previous 24 hours).
- Purulence (pharyngeal/tonsillar exudate).
- Attend rapidly (within 3 days after onset of symptoms).
- Severely Inflamed tonsils.
- No cough or coryza.
- A score of 0 or 1 is associated with a 13-18% likelihood of isolating streptococcus.
- A score of 2 or 3 is associated with a 34-40% likelihood of isolating streptococcus.
- A score of 4 or 5 is associated with a 62-65% likelihood of isolating streptococcus.
- Centor criteria: score 1 point for each (maximum score of 4).
- Tonsillar exudate.
- Tender anterior cervical lymphadenopathy or lymphadenitis.
- History of fever (over 38°C).
- Absence of cough.
- A score of 0, 1 or 2 is thought to be associated with a 3-17% likelihood of isolating streptococcus.
- A score of 3 or 4 is thought to be associated with a 32-56% likelihood of isolating streptococcus.
Management
- Glandular fever serology
- Analgesia
- If severe- unable to swallow- STAT dose IV dexamethasone 6.6 mg
- IV antibiotics- until glandular fever test results: IV Benzylpenycillin
- IV fluids
Complications
- Peritonsillar abscess
- Pharapharyngeal/ retropharyngeal abscess
Links
- Oxford Handbook of Clinical Specialties – Baldwin, Oxford Academic, 2020 page 414 [Access via Knowledge Network]
- How do I diagnose the cause of a sore throat? – NICE: August 2023