Acute tonsillitis (急性扁桃體炎)

Incidence:

A very common disease particularly affecting children between the ages of 4 and 10 years.

Aetiology:

Over 50% of the cases are due to a B haemolytic streptococcus, the majority of the others being of viral, staphylococcal or pneumococcal origin.

Clinical features:

Sore throat, dysphagia, pain on swallowing and otalgia are associated with pyrexia and general malaise. The pharyngeal mucosa appears red and the tonsils are often enlarged and covered by discrete microabscesses or a confluent exudate. 

The tonsils often remain chronically enlarged and inflamed. Lymphadenopathy is frequent, the jugulo-digastric nodes being most commonly involved. A full blood count reveals a leukocytosis but a bacteriology swab does not always grow the pathogen concerned.

Differerntial diagnosis:

• Infectious mononucleosis – it may be impossible to distinguish between the two without a Paul-Bunnell test and a differential white cell count (the latter shows atypical monocytes and a lymphocytosis).
• Blood dyscrasias – any white cell abnormality giving an impaired immune status may present as a severe pharyngitis, e.g. acute leukaemia.
• Diphtheria – rarely seen but should always be borne in mind when there is a membranous exudate over the tonsils or when severe airways obstruction is evident.

Management:

Bed rest, antibiotics and adequate hydration. Penicillin is given (orally or intravenously) unless organism sensitivities or allergy dictate otherwise. In severe cases with grossly enlarged tonsils a tracheostomy may be necessary for airway obstruction.

Recurrent episodes over a prolonged period of time are best managed by tonsillectomy. Following surgery the tonsillar fossae heal over a period of 7-10 days during which time they are covered by a slough, which may mimic an ulcerative pharyngitis. Infection and secondary haemorrhage from the fossae can occur during this period.

Complications:

Chronic tonsillitis

• Peritonsillar abscess (quinsy): hospitalization, antibiotics and intraoral incision and drainage are required
• Parapharyngeal abscess: requires surgical drainage through an external neck incision

Acute otitis media

Post-streptococcal rheumatic fever/glomerulonephritis: now rare.