And the following that will be covered elsewhere in the curriculum:
Pharyngitis, common cold, foreign body, dental infections
Tonsillitis is inflammation of the pharyngeal tonsils. The inflammation usually extends to the lingual tonsils and adenoids therefore pharyngotonsillitis and adenotonsillitis are synonymous with tonsillitis
Consider infectious mononucleosis particularly when tonsillitis is accompanied by:
- tender lymph nodes
- severe lethargy
- white/gray membrane may cover tonsils that are infected with EBV (see image)
However, EBV diagnosis can only be confirmed via blood tests. The importance of this is that EBV tonsillitis takes longer to resolve and patients should avoid contact sport
Peritonsillar Abscess (Quinsy)
Each tonsil is surrounded by a capsule.It is in the potential space (peritonsillar space) between the tonsil and capsule that abscesses can form - a peritonsillar abscess, or in layman's terms, quinsy
IMPORTANT: the peritonsillar space is contiguous with several deeper spaces and infections can involve the parapharyngeal and retropharyngeal spaces (see deep neck space infections) Compare these pictures above with the pictures shown in the tonsillitis section. What are the differences?
Note carefully the following:
Uvula deviation to contralateral side
Inferior and medial tonsil displacement
Localised fluctuance (easier to appreciate when examining a patient than in pictures)
Swelling of supratonsillar fold/soft palate rather than tonsil itself
Tonsillitis can progress to cellulitis and then via tissue necrosis and pus formation to a peritonsillar abscess
or starts via an infection of minor salivary glands
A polymicrobial flora is isolated from peritonsillar abscesses
Always first think ABC's: In severe circumstances endotracheal intubation or a surgical airway may be required.
The cornerstone of PTA treatment is: incision and drainage
In addition the treatment regime includes the same medication and considerations as for tonsillitis.
Patients with PTA tend to be more toxic - therefore require more IV fluid resus (and greater care)
Epiglottitis and supraglottitis are interchangeable terms meaning:
inflammation of structures above the insertion of the glottis in the oropharynx including the epiglottis, vallecula, arytenoids and aryepiglottic folds (see picture below for nasoendoscopic view of the larynx)
Haemophilus influenzae type b (Hib) used to be responsible for >90% of epiglottitis cases
Due to vaccination the incidence has dropped markedly
Now other bacterial pathogens are responsible for the majority of cases including Strep, Staph and a number of gram negative bacilli
A Danish study demonstrated an incidence of paediatric epiglottitis of 4.9 cases per 100,000 per year in the decade before Hib vaccination.
With the introduction of widespread Hib vaccination - 1996 to 2005 - an incidence of only 0.02 cases per 100,000 per year was seen. (1) History
Muffled voice - "Hot potato voice"
Adults may have had a preceding upper respiratory tract infection (URTI)
Always ask about vaccination if you suspect supraglottitis