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A. Clinical Characteristicsnavigator

  1. History
    1. Odynophagia and/or sore throat
    2. Antecedent upper respiratory infection
  2. Physical exam
    1. Fever
    2. Erythema of tonsils and/or pharynx
    3. Tender cervical lymph nodes
  3. Laboratory
    1. Elevated leukocyte (WBC) count, evidence of dehydration
    2. Monospot for mononucleosis
    3. Throat culture
  4. Etiology
    1. Most commonly viral
    2. ß-hemolytic streptococci most common bacterium; S. pneumoniae
    3. Gram negative rods: H. influenza, Moraxella catarrhalis
  5. Treatment
    1. Hydration
    2. Antibiotics directed at likely organisms
    3. Adequate analgesia including acetaminophen (± codeine)
    4. Saline gargles
  6. Complications
    1. Peritonsillar abscess with extension to deep neck spaces
    2. Patient usually cannot open mouth (tenismus)
    3. Recurrent tonsillitis in ~20% of persons

B. Peritonsillar Abscess [4]navigator

  1. Physical exam
    1. Usually unilateral at superior pole
    2. Classic Triad: muffled "hot potato" voice, trismus, uvular shift
    3. Fever
  2. Bacteria
    1. ß-hemolytic streptococci most common bacterium; S. pneumoniae
    2. Gram negative rods: H. influenza, Klebsiella pneumoniae, Pseudomonas ssp
  3. Complications
    1. Airway obstruction - stridor
    2. Rupture with aspiration
    3. Abscess with extension to deep neck spaces
    4. Hemorrhage (rare)
  4. Treatment of Abscess
    1. Transmucosal needle aspiration - usually sufficient
    2. Incision and drainage - used when aspiration fails
    3. Immediate (Quinsy) tonsillectomy
    4. Antibiotic coverage - intravenous penicillin, 3rd generation cephalosporin, or ampicillin-sulbactam (due to increasing resistance)

C. Tonsillectomynavigator

  1. Indications
    1. Upper airway obstruction: cor pulmonale, obstructive sleep apnea
    2. Peritonsillar abscess
    3. Suspicion of malignancy
    4. Recurrent tonsillitis
    5. Recurrent otitis media with effusion - benefits unclear [3]
  2. Complications
    1. Hemorrhage: early or delayed up to two weeks
    2. Airway obstruction: edema, blood clot, dislodged endotracheal tube
    3. Pulmonary edema
    4. Nasopharyngeal stenosis (with adenoidectomy)

References navigator

  1. Deutsch ES. 1996. Pediatr Clin North Am. 43(6):1319 abstract
  2. Millan SB and Cumming WA. 1996. Prim Care. 23(4):741 abstract
  3. Paradise JL, Bluestone CD, Colborn DK, et al. 1999. JAMA. 282(10):945 abstract
  4. Steyer TE. 2002. Am Fam Phys. 65(1):93 abstract