--- title: "Acute Tonsillitis - Etiology, Types, Clinical Features, Investigations, Treatment & Complications" description: "ENT notes on Acute Tonsillitis - Definition, etiology, types, pathophysiology, symptoms, signs, investigations, treatment, complications & differential diagnosis." source: "The ENT Resident" author: "Dr. Mausumi Das" canonical_url: "https://www.theentresident.com/ent-notes-lectures/acute-tonsillitis-symptoms-pathophysiology-treatment-types-causes" categories: ["Pharynx"] video: "https://www.youtube.com/watch?v=SkBVU2rOeIk" image: "https://media.theentresident.com/og-images/acute-tonsillitis-symptoms-pathophysiology-treatment-types-causes.png" --- # Acute Tonsillitis - Etiology, Types, Clinical Features, Investigations, Treatment & Complications ENT notes on Acute Tonsillitis - Definition, etiology, types, pathophysiology, symptoms, signs, investigations, treatment, complications & differential diagnosis. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=SkBVU2rOeIk ## 🦠 Acute Tonsillitis Acute tonsillitis is the **acute inflammation of the palatine tonsils**, which may involve the: * Mucosa * Crypts of the tonsil * Follicles * Tonsillar parenchyma The type of acute tonsillitis depends on which part of the tonsil is involved. > What are the parts of the palatine tonsil? --- ### Age Group Affected * Most common in **school-going children** * Followed by **young adults** ⭐ Rare in **infants** and in **adults over 50 years of age**. --- ### Etiology of Acute Tonsillitis Acute tonsillitis may occur as: 1- A localized episode 2- In association with an upper respiratory tract illness 3- Part of a generalized systemic infection > What is the most common causative organism in Acute tonsillitis? > What microorganisms are involved in causing Acute tonsillitis? > What is the Route of Spread in Acute tonsillitis? --- ### Pathophysiology of Acute Tonsillitis Inflammation begins within the tonsil → Hyperemia and edema → **Lymphoid follicles** of the tonsil convert into **small abscesses** → Abscesses discharge into the **crypts of the tonsil** ⭐ The palatine tonsil forms a part of **Waldeyer's ring**, the protective lymphoid structure of the upper aerodigestive tract responsible for immunity. > What are the structures forming the Waldeyer's ring? > What is the clinical significance of Waldeyer's ring? --- ### Types of Acute Tonsillitis Based on the progression of the disease: #### 1- Acute Catarrhal (Superficial) Tonsillitis * Tonsils are inflamed as a result of a **generalized infection of the oropharyngeal mucosa** * Commonly seen along with **acute pharyngitis** * Usually occurs due to a **viral upper respiratory tract infection** #### 2- Acute Follicular Tonsillitis * Inflammatory exudate collects in the **tonsillar crypts** * Exudate presents on the surface of the tonsil as **multiple yellowish white spots** * The spots correspond to the **openings of the crypts** #### 3- Acute Membranous Tonsillitis ⭐ One stage ahead of follicular tonsillitis. * Untreated follicular tonsillitis progresses to this stage * The yellowish white spots and exudate from the crypts **coalesce** to form a **membrane over the surface of the tonsil** > What is the differential diagnosis of membrane over the tonsil? #### 4- Acute Parenchymatous Tonsillitis * The whole **tonsillar parenchyma** becomes uniformly congested and swollen * Occurs due to **hyperplasia of the lymphoid follicles** in the tonsillar parenchyma * Tonsils appear uniformly enlarged on both sides, reddish and congested --- ### Clinical Features of Acute Tonsillitis #### Symptoms of Acute Tonsillitis * Sore throat * Dysphagia * Fever * Earache * Constitutional symptoms * Voice change > What is the most common symptom seen in Acute tonsillitis? > What are the causes of earache in Acute tonsillitis? > What is the reason behind voice change in Acute tonsillitis? #### Signs of Acute Tonsillitis **General Examination** * Toxic look (especially in children) * Fever **Oral Cavity & Oropharynx** * Coated tongue * Halitosis * Hyperemia of the tonsillar pillars, soft palate and uvula > What is the reason behind coated tongue and halitosis in Acute tonsillitis? **Findings According to Type of Tonsillitis** | Type | Findings | | --- | --- | | Acute Catarrhal Tonsillitis | Generalized congestion involving the posterior pharyngeal wall | | Acute Follicular Tonsillitis | Reddish, swollen tonsils with yellowish white spots of purulent material at the crypt openings | | Acute Membranous Tonsillitis | Whitish membrane over the medial surface of the tonsil, easily wiped away with a swab | | Acute Parenchymatous Tonsillitis | Enlarged, congested tonsils almost meeting in the midline, with edema of the uvula and soft palate | **Neck Examination** * Enlarged and tender **jugulodigastric nodes** ⭐ Jugulodigastric nodes are the primary nodes draining the tonsils. --- ### Investigations of Acute Tonsillitis Acute tonsillitis is primarily a **Clinical diagnosis**. Investigations are mostly done in patients **not responding to treatment**. **1- Complete Blood Count** * Leukocytosis with **neutrophilia** (acute infection) * **Lymphocytosis** is seen in chronic infection **2- Rapid Strep Test** **3- Throat Swab for Culture & Sensitivity** > Where is the throat swab taken from in a suspected case of Acute tonsillitis? **4- ASO Titre** Elevated **Anti-Streptolysin O** antigen indicates streptococcal infection **5- Peripheral Smear** To rule out: * Agranulocytosis * Leukemia **6- Monospot Test** To rule out **Infectious mononucleosis** --- ### Treatment of Acute Tonsillitis **1- Supportive Treatment** * Bed rest * Plenty of fluids **2- Analgesics & Antipyretics** * Paracetamol * Aspirin **3- Antibiotics** | Situation | Drug | | --- | --- | | Streptococcal infection | Penicillin (Drug of choice) | | Beta-lactamase producing organisms | Amoxicillin + Clavulanic acid | | Penicillin allergy | Erythromycin | * Antibiotics are continued for **7–10 days** * **IV antibiotics** are started in severe infection or a toxic, ill patient **4- Antiseptic Throat Gargles** * Betadine gargles * Lukewarm saline gargles --- ### Complications of Acute Tonsillitis - Chronic Tonsillitis - Abscess Formation - Acute Otitis Media - Streptococcal Complications * Rheumatic fever * Acute glomerulonephritis (rarer nowadays) * Subacute bacterial endocarditis - Septicemia - Internal Jugular Vein Thrombosis > What are the Paradise Criteria for tonsillectomy? > What are the different abscesses that can form as complication of Acute tonsillitis? > How does Acute otitis media form in a case of Acute tonsillitis? > What is the microorganism involved in Subacute bacterial endocarditis? --- ### Differential Diagnosis of Acute Tonsillitis * Scarlet fever * Diphtheria * Vincent's angina * Infectious mononucleosis * Agranulocytosis * Glandular fever * Leukemia ⭐ In diphtheria, a **true membrane** is seen over the tonsil, whereas acute membranous tonsillitis shows a **false membrane (pseudomembrane)**. > What is a true membrane and a false membrane? How will you differentiate it clinically? What are the causes of true membrane and false membrane over tonsil? --- ### 🧠 Viva Pearls * Acute tonsillitis is acute inflammation of the palatine tonsils. * Most common in school-going children, followed by young adults. * Rare in infants and adults over 50 years of age. * Palatine tonsil is a part of Waldeyer's ring. * Acute catarrhal tonsillitis is usually due to a viral upper respiratory tract infection. * Acute follicular tonsillitis shows yellowish white spots at the crypt openings. * Acute membranous tonsillitis is one stage ahead of follicular tonsillitis. * Acute parenchymatous tonsillitis occurs due to hyperplasia of the lymphoid follicles. * Jugulodigastric nodes are the primary nodes draining the tonsils. * Rapid strep test is highly specific but less sensitive than culture. * Penicillin is the drug of choice; erythromycin is used in penicillin allergy. * Antibiotics are continued for 7–10 days. --- ## About This Note This free ENT note on Acute Tonsillitis - Etiology, Types, Clinical Features, Investigations, Treatment & Complications was written by Dr. Mausumi Das and is paired with a corresponding video lecture. 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