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Chronic Tonsillitis

Chronic tonsillitis is defined as more than five attacks of typical throat infection related symptoms per year accompanied by hypertrophy of the tonsils, most frequently caused by bacterial pathogens. The diagnosis can be made by physical examination and microbiological studies.


Presentation

The condition associated with the repeated episodes of tonsillitis throughout the year is termed as chronic (or recurrent) tonsillitis, with the number of episodes being around five per year, whereas persistence of symptoms for a prolonged period of time may also be considered a chronic form of this infection [1]. The condition is more frequently encountered in children, but adults of any age may be affected. The clinical presentation initially focuses on symptoms such as cervical lymphadenopathy, presence of tonsillar exudates, fever and swallowing difficulties, which is considered a hallmark of tonsillitis [2] [3]. Additional signs may include odynophagia, airway obstruction, loss of appetite and the presence of cough that could indicate an infection of the respiratory tract. Constitutional symptoms like lethargy, fatigue, malaise and weakness are common in patients who develop a tonsillar infection. Symptoms of tonsillitis last approximately 1 week and they rarely last more [3], but the progression of acute tonsillitis into chronic over time results in a more frequent onset of symptoms and persistently enlarged cervical lymph nodes. Since chronic tonsillitis is more frequently encountered as a repeated onset of symptoms in a short period of time, the terms "chronic tonsillitis with acute exacerbation" or simply recurrent tonsillitis have been recommended by certain authors [1]. Regardless of the etiology (bacterial or viral), the clinical presentation is the same, which is why laboratory workup is oriented toward identifying the underlying cause; thus determining the optimal therapy.

Constitutional Symptom
  • Constitutional symptoms like lethargy, fatigue, malaise and weakness are common in patients who develop a tonsillar infection.[symptoma.com]
Splenectomy
  • This can lead to exposure to a variety of treatment regimens including immunosuppressants and splenectomy.[ncbi.nlm.nih.gov]
Cervical Lymphadenopathy
  • A physical exam can easily identify key findings of tonsillitis - cervical lymphadenopathy and hypertrophy of the tonsils with exudative content.[symptoma.com]
  • The most common presentations are cervical lymphadenopathy, oro-oesophageal candidiasis and otitis media. Investigations It is recommended that throat swabs and rapid antigen tests should not be performed routinely.[patient.info]
  • Symptoms may include sore throat, dysphagia, cervical lymphadenopathy, and fever. Diagnosis is clinical, supplemented by culture or rapid antigen test.[merck.com]
  • Patients may present with a variety of symptoms including painful throat (may be unilateral), dysphagia, fevers, tender cervical lymphadenopathy and/or tonsillar exudate. Ear pain and trismus can also occur 1.[radiopaedia.org]
Cough
  • Cough with sputtering Worse with emotional turmoil or anger Difficult to cough up sputum Maybe Blood-streaked sputum The cough may drag on or may recur regularly Pain over the chest and hypochondrium During the coughing, the patient may get hot, flushed[americandragon.com]
  • Additional signs may include odynophagia, airway obstruction, loss of appetite and the presence of cough that could indicate an infection of the respiratory tract.[symptoma.com]
  • Runny nose; Cough; Nose and chest congestion; Watery eyes; Constant Inhaling steam is one of the most effectual ways to get rid of a stuffy nose. QUESTION 4 OF 10: period of 30 years between 1976.[cedag.eu]
  • Chronic irritation in throat with cough. 3. Bad taste in mouth and foul breath (halitosis) due to pus in crypts. 4 Thick speech, difficulty in swallowing and choking spells at night (when tonsils are large and obstructive). Examination 1.[earnosethroatclinic.blogspot.com]
  • Sometimes it is followed by a nagging dryness in the throat and an itching cough. I have had a lot of hair loss since the pregnancy. Combined with a low immune system, I am getting frequent colds so it has been difficult.[homeopathicservices.com]
Tonsillar Hypertrophy
Tonsillar Exudate
  • The clinical presentation initially focuses on symptoms such as cervical lymphadenopathy, presence of tonsillar exudates, fever and swallowing difficulties, which is considered a hallmark of tonsillitis.[symptoma.com]
  • Infectious mononucleosis is suggested by posterior cervical or generalized adenopathy, hepatosplenomegaly, fatigue, and malaise for 1 wk; a full neck with petechiae of the soft palate; and thick tonsillar exudates.[merck.com]
  • Tonsillar exudates. No cough. Tender anterior cervical lymphadenopathy. Patients with one or none of these criteria are unlikely to have GABS. Consideration of antibiotic prescription should be limited to patients with three or four criteria [ 1 ].[patient.info]
  • exudate Tender and enlarged anterior cervical lymph nodes Absence of cough 15 234 NS NS 56 Steinhoff † (1997) 17 Pharyngeal/tonsillar exudate or enlarged anterior cervical lymph nodes 2–13 451 84 40 30 McIsaac † (1998) 18 Tender and enlarged anterior[web.archive.org]
Halitosis
  • Bad taste in mouth and foul breath (halitosis) due to pus in crypts. 4 Thick speech, difficulty in swallowing and choking spells at night (when tonsils are large and obstructive). Examination 1. Tonsils may show varying degree of enlargement.[earnosethroatclinic.blogspot.com]
  • Symptoms include halitosis (bad breath), sore throat, enlarged tonsils and visualization of tonsilloliths within the tonsils.[bergerhenryent.com]
  • Because of this, halitosis or bad breath is a frequent symptom. In addition, a chronically sore throat and enlarged or sore lymph nodes in the neck are usually present.[livestrong.com]
  • Number of days with either sore throat/difficulties in swallowing or halitosis or exhaustion [measurement: documentation in patient's diary] 2. Number of upper respiratory tract infections [measurement: documentation of investigator] 3.[isrctn.com]
  • High fever, malaise, headache, and GI upset are common, as are halitosis and a muffled voice. A rash may also be present. The tonsils are swollen and red and often have purulent exudates. Tender cervical lymphadenopathy may be present.[merck.com]
Skin Lesion
  • Whereas psoriasis has been considered a "double hit" phenomenon, we believe that the development of skin lesions is likely attributable to the presence of the gene PSORS together with the biofilm in psoriasis patients rather than to the biofilm itself[ncbi.nlm.nih.gov]
Neuralgia
  • Glossopharyngeal neuralgia (GPN) is a rare type of neuralgia. Depending on the cause, it is classified as idiopathic GPN and secondary GPN.[ncbi.nlm.nih.gov]

Workup

Firstly, a detailed patient history regarding the onset and duration of symptoms should be performed, followed by a thorough physical examination of the head and neck area, with an emphasis on the throat. A physical exam can easily identify key findings of tonsillitis - cervical lymphadenopathy and hypertrophy of the tonsils with exudative content. Their confirmation can be sufficient for the diagnosis, but to identify the underlying cause and determine whether antibiotic therapy is necessary, microbiological studies should be performed. Throat cultures are rarely done, primarily due to a prolonged time to obtain viable results, which is why throat swabs and rapid antigen detection test (RADT) is recommended, as it can yield a positive result within an hour [4]. However, it is used exclusively for streptococcal infection [4] [5]. RADT carries a 98% specificity for streptococcal species, and the test should be repeated if the initial turns out to be negative [4]. RADT is positive in chronic asymptomatic carriers as well (approximately 10% of healthy children), but the absence of symptoms indicate that therapy is not necessary [4]. Evaluation of antistreptolysin O (ASO) antibodies through serology may also be a possibility, but its use in the setting of an active infection is minimal and establishing prior infection is the main purpose of this test [4]. A valid diagnostic tool to distinguish viral agents as the cause of tonsillitis is yet to be created, especially when having in mind that adenovirus and parainfluenza virus have been detected in > 95% of children with bacterial tonsillitis [4].

Immunoglobulin A Decreased
  • The post-operative levels for the three immunoglobulins were decreased; however, a significant reduction was observed for IgG only where the mean value was comparable with the control group.[ncbi.nlm.nih.gov]
Helicobacter Pylori
  • Abstract Helicobacter pylori, a well-known gastric pathogen, has been detected in the oral cavity and oropharynx in tonsillar tissue.[ncbi.nlm.nih.gov]
Human Papillomavirus
  • Tonsillar human papillomavirus (HPV) status was determined by PCR. In patients with benign tonsillar disease, chronic tonsillitis without hypertrophy was associated with enhanced systemic MMP-8 response.[ncbi.nlm.nih.gov]

Treatment

  • Although it is usually short-lived, some cases persist and are unresponsive to treatment. This can lead to exposure to a variety of treatment regimens including immunosuppressants and splenectomy.[ncbi.nlm.nih.gov]

Prognosis

  • Estimations of the serum immunoglobulin, or simply of IgA, may help us to select those candidates for adeno-tonsillectomy who will have a good prognosis, or at least to exclude those with an underlying sub-clinical immunodeficiency disease.[ncbi.nlm.nih.gov]
  • Prognosis The average duration of acute tonsillitis is one week [ 1 ]. One study found that if tonsillectomy does have to be performed in children it produces a positive and durable increase in 'health-related quality of life' measures [ 13 ].[patient.info]
  • In general, the prognosis for tonsillitis is excellent, and most people recover without any complications or long-term problems. Most cases of viral tonsillitis resolve within 7-10 days with watchful waiting.[emedicinehealth.com]

Etiology

  • TY - JOUR T1 - [Chronic tonsillitis, etiological and pathogenetic aspects of the development of metatonsillar complications].[unboundmedicine.com]
  • Abstract Group A Streptococcus has been identified as a possible etiologic agent in psoriasis in epidemiologic, immunologic, immunopathologic, medical, and surgical studies.[ncbi.nlm.nih.gov]
  • Regardless of the etiology (bacterial or viral), the clinical presentation is the same, which is why laboratory workup is oriented toward identifying the underlying cause; thus determining the optimal therapy.[symptoma.com]
  • Anginas of other etiologies (not as chronic tonsillitis exacerbation) are characterized by repeatability absence.[iliveok.com]

Epidemiology

  • Abstract Group A Streptococcus has been identified as a possible etiologic agent in psoriasis in epidemiologic, immunologic, immunopathologic, medical, and surgical studies.[ncbi.nlm.nih.gov]
  • Epidemiology It is a very common condition, most frequent in children aged 5-10 years and young adults between 15 and 25 years.[patient.info]
  • Epidemiologic observations made decades earlier indicated that some outbreaks of streptococcal pharyngitis in rheumatic fever hospitals or wards were followed closely by recurrent ARF, whereas other outbreaks failed to trigger such recurrences, even in[doi.org]
Sex distribution
Age distribution

Pathophysiology

  • Presence of MDA and SOD in tonsillar tissue reinforce involvement of oxidative stress in pathophysiology of chronic tonsillitis.[ncbi.nlm.nih.gov]

Prevention

  • Postsurgical care is aimed at prevention of hemorrhage, prevention of aspiration of drainage, and control of pain. The child is positioned on side until fully alert to facilitate drainage of secretions and prevent aspiration.[medical-dictionary.thefreedictionary.com]
  • Further studies are necessary to evaluate their possible therapeutic role in preventing recurrent tonsillitis and treating postoperative patients to help normalize their blood levels of antioxidants.[ncbi.nlm.nih.gov]
  • The episodes of sore throat are disabling and prevent normal functioning.[patient.info]

References

Article

  1. Georgalas CC, Tolley NS, Narula PA. Tonsillitis. BMJ Clin Evid. 2014;2014:0503.
  2. Pribuišienė R, Kuzminienė A, Sarauskas V, Saferis V, Pribuišis K, Rastenienė I. The most important throat-related symptoms suggestive of chronic tonsillitis as the main indication for adult tonsillectomy. Medicina (Kaunas). 2013;49(5):219-222.
  3. Worrall G. Acute sore throat. Can Fam Physician. 2011;57(7):791-794.
  4. Stelter K. Tonsillitis and sore throat in children. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2014;13:Doc07.
  5. Johansson L, Månsson NO. Rapid test, throat culture and clinical assessment in the diagnosis of tonsillitis. Fam Pract. 2003;20(2):108-111.

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Last updated: 2019-06-28 11:25