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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.

Cervical Lymphadenopathy
  • A physical exam can easily identify key findings of tonsillitis - cervical lymphadenopathy and hypertrophy of the tonsils with exudative content.[symptoma.com]
  • There are four Centor Criteria that may be used: [ 2 ] History of fever Tonsillar exudates No cough Tender anterior cervical lymphadenopathy Patients with one or none of these criteria are unlikely to have GABS.[patient.info]
  • 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]
Tonsillar Hypertrophy
  • The association of apoptosis with tonsillar hypertrophy seemed to be age-dependent.[ncbi.nlm.nih.gov]
  • […] of chronic tonsillitis and tonsillar hypertrophy.[ncbi.nlm.nih.gov]
  • Cases of idiopathic tonsillar hypertrophy (ITH) not associated with recurrent infections were used for comparison. We performed a histopathological study of 126 palatine tonsils of children (57 cases due to RT and 69 due to ITH).[ncbi.nlm.nih.gov]
  • In this prospective study, 97 patients who underwent tonsillectomy were divided into the following 2 groups: patients with chronic tonsillitis (n 62) and patients with tonsillar hypertrophy (control group; n 35).[ncbi.nlm.nih.gov]
  • The aim of this study was to assess levels of lipid peroxidation, evidenced by formation of thiobarbituric acid reactive substance (TBARS), level of total sulfhydryl groups (TSH), and carbonyl content in patients with tonsillar hypertrophy (TH) and recurrent[ncbi.nlm.nih.gov]
Splenectomy
  • This can lead to exposure to a variety of treatment regimens including immunosuppressants and splenectomy.[ncbi.nlm.nih.gov]
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]
  • 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]
  • Clinical Manifestations Chronically enlarged tonsils or Incomplete or deformed tonsils No particular abnormal symptoms or Halitosis Mild soreness of the throat Sensation of a foreign object in the throat Tonsils are greatly enlarged May block the respiratory[americandragon.com]
  • […] difficulty swallowing; pain referred to the ears; enlarged anterior cervical nodes; fever and chills; headache; muscle and joint pain; anorexia; increased secretions from the throat; enlarged, reddened, inflamed tonsils; pus or exudate on the tonsils; halitosis[medical-dictionary.thefreedictionary.com]
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]
  • There are four Centor Criteria that may be used: [ 2 ] History of fever Tonsillar exudates No cough Tender anterior cervical lymphadenopathy Patients with one or none of these criteria are unlikely to have GABS.[patient.info]
  • 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]
  • Your health-care professional will pay special attention to the following findings: Signs of throat infection (redness, swelling, tonsillar exudate, enlarged lymph nodes in the neck) Peritonsillar abscess formation (bulging of one tonsil toward the center[emedicinehealth.com]
  • Strep throat is more likely if at least three of the following signs or symptoms are present: Fever White or yellow spots or coating on the throat and/or tonsils (tonsillar exudates) Red spots on the roof of the mouth (upper palette) Swollen or tender[rxlist.com]

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]
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]
  • Shortly after the cessation of the treatment significant increase of secretory immunoglobulin A in saliva was observed which was followed by increase of IgA serum level after 4 weeks of follow-up.[ncbi.nlm.nih.gov]
  • TJ-109 was prescribed, and after one year of daily treatment the incidence of acute tonsillitis before and after the treatment was compared.[ncbi.nlm.nih.gov]
  • We describe a 28-year-old woman with treatment-resistant RA and chronic tonsillitis.[ncbi.nlm.nih.gov]
  • Although the results do not lead to a direct treatment, the epigenetic pathogenesis of chronic inflammation, such as immunoglobulin A nephropathy, by focal infections will be described in greater detail in future studies, which will lead to new treatments[ncbi.nlm.nih.gov]

Prognosis

  • In head and neck cancer, high plasma level of tissue inhibitor of metalloproteinase (TIMP)-1 predicts poor prognosis.[ncbi.nlm.nih.gov]
  • 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 ] Prevention[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]
  • Prognosis Tonsillitis usually resolves within a few days with rest and supportive care. Treating the symptoms of sore throat and fever will make the patient more comfortable.[medical-dictionary.thefreedictionary.com]

Etiology

  • 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]
  • Etiology Chronic tonsillitis etiology Etiology Chronic tonsillitis, crypt epithelial necrosis, bacterial and inflammatory exudate gathered, the crypt can produce small ulcers and scar formation and poor drainage, suitable for bacterial growth and reproduction[healthfrom.com]
  • Source MeSH Chronic Disease Humans Palatine Tonsil Streptococcus pyogenes Tonsillitis Pub Type(s) English Abstract Journal Article Review Language rus PubMed ID 26331161 TY - JOUR T1 - [Chronic tonsillitis, etiological and pathogenetic aspects of the[unboundmedicine.com]
  • Anginas of other etiologies (not as chronic tonsillitis exacerbation) are characterized by repeatability absence.[iliveok.com]

Epidemiology

  • 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]
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]
  • The presence of malondialdehyde and superoxide dismutase in plasma and tonsil tissue reinforces the involvement of oxidative stress in the pathophysiology of chronic tonsillitis.[ncbi.nlm.nih.gov]
  • However, our knowledge on the pathophysiology of chronic tonsils is limited. The aim of this study was to investigate the association between beta defensin 1 gene single nucleotide polymorphisms and 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]
  • I propose careful treatment of patients with chronic tonsillitis, especially for the young age patients as well as measurement taking for an adequate treatment on time (adenotonsillectomy) since it is the only method to complication prevention in the[ncbi.nlm.nih.gov]
  • Children are especially sensitive to infections, allergies and other conditions that must be treated at a young age to prevent complications when older.[heritagefirstent.com]
  • Prevention Prevention of chronic tonsillitis 1.[healthfrom.com]

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: 2018-06-22 04:58