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| {{Infobox_Disease | | | {{Infobox_Disease | |
| Name = {{PAGENAME}} | | | Name = {{PAGENAME}} | |
| Image = Tonsillitis.jpg | | | Image = Tonsillitis.jpg | |
| Caption = Tonsils showing tonsillitis | | | Caption = Enlarged, red tonsils and exudative white patches of tonsillitis | |
| DiseasesDB = 13165 |
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| ICD10 = {{ICD10|J|03||j|00}}, {{ICD10|J|35|0|j|30}} |
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| ICD9 = {{ICD9|463}} |
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| ICDO = |
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| OMIM = |
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| MedlinePlus = |
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| eMedicineSubj = ent |
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| eMedicineTopic = 314 |
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| MeshID = D014069 |
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| }} | | }} |
| {{SI}} | | {{Tonsillitis}} |
| {{CMG}}
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| {{EH}} | | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
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| ==Overview==
| | {{CMG}}; {{AE}} {{USAMA}}, {{LRO}} |
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| '''Tonsillitis''' is an [[inflammation]] of the [[tonsil]]s and will often, but not necessarily, cause a [[sore throat]] and [[fever]].
| | {{SK}} Inflamed tonsils; tonsils inflamed |
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| ==Types== | | ==[[Tonsillitis overview|Overview]]== |
| There are 3 main types of tonsillitis: '''[[Acute (medical)|acute]]''', '''[[subacute]]''' and '''[[Chronic (medicine)|chronic]]'''. Acute tonsillitis can either be [[bacterial]] or [[viral]] in origin. Subacute tonsillitis (which can last between 3 weeks and 3 months) is caused by the [[bacterium]] ''[[Actinomyces]]''. Chronic tonsillitis, which can last for long periods if not treated, is almost always bacterial.
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| ==Symptoms== | | ==[[Tonsillitis historical perspective|Historical Perspective]]== |
| Tonsillitis is characterized by red, swollen tonsils. White patches may or may not appear on the tonsils. Other signs and symptoms of tonsillitis include a severe sore throat, painful/difficult swallowing, headache, fever and chills, enlarged and tender lymph nodes, pain in the tonsil area, and loss of voice.
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| ==Causes== | | ==[[Tonsillitis classification|Classification]]== |
| Bacterial tonsillitis may be caused by ''[[Group A streptococcal infection|Group A streptococcal bacteria]]'',<ref name="putto">Putto, Anne. "Febrile Exudative Tonsillitis: Viral or Streptococcal?" Pediatrics 80 (1987): 6-12 - Putto studied 110 children treated for febrile exudates tonsillitis. The patients had at least one symptom like fever, pharyngeal edema, or sore throat. Two tests were performed. One method involved cotton tipped swabs that were used to collected specimens when swabbed over the patients tonsils. Second method involved the latex slide agglutination that used rayon tipped swabs to collected specimens. The results showed that 13 out of the 41 patients with bacterial tonsillitis were caused by Group A streptococci</ref> resulting in [[strep throat]].<ref>Putto, Anne. "Febrile Exudative Tonsillitis: Viral or Streptococcal?" Pediatrics 80 (1987): 6-12 - Putto studied 110 children treated for febrile exudates tonsillitis. The patients had to a symptom of fever, pharyngeal edema, or sore throat. Two tests were performed. One method involved cotton tipped swabs that were used to collected specimens when swabbed over the patients tonsils. Second method involved the latex slide agglutination that used rayon tipped swabs to collected specimens. The results had 92 patients that had traced of streptococci in their throat</ref> Viral tonsillitis may be caused by numerous viruses<ref>Putto, Anne. "Febrile Exudative Tonsillitis: Viral or Streptococcal?" Pediatrics 80 (1987): 6-12 - Putto studied 110 children treated for febrile exudates tonsillitis. The patients had to a symptom of fever, pharyngeal edema, or sore throat. Two tests were performed. One method involved cotton tipped swabs that were used to collected specimens when swabbed over the patients tonsils. Second method involved the latex slide agglutination that used rayon tipped swabs to collected specimens. The results had 46 of the 110 patients that had viruses like the Adenovirus that caused 21 of the 46 to get tonsillitis. Epstein-Barr virus caused 10 out of the 46 patient to get tonsillitis and Herpes Simplex virus caused 2 out of the 46</ref> such as the [[Epstein-Barr virus]]<ref>Putto, Anne. "Febrile Exudative Tonsillitis: Viral or Streptococcal?" Pediatrics 80 (1987): 6-12 - Putto studied 110 children treated for febrile exudates tonsillitis. The patients had to a symptom of fever, pharyngeal edema, or sore throat. Two tests were performed. One method involved cotton tipped swabs that were used to collected specimens when swabbed over the patients tonsils. Second method involved the latex slide agglutination that used rayon tipped swabs to collected specimens. The results had 46 of the 110 patients that had viruses like the Adenovirus that caused 21 of the 46 to get tonsillitis. Epstein-Barr virus caused 10 out of the 46 patient to get tonsillitis and Herpes Simplex virus caused 2 out of the 46</ref> (the cause of [[infectious mononucleosis]])<ref>Renn, Claudia N. and et al. "Amoxicillin-induced exanthema in young adults with infectious mononucleosis: demonstration of drug-specific lymphocyte reactivity." British Journal of Dermatology 147 (2002): 1166-1170 -Renn studied 4 patients who where treated amoxicillin for throat infection and lymphadenopathy. Infectious mononucleosis was present in the patient’s blood due to trace of Epstein-Barr antibodies. The three tests performed where the patched test, intracutaneous test, and lymphocyte transformation test. The results of the patched test that pointed to amoxicillin as the caused of their rash were 1 out of 4 patients. The intracutaneous showed 2 out of 4 patients with positive results that pointed to amoxicillin. The LTT results showed 3 out of 4 that pointed to amoxicillin</ref> or the [[Adenovirus]].<ref>Putto, Anne. "Febrile Exudative Tonsillitis: Viral or Streptococcal?." Pediatrics 80 (1987): 6-12 - Putto studied 110 children treated for febrile exudates tonsillitis. The patients had to a symptom of fever, pharyngeal edema, or sore throat. Two tests were performed. One method involved cotton tipped swabs that were used to collected specimens when swabbed over the patients tonsils. Second method involved the latex slide agglutination that used rayon tipped swabs to collected specimens. The results had 46 of the 110 patients that had viruses like the Adenovirus that caused 21 of the 46 to get tonsillitis. Epstein-Barr virus caused 10 out of the 46 patient to get tonsillitis and Herpes Simplex virus caused 2 out of the 46</ref>
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| Sometimes, tonsillitis is caused by a [[superinfection]] of [[spirochaeta]] and [[treponema]], in this case called [[Trench mouth|Vincent's angina]] or Plaut-Vincent angina.<ref>{{cite journal | author = Van Cauwenberge P | title = [Significance of the fusospirillum complex (Plaut-Vincent angina)] | journal = Acta Otorhinolaryngol Belg | volume = 30 | issue = 3 | pages = 334-45 | year = 1976 | id = PMID 1015288}} - fusospirillum complex (Plaut-Vincent angina) Van Cauwenberge studied the tonsils of 126 patients using direct microscope observation. The results showed that 40% of acute tonsillitis was caused by Vincent’s agina and 27% of chronic tonsillitis was caused by Spirochaeta</ref>
| | ==[[Tonsillitis pathophysiology|Pathophysiology]]== |
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| ==Treatment== | | ==[[Tonsillitis causes|Causes]]== |
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| Treatments of tonsillitis consist of pain management medications<ref>Boureau, F. and et al. "Evaluation of Ibuprofen vs Paracetamol Analgesic Activity Using a Sore Throat Pain Model." Clinical Drug Investigation 17 (1999): 1-8. - Boureau studied 113 patients who saw 19 physicians in France. Patients were give Ibuprofen 400mg or Paracetamol 1000mg randomly. Pain intensity, difficulty swallowing, and global pain relief were use to measure in hourly increments until 6 hours after patients first dose. The results showed that Ibuprofen better than Paracetamol in all three categories</ref> and lozenges.<ref>Praskash, T. and et al. "Koflet lozenges in the Treatment of Sore Throat." The Antiseptic 98 (2001): 124-127 - The efficacy of Koflet Lozenges was evaluated by symptomatic relief of pain. The 48 patients were examined by the Physicians and given a scale rating from 0-3. 0 stating no signs and symptoms and 3 being the worse. The results showed patients with pharyngitis 95% of the patient with positive feedbacks. Tonsillitis patients and patients with both symptoms gave 100% positive feedbacks</ref> If the tonsillitis is caused by [[bacteria]],<ref>Touw-Otten, Fransje WMM. and Kristen Staehr Johansen. "Diagnosis, Antibiotic Treatment and Outcome of Acute Tonsillitis: Report of a WHO Regional Office for Europe Study in 17 European Countries." Family Practice 9 (1992): 255-262 - 17 European Countries had a minimum of 10 physicians each that participated in a studied that involved 4094 patients that they had seen from Nov 1989 to May 1990.
| | ==[[Tonsillitis differential diagnosis|Differentiating Tonsillitis from other Diseases]]== |
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| Sore throat, redness and swelling of tonsils, pus on tonsils, enlarge regional lymph nodes, or fever. Bacterial and serology test were performed to determined antibiotics usage. Antibiotics results had 2334 out of 3646 patient using penicillin. 343 out of the 3646 used amoxicillin and 554 out of 3646 used macrolides</ref> then [[antibiotics]] are prescribed.<ref>Touw-Otten, Fransje WMM. and Kristen Staehr Johansen. "Diagnosis, Antibiotic Treatment and Outcome of Acute Tonsillitis: Report of a WHO Regional Office for Europe Study in 17 European Countries." Family Practice 9 (1992): 255-262 - 17 European Countries had a minimum of 10 physicians each that participated in a studied that involved 4094 patients that they had seen from Nov 1989 to May 1990. Sore throat, redness and swelling of tonsils, pus on tonsils, enlarge regional lymph nodes, or fever. Bacterial and serology test were performed to determined antibiotics usage. Antibiotics results had 2334 out of 3646 patient using penicillin. 343 out of the 3646 used amoxicillin and 554 out of 3646 used macrolides</ref> [[Penicillin]] is the most commonly used antibiotic.<ref>Touw-Otten, Fransje WMM. and Kristen Staehr Johansen. "Diagnosis, Antibiotic Treatment and Outcome of Acute Tonsillitis: Report of a WHO Regional Office for Europe Study in 17 European Countries." Family Practice 9 (1992): 255-262 - 17 European Countries had a minimum of 10 physicians each that participated in a studied that involved 4094 patients that they had seen from Nov 1989 to May 1990. Sore throat, redness and swelling of tonsils, pus on tonsils, enlarge regional lymph nodes, or fever. Bacterial and serology test were performed to determined antibiotics usage. Antibiotics results had 2334 out of 3646 patient using penicillin. 343 out of the 3646 used amoxicillin and 554 out of 3646 used macrolides</ref>
| | ==[[Tonsillitis epidemiology and demographics|Epidemiology and Demographics]]== |
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| In many cases of tonsillitis, the pain caused by the inflamed tonsils warrants the prescription of topical anesthetics for temporary relief. Viscous [[lidocaine]] solutions are often prescribed for this purpose.
| | ==[[Tonsillitis risk factors|Risk Factors]]== |
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| [[Ibuprofen]] or other [[analgesic]] can help to decrease the [[edema]] and inflammation which will ease the pain and allow the patient to swallow liquids sooner.<ref>Boureau, F. and et al. "Evaluation of Ibuprofen vs Paracetamol Analgesic Activity Using a Sore Throat Pain Model." Clinical Drug Investigation 17 (1999): 1-8- Boureau studied 113 patients who saw 19 physicians in France. Patients were give Ibuprofen 400mg or Paracetamol 1000mg randomly. Pain intensity, difficulty swallowing, and global pain relief were use to measure in hourly increments until 6 hours after patients first dose. The results showed that Ibuprofen better than Paracetamol in all three categories</ref> | | ==[[Tonsillitis natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| When tonsillitis is caused by a virus, the length of illness depends on which virus is involved. Usually, a complete recovery is made within one week, however some rare infections may last for up to two weeks.
| | ==Diagnosis== |
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| [[Chronic (medicine)|Chronic]] cases may indicate [[tonsillectomy]] (surgical removal of tonsils) as a choice for treatment.<ref>Paradise, JL. and et al. "Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and non randomized clinical trials." The New England Journal of Medicine 310 (1984): 674-83 - Paradise studied 187 children with tonsillectomy or tonsillectomy and adenoidectomy. 91 children were randomly put in surgical and non-surgical groups. The other 96 were place by parent’s choice. The results favored the surgical group on reoccurrence of throat infections during their initial and second year follow-up where the data was collected. While non-surgical groups did better in the long run. 13 out of the 95 surgical group encountered surgical complications after their second year follow up</ref> | | [[Tonsillitis history and symptoms|History and Symptoms]] | [[Tonsillitis physical examination|Physical Examination]] | [[Tonsillitis laboratory findings|Laboratory Findings]] | [[Tonsillitis x ray|X Ray]] | [[Tonsillitis CT|CT]] | [[Tonsillitis other imaging findings|Other Imaging Findings]] | [[Tonsillitis other diagnostic studies|Other Diagnostic Studies]] |
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| Also using warm water and salt solution, and [[gargling]] may help kill the infection, though it's not a strong treatment.<ref>http://www.mayoclinic.com/health/tonsillitis/DS00273/DSECTION=10</ref>
| | ==Treatment== |
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| ==Complications== | |
| An [[abscess]] may develop lateral to the tonsil during an infection, typically several days after the onset of tonsillitis. This is termed a [[peritonsillar abscess]] (or [[quinsy]]).
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| Rarely, the infection may spread beyond the tonsil resulting in inflammation and infection of the internal jugular vein giving rise to a spreading [[septicaemia]] infection ([[Lemierre's syndrome]]).
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| In chronic/recurrent cases (generally defined as seven episodes of tonsillitis in the preceding year, five episodes in each of the preceding two years or three episodes in each of the preceding three years),<ref>{{cite book | title=Management of Sore Throat and Indications for Tonsillectomy | url=http://www.sign.ac.uk/guidelines/fulltext/34/index.html | chapter=6.3 Referral Criteria for Tonsillectomy | chapterurl=http://www.sign.ac.uk/guidelines/fulltext/34/section6.html | publisher=[http://www.sign.ac.uk Scottish Intercollegiate Guidelines Network] | id=ISBN 1-899893-66-0 | year=1999 | month=January}} - notes though that these criteria "have been arrived at arbitrarily" from:<br>{{cite journal | author = Paradise J, Bluestone C, Bachman R, Colborn D, Bernard B, Taylor F, Rogers K, Schwarzbach R, Stool S, Friday G | title = Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and nonrandomized clinical trials. | journal = N Engl J Med | volume = 310 | issue = 11 | pages = 674-83 | year = 1984 | id = PMID 6700642}}</ref><ref>{{cite journal | author = Paradise J, Bluestone C, Colborn D, Bernard B, Rockette H, Kurschildren. | journal = Pediatrics | volume = 110 | issue = 1 Pt 1 | pages = 7-15 | year = 2002 | id = PMID 12093941}} - this later study by the same team looked at less severely affected children and concluded "modest benefit conferred by tonsillectomy or adenotonsillectomy in children moderately affected with recurrent throat infection seems not to justify the inherent risks, morbidity, and cost of the operations"</ref><ref>{{cite journal | author = Wolfensberger M, Mund M | title = [Evidence based indications for tonsillectomy] | journal = Ther Umsch | volume = 61 | issue = 5 | pages = 325-8 | year = 2004 | id = PMID 15195718}} - review of literature of the past 25 years concludes "No consensus has yet been reached, however, about the number of annual episodes that justify tonsillectomy"</ref> or in acute cases where the palatine tonsils become so swollen that swallowing is impaired, a [[tonsillectomy]] can be performed to remove the tonsils. Patients whose tonsils have been removed are certainly still protected from infection by the rest of their immune system.
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| [[Bacteria]] feeding on [[mucus]] which accumulates in pits (referred to as 'crypts') in the tonsils, produce whitish-yellow deposits known as [[tonsilloliths]]. These "tonsil stones" emit a very pungent odour due to the presence of volatile sulphur compounds.
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| [[Tonsilloliths]] which occur in the crypts of the tonsils can only be completely cured by tonsillectomy or by resurfacing the tonsil by laser, but practicing good [[oral hygiene]] and use of a water pick may help lessen the symptoms.
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| [[Organ hypertrophy|Hypertrophy]] of the tonsils can result in snoring, mouth breathing, disturbed sleep, and [[obstructive sleep apnea]], during which the patient stops breathing and experiences a drop in the oxygen content in the bloodstream. A [[tonsillectomy]] can be curative. | | [[Tonsillitis medical therapy|Medical Therapy]] | [[Tonsillitis surgery|Surgery]] | [[Tonsillitis primary prevention|Primary Prevention]] | [[Tonsillitis secondary prevention|Secondary Prevention]] | [[Tonsillitis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Tonsillitis future or investigational therapies|Future or Investigational Therapies]] |
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| In very rare cases, diseases like [[rheumatic fever]] or [[glomerulonephritis]] can occur. These complications are extremely rare in developed nations but remain a significant problem in poorer nations.
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| ==References==
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| {{Reflist|2}}
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| ==External links==
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| *[http://www.netdoctor.co.uk/diseases/facts/tonsillitis.htm Tonsillitis at NetDoctor.co.uk]
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| *[http://www.thelymphnodes.com/tonsillitis/index.php Tonsillitis]
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| *[http://www.llc.co.uk/tons.php Laser surgery for tonsil problems]
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| *[http://www.drgreene.com/21_1209.html Tonsillitis at DrGreene.com]
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| | ==Case Studies== |
| | [[Tonsillitis case study one|Case #1]] |
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| {{Respiratory pathology}} | | {{Respiratory pathology}} |
| {{SIB}}
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| [[ar:التهاب اللوزتين]]
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| [[cs:Angína]]
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| [[da:Halsbetændelse]]
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| [[de:Tonsillitis]]
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| [[es:Amigdalitis]] | | [[es:Amigdalitis]] |
| [[eo:Tonsilito]]
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| [[fr:Amygdalite]] | | [[fr:Amygdalite]] |
| [[hr:Tonzilitis]]
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| [[pt:Tonsilite]] | | [[pt:Tonsilite]] |
| [[qu:Amuqlli unquy]]
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| [[ru:Ангина]] | | [[ru:Ангина]] |
| [[sv:Halsfluss]]
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| [[uk:Ангіна]]
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| [[pl:Angina]] | | [[pl:Angina]] |
| [[tr:Tonsilit]] | | [[tr:Tonsilit]] |
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