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Definition
Tonsillitis is an inflammation of the tonsils. In practice, the term is reserved for the inflammation of the palatine tonsils.
Classification
Tonsillitis can be classified according to different aspects:
...According to time-dependent course
...According to location
- Unilateral tonsillitis
- Bilateral tonsillitis
...According to clinical aspect
- Catarrhal angina: redness and swelling of the tonsils
- Follicular angina: stipple on the tonsillar crypts
- Lacunar angina: redness and confluent fibrinous coating
...According to degree of severity
- Simple tonsillitis
- Suppurative tonsillitis
- Necrotizing tonsillitis (Vincent's tonsillitis)
Etiology
Tonsillitis is mostly triggered by bacteria, less frequently by viruses. Typical viruses are:Also of importance are:
Many of these germs belong to the resident oral flora. But the infection is mostly triggered by new serotypes of the viruses for which no immunity exists. Additional factors can be a weak general condition or an immune deficiency.
Chronic tonsillitis is mostly a mixed infection with anaerobic and aerobic viruses.
Symptoms
- Swollen, reddened palatine tonsils
- Difficulty to swallow (constricted fauces)
- Ulcerations of the mucous membrane
- Suppurative, fibrinous coating ("stipple")
- Fetid breath
- Swelling of lymphatic nodes
- Scarlatiniform exanthem
- General symptoms (fever, headaches and abnormal fatigue)
Also in chronic tonsillitis:
Diagnosis
As a rule, the diagnosis is made by the typical clinical picture (inspection). If necessary, the diagnosis can be verified by:- Streptococcus rapid test
- Bacteria culture from pharyngeal smear
- Antibody detection (Antistreptolysin O Ab; Attention: increases only after weeks)
Therapy
The therapy depends on the cause and progression of the tonsillitis. As a rule, local and general treatments are combined. In acute tonsillitis:- Antibiotics (penicillin)
- Analgesics
- Pharyngeal irrigations and gargling with disinfectants
- Painting with antiseptics (e.g. pyoktanin solution)
- Mucous membrane anesthetics, oral hygiene
- Bed rest
- Throat compresses (cold, moist)
In chronic tonsillitis:
- Antibiotics
- Tonsillectomy
Differential diagnostics
- Plaut-Vincent Angina (unilateral, necrotizing tonsillitis)
- Infectious mononucleosis
- Diphtheria
- Scarlet fever
- Primary syphilitic lesion
- Herpangina
- Agranulocytosis
- Tonsil carcinoma
- Tuberculosis
Complications
- Peritonsillar abscess
- Retropharyngeal abscess
- Sepsis
- Rheumatic fever
- Endocarditis, myocarditis and pericarditis
- Glomerulonephritis
