👩‍⚕️ Tonsillitis = acute infection of the palatine tonsils, usually viral but sometimes bacterial. Most children experience it; adults less often, but complications (e.g. quinsy) are more severe. Always consider red flags → stridor, drooling, severe dysphagia → 🚨 emergency referral.

🦠 Aetiology

Viral: EBV (infectious mononucleosis), HSV, Adenovirus 🤒
Bacterial: Group A β-haemolytic Streptococcus (Strep pyogenes), Mycoplasma, Corynebacterium diphtheriae

🧾 Clinical Presentation

Severe sore throat, fever 🌡️, headache, malaise
Tonsillar findings: erythema, exudates, enlargement (torch often needed)
Lymph nodes: tender anterior cervical lymphadenopathy
Viral → coryzal symptoms; EBV → splenomegaly + marked fatigue
Bacterial → white tonsillar exudate more likely

📊 Paradise Criteria (for “true” tonsillitis episodes)

Sore throat + ≥1 of:

Fever >38.3°C 🌡️
Swollen/tender cervical lymph node >2 cm
Tonsillar exudate
Positive strep culture

👶 Tonsillitis in Children

Frequent, but tends to improve with age
Significant impact on schooling (3–5 days absence/episode)

🧑 Tonsillitis in Adults

Less common than children, but usually more severe
Can cause prolonged work absence
Complication: Peritonsillar abscess (Quinsy) → trismus, muffled “hot potato” voice, uvula deviation 🚨

🚨 Red Flags (do not attempt throat exam)

Stridor, drooling, severe respiratory distress
Very unwell/systemic sepsis
Dysphagia, muffled voice, suspicion of epiglottitis
Immediate hospital transfer required 🚑

🔍 Investigations

FBC, CRP, U&E in unwell patients
Throat swab for bacterial culture
EBV serology (Monospot/Paul Bunnell), atypical lymphocytosis on FBC

⚠️ Complications

Local: peritonsillar abscess (quinsy), retropharyngeal abscess
Systemic: scarlet fever, rheumatic fever, glomerulonephritis
EBV: hepatitis, prolonged fatigue, splenic rupture (rare)

🏥 Severe Complications

Quinsy: fever, trismus, uvula deviation, “hot potato” voice → ENT referral + IV antibiotics, drainage
Retropharyngeal abscess: neck swelling, stridor, sepsis → surgical emergency
Lemierre’s syndrome: septic thrombophlebitis of jugular vein → ICU risk

📌 Admission Criteria

Airway compromise (stridor, drooling, severe dysphagia)
Severe systemic illness or dehydration
Peritonsillar cellulitis/abscess
Immunocompromised, diphtheria suspicion, or unusual systemic illness

💊 Management

Analgesia: paracetamol/ibuprofen for fever & pain
Hydration: oral fluids; IV if unable to swallow
Antibiotics (if severe/systemic, bacterial suspected):
- First-line: Penicillin V (phenoxymethylpenicillin) 5–10 days
- Avoid amoxicillin in EBV → rash 🚫
- Alternative: clarithromycin if penicillin-allergic
Tonsillectomy: Consider if recurrent tonsillitis (Paradise criteria) or after quinsy → ENT referral

📚 References

NHS Tonsillitis & Tonsillectomy Guidelines

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Tonsilitis