ENT (Otorhinolaryngology) · MU Sofia

32. Inflammatory diseases of the pharynx and oral cavity - acute tonsillitis - types, acute pharyngitis.

Covers acute tonsillitis first: its definition, bacterial and viral causes, transmission and predisposing factors, and the seven types from catarrhal to diphtheritic, plus herpangina and phlegmonous forms. It then moves through clinical picture, investigations, treatment, complications and differential diagnosis. A second part on acute pharyngitis follows the same structure, with a comparison table of differential diagnoses and a list of Centor criteria.

Inside: 3 sections · 3 labelled pictures · 1 table · 16 flashcards · 6 min

Topic 32 of 52 in the MU Sofia syllabus for ENT (Otorhinolaryngology) (Medicine, Year 4). The free AceMed note covers it in 3 sections, about 861 words (6 min of reading), with 16 flashcards.

In this note

  1. Inflammatory diseases of the pharynx and oral cavity – acute tonsillitis – types, acute pharyngitis.
  2. Acute tonsillitis
  3. Acute pharyngitis

Acute tonsillitis

1. Definition: Acute tonsillitis is an acute inflammation of the palatine tonsils, part of a more generalized inflammation of the pharyngeal mucous membrane (Waldeyer's ring). While it can occur at any age, it is most common in children and young adults.

2. Etiopathogenesis

  • Bacterial: Most commonly Group A-haemolytic Streptococcus (GABHS), also known as Streptococcus pyogenes. Other pathogens include Staphylococcus aureus, Streptococcus pneumoniae, and Haemophilus influenzae.
  • Viral: precursor or primary cause. Includes Adenovirus, Rhinovirus, Influenza, and EPV (Infectious Mononucleosis).
  • Transmission: Droplet infection or direct contact.
  • Predisposing factors: Fatigue, Immunosuppression, or sudden changes in environmental temperature.
  • Pathogenesis: Colonization → penetration of tonsillar crypt epithelium → inflammation → edema + pus formation → lymphadenitis.

3. Classification

  1. 1. Catarrhal tonsillitis: Tonsils hyperaemic and oedematous., mildest form, no exudate
  2. 2. Follicular tonsillitis: Yellow-white points (pus-filled follicles). Tonsils swollen and painful.
  3. 3. Lacunar tonsillitis: Confluent white-yellow exudates in tonsillar crypts. More severe systemic symptoms
  4. 4. Ulcerative-necrotic tonsillitis (Agronovsky, Plaut–Vincent angina): Ulcers with gray necrotic membrane.
  5. 5. Pseudo-membranous / Diphtheritic tonsillitis: Thick membranes strongly adherent (C. diphtheriae).
  6. 6. Herpangina: Vesicular lesions of soft palate & tonsillar pillars (Coxsackie).
  7. 7. Tonsillitis in Infectious Mononucleosis: Marked edema, white patches, generalized lymphadenopathy.

e. Phlegmonous tonsillitis

  • Progresses to peritonsillar abscess
  • Surgical emergency

4. Clinical Picture

  • General: Sudden onset of high fever, chills, malaise, headache, and body aches.
  • Local: Severe sore throat: Worsened by swallowing (odynophagia).
  • Referred otalgia: Pain radiating to the ears (via the glossopharyngeal nerve).
  • Thick speech: Due to enlarged tonsils narrowing the oropharynx.
  • Physical Signs: Congested tonsils, exudates (follicular/lacunar), and tender, swollen jugulodigastric lymph nodes.

5. Paraclinical & Radiological Examinations

  • Laboratory: CBC: Shows polymorphonuclear leukocytosis.
  • ESR/CRP: Elevated inflammatory markers.
  • Rapid Antigen Detection Test (RADT): For quick GABHS screening.
  • Throat Swab/Culture: gold standard
  • Monospot test (EBV)
  • Radiology: CT scan of the neck with contrast is essential if a peritonsillar or retropharyngeal abscess is suspected.

6. Treatment Options

  • General/Supportive: Bed rest, plenty of fluids and Analgesics/Antipyretics
  • Antibiotics: First-line: Penicillin V for 10 days to prevent Rheumatic Fever.
  • Alternatives: Amoxicillin-Clavulanic acid or Macrolides (Erythromycin) for penicillin-allergic patients.
  • Surgical: Tonsillectomy is considered for recurrent acute tonsillitis (Paradise criteria).
  • Gargle.

7. Possible Complications

  • Local: Peritonsillar Abscess (Quinsy), Parapharyngeal/Retropharyngeal Abscess, Acute Otitis Media
  • Systemic: Acute Rheumatic Fever, Acute Post-streptococcal Glomerulonephritis, Septicaemia.

8. Differential Diagnosis

  1. 1. Infectious Mononucleosis: Look for generalized lymphadenopathy and splenomegaly (diagnosed via Monospot test).
  2. 2. Diphtheria: Grayish, tough, adherent membrane that bleeds when removed.

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