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Tonsillitis and Tonsilloliths: Diagnosis and Management.
Kelly Lacy Smith1, Rachel Hughes1, Palee Myrex1
1University of North Carolina School of Medicine, Chapel Hill, North Carolina.
American Family Physician
|January 23, 2023
Summary
Tonsillitis is common, often viral, but bacterial infections like group A Streptococcus require antibiotics. Differentiating causes is key to prevent serious complications and guide treatment, including watchful waiting for recurrent cases.
Area of Science:
- Infectious Diseases
- Otolaryngology
- Pediatrics
Background:
- Tonsillitis affects 0.4% of US outpatient visits, predominantly viral (70-95%).
- Bacterial tonsillitis, particularly group A Streptococcus (GAS), occurs in 5-30% of patients.
- GAS tonsillitis poses risks for systemic complications like rheumatic fever and scarlet fever.
Purpose of the Study:
- To review the diagnosis and management of tonsillitis.
- To highlight the importance of differentiating viral from bacterial causes.
- To outline treatment strategies for acute and recurrent tonsillitis and tonsilloliths.
Main Methods:
- Review of diagnostic tools including Centor score and laboratory testing.
- Discussion of treatment guidelines for bacterial tonsillitis.
- Evaluation of management strategies for recurrent tonsillitis and tonsilloliths.
Main Results:
- Accurate diagnosis is crucial for appropriate antibiotic selection, with penicillin as first-line for GAS.
- Watchful waiting is recommended for recurrent tonsillitis based on episode frequency.
- Tonsilloliths are typically managed expectantly, with surgery rarely needed.
Conclusions:
- Effective management of tonsillitis hinges on accurate etiological diagnosis.
- Timely antibiotic treatment for GAS prevents severe sequelae.
- Conservative management is preferred for recurrent tonsillitis and tonsilloliths.
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