[Diagnosis and Treatment of recurrent acute Tonsillitis]

When surgery on the palatine tonsils is indicated in children and adults with recurrent acute tonsillitis (RAT) is still the subject of debate. The aim of this article on specialist knowledge is to provide an overview of evidence-based decision-making for optimal diagnosis and treatment of RAT based on current studies and the new S3 guideline on tonsillitis. The diagnosis of a new episode of acute tonsillitis / sore throat should always include a classification with a scoring system (Centor, McIssac, FeverPain score) to assess the likelihood of bacterial tonsillitis, mainly due to group A streptococci (GAS). In unclear cases, a point-of-care test (POCT) for a GAS smear is helpful. Accurate counting of episodes is important in patients with RAT, as the cumulative frequency is the most important marker for or against tonsil surgery to date. In addition, a specific quality of life questionnaire should be used for each episode. Conservative symptomatic treatment of an episode includes a combination of paracetamol and/or non-steroidal anti-inflammatory drugs. If there is a high probability of bacterial tonsillitis, especially in high-risk patients, antibiotic treatment is initiated directly or by delayed prescription. Tonsillectomy is indicated and highly effective if the patient had ≥7 adequately treated episodes of RAT in the previous year or ≥5 such episodes in each of the previous two years or ≥3 such episodes in each of the previous three years. Whether a tonsillotomy is equivalent to a tonsillectomy in these cases will only be answered once the TOTO study has been completed. Standardized pain management is an essential part of the operation, as most patients are likely to experience severe postoperative pain. Nowadays, evidence-based treatment of patients with RAT is readily available.