Acute tonsillitis chronic tonsillitis

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ENT: Acute vs. Chronic Tonsillitis

High-Yield Revision Notes for Board Review & PG Entrance Examinations

1. Acute Tonsillitis

Acute inflammation of the palatine tonsils. Most common in children and young adults.

  • Etiology: Most cases are Viral (Adenovirus, Rhinovirus). The most important bacterial pathogen is Group A Beta-Hemolytic Streptococcus (GABHS / S. pyogenes) due to its risk of non-suppurative complications (Rheumatic Fever, Post-streptococcal Glomerulonephritis).
  • Clinical Presentation: Severe sore throat, odynophagia (painful swallowing), fever, and tender cervical lymphadenopathy (jugulodigastric nodes).
  • Types:
    • Acute Follicular: Pus in crypts (looks like yellow spots).
    • Acute Parenchymatous: The whole tonsil is inflamed and enlarged.
  • Treatment: Supportive care (fluids, analgesics). Antibiotics (Penicillin V or Amoxicillin) are indicated only for confirmed or highly suspected GABHS infection (based on Centor criteria).

2. Chronic Tonsillitis

Persistent or recurrent infection leading to chronic mucosal changes and hypertrophic or fibrotic tonsils.

  • Clinical Presentation: Recurrent sore throats, halitosis (foul breath), sensation of a lump in the throat (globus pharyngeus), and often associated with hypertrophy, causing obstruction.
  • Examination: Tonsils may be enlarged (hypertrophic) or small and scarred (fibrotic). Pressure on the tonsil may express cheesy/foul-smelling debris (tonsilloliths) from the crypts.
  • Tonsillectomy Indications (Paradise Criteria):
    • 7 episodes in 1 year, OR
    • 5 episodes/year for 2 consecutive years, OR
    • 3 episodes/year for 3 consecutive years.

3. Differential Matrix & Pearls

Feature High-Yield Detail
Peritonsillar Abscess (Quinsy) Complication of acute tonsillitis; presents with “Hot Potato” voice, uvula deviation to the opposite side, and trismus.
Diphtheria Characterized by a dirty-grey, adherent pseudomembrane that bleeds upon attempted removal.
Infectious Mononucleosis Caused by EBV; presents with severe tonsillar enlargement, shaggy grey exudate, generalized lymphadenopathy, and splenomegaly.
Surgical Risk Post-tonsillectomy hemorrhage is the most serious complication; primary occurs within 24 hours; secondary occurs between days 5–10 due to sloughing of eschar.