TONSILITIS

Definition:
- Tonsillitis is inflammation (swelling) of the tonsils most commonly caused by viral or bacterial infection.
Risk Factors:
Young age. Tonsillitis is most common from the preschool years to the mid-teenage years.
Frequent exposure to germs. School-age children are in close contact with their peers and frequently exposed to
viruses or bacteria that can cause tonsillitis.
Causes:
- Caused by common cold viruses
o adenovirus, rhinovirus, influenza, coronavirus, respiratory syncytial virus
o can also be caused by Epstein-Barr virus (the cause of infectious mononucleosis), herpes simplex
virus, cytomegalovirus, or HIV
- Second most common cause are bacteria
o Most common bacterial cause is Group A -hemolytic streptococcus (GABHS) which causes strep throat
o Less common bacterial causes include: Staphylococcus aureus, Streptococcus pneumonia, Mycoplasma
pneumonia, Chlamydia pneumonia, pertussis, Fusobacterium, diphtheria, syphilis, and gonorrhea.
- Sometimes, tonsillitis is caused by an infection of spirochaeta and treponema, in this case called Vincent's
angina or Plaut-Vincent angina.
Infection Process:
- The tonsils are lymph nodes in the back of the mouth and top of the throat. They normally help to filter out
bacteria and other germs to prevent infection in the body.
- As viruses and bacteria enter the body through the nose and mouth, they are filtered in the tonsils.
- Within the tonsils, white blood cells of the immune system mount an attack that helps destroy the viruses or
bacteria, and also causes inflammation and fever.
- The infection may also be present in the throat and surrounding areas, causing inflammation of the pharynx. This
is the area in the back of the throat that lies between the voice box and the tonsils.
Tonsillitis is very common, especially in children.
Symptoms:

Difficulty swallowing
Ear pain
Fever, chills
Headache
Sore throat - lasts longer than 48 hours and may be severe
Tenderness of the jaw and throat
Voice changes, loss of voice

Diagnostoc Evaluations:
Tests that may be done include:
Blood count
Mononucleosis test
Rapid strep test
Throat swab culture

Treatment:
If bacteria such as strep are causing the tonsillitis:
antibiotics are given to cure the infection
Penicillin or Amoxicillin being first line
Macrolide such as erythromycin is used for patients allergic to penicillin
May be given once as a shot, or taken for 10 days by mouth.
If antibiotic pills are used, they must be taken for the entire amount of time prescribed by
the doctor.
DO NOT stop taking them just because the discomfort stops, or the infection may not be
cured.
Drink cold liquids or suck on popsicles. - can soothe a sore throat.
Encourage rest. - Get plenty of sleep and to rest his or her voice.
Drink fluids, especially warm (not hot), bland fluids. promote comfort and to keep the throat moist and prevent
dehydration,
Gargle with warm salt water
If your child can gargle, a saltwater gargle of 1 teaspoon (5 milliliters) of table salt to 8 ounces (237
milliliters) of warm water can help soothe a sore throat. Have your child gargle the solution and then spit
it out.
Suck on lozenges (containing benzocaine or similar ingredients) to reduce pain (these should not be used in young
children because of the choking risk) - to relieve a sore throat.
Humidify the air. Use a cool-air humidifier to eliminate dry air that may further irritate a sore throat, or sit with
your child for several minutes in a steamy bathroom.
Take over-the-counter medications, such as acetaminophen (Tylenol) or ibuprofen to reduce pain and fever. Do
NOT give a child aspirin. Aspirin has been linked to Reye syndrome.
Avoid irritants. Keep your home free from cigarette smoke and cleaning products that can irritate the throat.
Some people who have repeated infections may need surgery to remove the tonsils (tonsillectomy).

Prevention
The germs that cause viral and bacterial tonsillitis are contagious. Therefore, the best prevention is to practice good
hygiene. Health teaching includes:
Wash hands thoroughly and frequently, especially after using the toilet and before eating.
Avoid sharing food, drinking glasses or utensils.
To help prevent the spread of a bacterial or viral infection to others:
Ask the doctor when it's all right to return to school.
Teach to cough or sneeze into a tissue or, when necessary, into his or her elbow.
Teach the importance of washing his or her hands after sneezing or coughing.

Complications:
Blocked airway from swollen tonsils
Dehydration from difficulty swallowing fluids
Kidney failure
Peritonsillar abscess or abscess in other parts of the throat
Pharyngitis bacterial
Post-streptococcal glomerulonephritis
Rheumatic fever and related cardiovascular disorders

Calling your health care provider:
If there is:
Excess drooling in a young child
Fever, especially 101F or higher
Pus in the back of the throat
Red rash that feels rough, and increased redness in the skin folds
Severe difficulty swallowing or breathing
Tender or swollen lymph glands in the neck

PHARYNGITIS
Definition:
- Pharyngitis - bacterial; Sore throat
- A discomfort, pain, or scratchiness in the throat. It often makes it painful to swallow.

Cause:
A. Infectious
a. Viral
i. Adenovirus the most common of the viral causes. Typically the degree of neck lymph
node enlargement is modest and the throat often does not appear red, although it is very painful.
ii. Orthomyxoviridae which cause influenza present with rapid onset high temperature, headache
and generalised ache. A sore throat may be associated.
iii. Infectious mononucleosis ("glandular fever") caused by the Epstein-Barr virus. This may cause
significant lymph gland swelling and anexudative tonsillitis with marked redness and swelling of
the throat. The heterophile test can be used if this is suspected.
iv. Herpes simplex virus can cause multiple mouth ulcers
v. Measles
vi. Common cold: rhinovirus, coronavirus, respiratory syncytial virus, parainfluenza virus can cause
infection of the throat, ear, and lungs causing standard cold-like symptoms and often extreme
pain.
b. Bacterial
i. Group A streptococcus most common
ii. Corynebacterium diphtheria
iii. Neisseria gonorrhoeae
iv. Chlamydophila pneumonia
v. Mycoplasma pneumoniae
c. Fungal - fungal infection
i. Candida albicans causing oral thrush

B. Non-infectious
- may also be caused by mechanical, chemical or thermal irritation, for example cold air or acid reflux
- Some medications may produce pharyngitis such as pramipexole and antipsychotics.
Classification:
Acute - may be catarrhal, purulent or ulcerative, depending on the virulence of the causative agent and the
immune capacity of the affected individual
Chronic - most common otolaringologic disease and may be catarrhal, hypertrophic or atrophic.
Pharyngotonsillitis - if the inflammation includes tonsillitis
Nasopharyngitis - the common cold
Symptoms:
sore throat main symptom
fever
Headache
Joint pain and muscle aches
Skin rashes
swollen lymph nodes in the neck
Diagnostic Evaluation:
- A rapid test or throat culture - to rule out strep throat

Management:

A. Pharmacological
Analgesics such as NSAIDs and acetaminophen can help reduce the pain associated with a sore throat.
Steroids (such as dexamethasone) have been found to be useful for severe pharyngitis. Viscous lidocaine relieves
pain by numbing the mucus membranes.
Antibiotics are useful if group A streptococcus is the cause of the sore throat. For viral infections, antibiotics have
no effect.

B. Nursing Management
Sore throats should only be treated with antibiotics if a strep test is positive.
Drink warm liquids such as lemon tea or tea with honey.
Gargle several times a day with warm salt water (1/2 tsp of salt in 1 cup water).
Drink cold liquids or suck on popsicles.
Suck on hard candies or throat lozenges. Young children should not be given such products because they can
choke on them.
A cool-mist vaporizer or humidifier can moisten and soothe a dry and painful throat.
Try over-the-counter pain medications, such as acetaminophen.

Complications
Blockage of the airway (in severe cases)
Sore (abscess) around the tonsils or behind the throat

Calling your health care provider
You develop a sore throat that does not go away after several days
You have a high fever, swollen lymph nodes in your neck, or a rash
Seek immediate medical care if you have a sore throat and trouble breathing.