Tonsil and Pharyngeal Infections

Definition | Acute Tonsillitis | Pharyngitis | Peritonsillar Abscess (Quinsy) | Retropharyngeal Abscess | References

Definition

Tonsil and pharyngeal infections are inflammations of the tonsils and pharynx, respectively, often caused by bacterial or viral pathogens. These infections can range from mild to severe and can sometimes lead to abscess formation.

Acute Tonsillitis

Definition: Acute tonsillitis is an infection of the tonsils, characterised by inflammation, swelling, and sometimes pus formation.

Aetiology: Viral infections (e.g., adenovirus, influenza), bacterial infections (e.g., Streptococcus pyogenes).

Pathophysiology: Pathogens invade the tonsillar tissue, causing inflammation and immune response, leading to swelling and pus formation.

Risk Factors: Young age, exposure to infected individuals, poor oral hygiene.

Signs and Symptoms: Sore throat, difficulty swallowing, fever, swollen and red tonsils, white or yellow patches on the tonsils, enlarged lymph nodes.

Investigations: Clinical examination, throat swab for culture.

Management:

• Analgesics and antipyretics (e.g., paracetamol, ibuprofen)
• Antibiotics if bacterial infection is confirmed or strongly suspected (e.g., Pen V, amoxicillin)
• Rest and hydration
• Saltwater gargles
• Referral to ENT specialist if recurrent or severe

Pharyngitis

Definition: Pharyngitis is the inflammation of the pharynx, causing a sore throat and discomfort.

Aetiology: Viral infections (e.g., rhinovirus, coronavirus), bacterial infections (e.g., Streptococcus pyogenes), irritants (e.g., smoke, pollutants).

Pathophysiology: Pathogens or irritants cause inflammation of the pharyngeal mucosa, leading to pain and swelling.

Risk Factors: Exposure to infectious agents, smoking, allergies.

Signs and Symptoms: Sore throat, difficulty swallowing, fever, red and swollen pharynx, sometimes with exudates.

Investigations: Clinical examination, throat swab for culture.

Management:

• Analgesics and antipyretics (e.g., paracetamol, ibuprofen)
• Antibiotics if bacterial infection is confirmed or strongly suspected (e.g., penicillin, amoxicillin)
• Rest and hydration
• Saltwater gargles
• Referral to ENT specialist if symptoms persist or complications develop

Peritonsillar Abscess (Quinsy)

Definition: A peritonsillar abscess, also known as quinsy, is a collection of pus beside the tonsil in the peritonsillar space, often resulting from untreated or inadequately treated tonsillitis.

Aetiology: Usually bacterial, often caused by Streptococcus pyogenes and Staphylococcus aureus.

Pathophysiology: Infection spreads from the tonsil to the peritonsillar space, leading to abscess formation.

Risk Factors: Recurrent tonsillitis, smoking, poor oral hygiene.

Signs and Symptoms: Severe sore throat (usually unilateral), difficulty swallowing, trismus (difficulty opening the mouth), fever, swollen and displaced tonsil, uvula deviation.

Investigations: Clinical examination, needle aspiration of pus for culture, imaging (e.g., ultrasound, CT) if needed.

Management:

• Needle aspiration or incision and drainage of the abscess (admit to hospital)
• Antibiotics (e.g., penicillin, clindamycin)
• Analgesics and antipyretics
• Hydration and rest
• Referral to ENT specialist for further management

Retropharyngeal Abscess

Definition: A retropharyngeal abscess is a deep neck infection located in the tissues at the back of the throat, behind the pharynx.

Aetiology: Bacterial infections, often polymicrobial, including Streptococcus species, Staphylococcus aureus, and anaerobes.

Pathophysiology: Infection spreads to the retropharyngeal space, causing abscess formation and potential airway obstruction.

Risk Factors: Recent upper respiratory infection, trauma to the pharynx, immunocompromised state.

Signs and Symptoms: Severe sore throat, fever, neck stiffness, dysphagia (difficulty swallowing), odynophagia (painful swallowing), stridor, respiratory distress.

Investigations: Clinical examination, imaging (CT scan with contrast) to confirm abscess and assess extent, blood cultures.

Management:

• Hospital admission for intravenous antibiotics (e.g., clindamycin, ceftriaxone)
• Surgical drainage of the abscess
• Airway management if necessary
• Referral to ENT specialist or emergency services for prompt treatment

References

1. NICE. (2024). Tonsillitis and Sore Throat: Diagnosis and Management. Retrieved from NICE
2. NHS. (2023). Tonsillitis. Retrieved from NHS
3. British Medical Journal (BMJ). (2022). Tonsillitis and Pharyngitis: Diagnosis and Management. Retrieved from BMJ
4. American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). (2021). Clinical Practice Guideline: Tonsillectomy in Children. Retrieved from AAO-HNS

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