Otorhinolaryngology (ENT)
Diseases of the Pharynx and Tonsils
Pharynx and tonsil disease for MBBS ENT: acute tonsillitis, quinsy, adenoid hypertrophy, tonsillectomy and deep neck infections, mapped to NMC codes EN4.
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Diseases of the Pharynx and Tonsils
Pharynx and tonsil disease for MBBS ENT: acute tonsillitis, quinsy, adenoid hypertrophy, tonsillectomy and deep neck infections, mapped to NMC codes EN4.
This chapter covers infections and other diseases of the pharynx and tonsils. It runs from acute tonsillitis and quinsy through adenoid hypertrophy and its effects on the ear, to deep neck space infections and pharyngeal tumours, with the indications and complications of tonsillectomy.
High-yield: Diseases of the Pharynx and Tonsils
- Acute tonsillitis is commonly caused by group A beta-haemolytic streptococcus and presents with sore throat, fever and enlarged tender tonsils.
- Complications of streptococcal tonsillitis include rheumatic fever and post-streptococcal glomerulonephritis, so a proven infection is treated with penicillin.
- The Centor criteria (fever, tonsillar exudate, tender anterior cervical nodes and absence of cough) predict streptococcal throat infection.
- A peritonsillar abscess (quinsy) causes severe unilateral throat pain, trismus, a muffled hot potato voice and uvular deviation, and is drained.
- Recurrent tonsillitis and obstructive sleep apnoea due to enlarged tonsils are the main indications for tonsillectomy.
- Reactionary haemorrhage occurs within twenty-four hours of tonsillectomy, while secondary haemorrhage occurs around a week later, usually from infection.
- Adenoid hypertrophy causes nasal obstruction, mouth breathing, snoring and a characteristic adenoid facies in children.
- Adenoids can obstruct the Eustachian tube and cause recurrent otitis media with effusion.
- Infectious mononucleosis (Epstein-Barr virus) causes membranous tonsillitis with marked cervical lymphadenopathy and can be worsened by ampicillin, which causes a rash.
- A retropharyngeal abscess in a young child causes fever, neck stiffness, drooling and difficulty swallowing.
- Ludwig angina is a spreading infection of the floor of the mouth that threatens the airway.
- Carcinoma of the tonsil and oropharynx is increasingly linked to human papillomavirus and presents with a persistent unilateral sore throat or neck node.
- Snoring and daytime sleepiness in a child are important pointers to adenotonsillar obstruction and sleep-disordered breathing.
- A unilaterally enlarged tonsil in an adult should be viewed with suspicion for malignancy or lymphoma.
Tonsil and pharynx problems, at a glance
- **Acute tonsillitis:** Often group A streptococcus. Penicillin prevents rheumatic fever and nephritis.
- **Quinsy (peritonsillar abscess):** Trismus, muffled voice, uvular deviation. Needs drainage.
- **Adenoid hypertrophy:** Mouth breathing, snoring, glue ear, adenoid facies in children.
- **Post-tonsillectomy bleed:** Reactionary within 24 hours; secondary around a week later from infection.
NMC competencies in this chapter
- **EN4.26:** Adenoids and adenoid hypertrophy
- **EN4.38:** Acute and chronic tonsillitis: features and management
- **EN4.39:** Peritonsillar abscess (quinsy) and deep neck infections
- **EN4.40:** Indications and complications of tonsillectomy
- **EN4.41:** Tumours of the pharynx and oropharynx
Frequently Asked Questions
Why treat streptococcal tonsillitis with antibiotics?
Because group A streptococcal infection can lead to rheumatic fever and post-streptococcal glomerulonephritis. A course of penicillin reduces these complications and the duration of illness.
What is quinsy?
A peritonsillar abscess. It causes severe unilateral throat pain, trismus, a muffled hot potato voice and deviation of the uvula, and it is treated by drainage and antibiotics.
When is tonsillectomy indicated?
Mainly for frequent recurrent tonsillitis and for obstructive sleep apnoea caused by enlarged tonsils. Suspicion of malignancy is another indication in adults.
Why avoid ampicillin in suspected glandular fever?
In infectious mononucleosis, ampicillin or amoxicillin commonly triggers a widespread rash, so they are avoided when Epstein-Barr virus infection is suspected.
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