Tonsillopharyngitis

Tonsillopharyngitis

What Is Acute Tonsillopharyngitis?
Tonsillopharyngitis is an abnormal condition wherein the tonsils (lymphoid tissue in the throat) and the lining of the throat becomes infected by bacterial or viral pathogens.  

How does one know if one has Acute Tonsillopharyngitis?
A person with ATP usually present with throat pain, enlarged red tonsils and surrounding tissue sometimes with pus or whitish membrane, fever, foul breath, body weakness, and painful neck lymph nodes. Viral ATP in general are milder than bacterial ATP.

What are the  most  common causative organisms in the development of Acute Tonsillopharyngitis
Among the bacterial causes of ATP the most common is Streptococcus ( specifically   Group A beta-hemolytic streptococcus). Other bacterial causes are Bacteroides species, non-typable H influenza and Moraxella specie. The viral causes can be any of the following: adenovirus, coxsackievirus parainfluenzae, and respiratory syncitial virus. Among the viral causes, the Epstein –Barr Virus greatly mimics a bacterial infection.

What is the function of the tonsils and adenoids?
The tonsils and adenoids comprise the Waldeyer's ring. It is called a ring because these lymphoid tissues surround the entrance to the upper aero-digestive tract. They act to protect the body from invading micro-organisms and other elements by mounting an immunologic reaction whenever pathogens enter the air & food passageway. The largest of these lymphoid tissues are the palatine tonsils thus, they are mainly implicated in Pharyngeal infections.

How Does Acute Tonsillopharyngitis Develop?
Pharyngeal infections develop and become worst when the defense mounted by the tonsils and adenoids is overwhelmed by the bacterial or viral organisms that infect the throat.  The Palatine tonsils are particularly vulnerable to infections because they are large and contain crypts, or deep pits that increase the surface area of these tonsils. Organisms that are normally present in these crypts (normal flora) tend to accumulate and may invade the mucosal lining when the immunity of the host deteriorates. Since these crypts have very little exposure to air, they propagate the growth of anaerobic (non-air requiring) bacteria that may lead to tremendous swelling and formation of pus.  

How Is Acute Tonsillopharyngitis Diagnosed?
In addition to the above mentioned symptoms, physical exam will show red swollen tonsils with our without pus, congested surrounding area,  presence of swollen and painful neck nodes, foul breath, change in voice(because of the swollen throat), and low to high grade fever. A patient is advised to consult a doctor whenever the fever persists, throat pain is not relieved and food and water intake is affected.

What laboratory tests are done toconfirm the diagnosis?
Blood tests include White blood cell count to help identify possible causative organism. A throat swab can be cultured to specifically identify organisms, but this may take time.  In general, empiric therapy is done based on the clinical presentation of the infection.

How is ATP generally treated? What are the available treatment options? 
Viral ATP is self limiting and is generally treated symptomatically to address pain, fever and congestion, and minimizing the load of the pathogen in the throat. Throat preparations include antiseptics and topical anti-inflammatory agents.

Bacterial causes of ATP should be treated with antibiotics. For the common pathogens including Streptococcus, Penicillin is the first drug of choice.  Other antibiotic classes that can be used include the cephalosporins, macrolodes and lincosamines. The latter drug includes Clindamycin and is particularly useful for recurrent bacterial throat infections with abscess.

What is Peritonsillar abscess (Quincy)?
A peritonsillar abscess is a collection of pus in the potential space that surrounds the palatine tonsil in the throat. This process develops when infection penetrates the capsule of the tonsil and enters the peritonsillar space. Over half of patients who present with PTA have a history of prior tonsillitis. In addition to the symptoms stated above, there is severe difficulty of swallowing, an inability to fully open the mouth, a muffled (“hot potato”) voice and drooling of saliva. Examination reveals infected swollen tonsils, a large swelling between the soft palate and the tonsils and pooling of saliva in the oropharynx. Peritonsillar abscess is generally treated either with large bore needle aspiration of the pus or with Incision and drainage of the abscess.  These procedures can be performed as an out- patient either in the office or in the ER. After drainage, an antibiotic with strong gram positive and anaerobic coverage is started and continued to 7 – 10 days. Tonsillectomy (surgical removal of the tonsils) is recommended for multiple (more than 1) episodes of PTA.

What are the indications for performing surgery in Adenotonsillar Infections?
In general, recurrent attacks of ATP can be an indication for doing surgery. Other indications include obstructive sleep apnea, heart and lung complications of chronic tonsillitis, suspicion of malignancy, bleeding tonsillitis and tonsillitis causing febrile seizures.

What are the possible complications of Tonsillectomy?
The most common complication of surgeries for Adenotonsillar disease is bleeding. This can be avoided by properly screening patients pre-operatively for bleeding tendencies and by employing safe and proven techniques in performing tonsillectomy. Other possible complications are airway obstruction due to edema, post-obstructive pulmonary edema, dehydration and weight loss, excessive narrowing or widening of the nasal-oral airway creating
problems in swallowing and speech.

In TMC, what related services are available?
All aspects of diagnosis and treatment of Adeno-Tonsillar diseases are offered in The Medical City.

At The Medical City we have a complete roster of competent otolaryngologists who may assess or treat people with acute tonsillopharyngitis.  For further inquiries or if you want to seek consult, please call:

EAR NOSE AND THROAT CENTER
Tel. No. (632) 988-1000 / (632) 988-7000 Ext. 6251 / 689-8201 (direct line)

CENTER FOR PATIENT PARTNERSHIP
Tel. No. (632) 635-6789 Ext. 6444

Note:   This information is not intended to be used as a substitute for professional medical advise, diagnosis or treatment.   If you or someone you know have any of the symptoms mentioned above, it is advisable to seek professional help.