A Case of Recurrent Tonsillitis

A 15-year-old girl presents to the ENT outpatient with history of throat pain for the past 3 days. It began as mild discomfort or sore throat and has now developed into odynophagia or pain on swallowing. She also has fever – low grade and intermittent, not associated with chills or rigors. She has no history of cough or change in voice. She also has no nasal or ear symptoms.

She gives history of similar complaints occurring in episodes every few months for the past three years. The symptoms usually subside with treatment.

Examination

The patient is afebrile at the time of examination. Examination of her oral cavity reveals normal teeth, gums, lips, buccal mucosa, tongue and palate. The anterior pillars are congested. The tonsils are enlarged and congested. Debris is seen as white spots on the surface of the tonsils. The posterior pharyngeal wall is also congested. Indirect laryngoscopy is normal.

Palpation of the neck shows enlarged and tender jugulodigastric lymph nodes. The nose and ears are normal.

Questions

Answer the following questions before you go on to read the discussion below.

• What is your diagnosis?
• What investigations does the condition require?
• How will you manage this case?

Discussion

History of pain and fever suggest an inflammatory condition. Hypertrophied tonsils, congestion in the anterior pillars and tonsils and pus in the tonsils all suggest tonsillitis. Tonsillitis causes odynophagia or pain on swallowing which has to be differentiated from dysphagia or difficulty in swallowing. It may also cause symptoms like fever, cough and halitosis. Enlarged jugulodigastric lymph nodes are characteristic of pathology in the tonsils.

Diagnosis

Recurrent tonsillitis

Management

Tonsillitis is usually diagnosed clinically. A throat swab may be taken for culture and sensitivity and the most common organism isolated is GABHS (Group A beta hemolytic streptococci).

Medical management

The infection is treated with penicillin group of antibiotics. Analgesics like paracetamol are given for pain and fever. Adequate hydration should be maintained. In cases with severe pain, the patient may require IV fluids. Warm saline gargles will give symptomatic relief to the patient.

Surgical management

Since the patient is suffering with recurrent tonsillitis, with several episodes every year for the past 3 years, she is advised tonsillectomy. Tonsillectomy can be performed after about 6 weeks after the symptoms have subsided.

See ENT cases for more case reports and discussions on diagnosis and management.

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