Complications and Diagnosis of Tonsillitis

Complications of Tonsillitis

1. Local complications A relatively common local complication is peritonsillar abscess. This occurs when the infection in the tonsil worsens and inflammation spreads behind the tonsil, causing pus to collect around it. It usually occurs on one side and is accompanied by severe pain, ear pain, fever, and chills.

There is severe pain when swallowing food, making it difficult to swallow saliva, and the mouth cannot be opened widely. Because the inside of the mouth becomes badly swollen, pronunciation may become difficult and the voice may change. If proper treatment is not provided, the infection can spread to the surrounding area and become serious, so treatment at a hospital is necessary, and in most cases the pus must be drained. In adults, this can usually be done immediately under local anesthesia, but in young children, general anesthesia is necessary. The procedure involves making a small incision above the swollen tonsil and breaking open the pocket of pus to drain it. If drainage is performed properly, symptoms such as difficulty opening the mouth improve quickly. Pus can also be drained using a syringe without making an incision. However, even after drainage, it usually takes more than a week to fully recover, and long-term antibiotic treatment is necessary.

2. Systemic complications Complications that can occur after streptococcal infection of the upper respiratory tract include acute rheumatic fever and streptococcal glomerulonephritis. These are generally known to occur in children due to an abnormal immune response after streptococcal infection.

Rheumatic fever is a condition in which symptoms such as carditis, arthritis, and skin symptoms like erythema appear 1–5 weeks after a streptococcal infection. It generally recovers completely within several weeks with proper treatment, but it can recur if streptococcal pharyngitis develops again, and in rare cases, heart failure may occur due to valvular abnormalities. Streptococcal glomerulonephritis is also a disease in which inflammation develops in the kidneys due to immune complexes 1–2 weeks after a streptococcal infection, causing oliguria and edema. In most cases, recovery occurs after several weeks with proper treatment.

Diagnosis

1. Medical history taking and physical examination In most cases, it can be diagnosed through medical history taking and a simple physical examination. If swollen tonsils with a white coating and redness are seen along with the characteristic symptoms of sudden sore throat, acute tonsillitis can be identified. On the other hand, chronic tonsillitis may show purulent material or caseous debris around the tonsils when the mouth is examined, but it can also present with various other findings, making diagnosis difficult based on examination alone.

In the early stages of chronic tonsillitis, the tonsils may enlarge due to hypertrophy of the tonsillar tissue, but if chronic inflammation continues, scarring develops and the size may actually decrease, so size is not an important finding. If there is a history of frequent tonsillitis in the past and chronic oral pain and pain when swallowing food, along with signs of tonsillar inflammation, the diagnosis can be made.

2. Imaging studies In general, imaging studies are not needed to diagnose tonsillitis. However, because adenoids are located in a place that cannot be seen when looking through the mouth, endoscopic examination at an otolaryngology clinic or a plain X-ray is needed to check for enlarged adenoids. In addition, if peritonsillar abscess is suspected or the inflammation may have spread further and deep neck infection is suspected, computed tomography may be needed to assess the abscess and the extent of inflammation.

In addition, blood tests may be needed to assess the degree of inflammation and check for complications, or bacterial culture and antibiotic susceptibility testing may be needed to use the appropriate antibiotics. Also, if one tonsil is enlarged or there is an ulcer that does not heal well, a biopsy may be performed to differentiate a tumor.

So far, we have explained the complications and diagnosis of tonsillitis. In the next post, we will look at the treatment of tonsillitis.

Source: Korea Disease Control and Prevention Agency, National Health Information Portal