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Tonsillitis and Pharyngitis
The tonsils are located in the back and to either side of the throat, or pharynx. Pharyngitis is an inflammation of the pharynx resulting from a viral or bacterial infection. Tonsillitis refers to inflammation of the tonsils caused by viral or bacterial infection. Since these two infections often coexist and are treated in the same manner, they are discussed together. The majority of cases of pharyngitis (and tonsillitis) are secondary to a viral infection. This means antibiotics will have no effect on the course of the llness. Viral infections are self-limiting, nonserious, and will resolve on heir own with only general supportive care. A common bacterial throat infection known as "strep throat" is caused by the bacteria Streptococcus. Streptococcal pharyngitis has peak incidence in the 5-15 year old age group. The usual incubation period is between two and four days. This infection will require antibiotic treatment and can result in serious complications if not treated. Common symptoms of tonsillitis and pharyngitis include painful, sore throat with additional pain upon swallowing. Fever, chills, and swollen glands in the neck are often present. A whitish pus appears on the back of a very red throat. Viral pharyngitis and viral tonsillitis usually improve over the course of several days, while bacterial infections persist. An important cause of viral tonsillitis is acute mononucleosis. This viral infection can mimic Streptococcal tonsillitis in presentation and physical findings. Patients with bacterial throat infections will have higher fevers (102 F.- 104 F.) and appear "more ill". Laryngeal involvement (hoarse voice) is not commonith Streptococcal pharyngitis but more typical of a viral infection. Evaluation will include history (possible exposure to a person with known strep throat) and physical examination. A patient unable to swallow liquids or open the mouth may have a more serious problem. A throat culture may be taken in uncertain cases. A monospot blood test may be performed to exclude mononucleosis as a cause for the infection.
Treatment includes orally administered antibiotics for bacterial pharyngitis (see below), and general supportive care for viral infections. Fever control with acetaminophen, every 4 hours, applies in both cases. Topical anesthetics (Chloraseptic Spray) can be quite helpful. Persistent throat infections, in the absence of a positive strep screen, may be treated with antibiotics. Antibiotic treatment (penicillin V or erythromycin are commonly used) should be carried out for a least 10 days to prevent the complications of untreated strep throat (rheumatic fever and acute glomerulonephritis). Those with bacterial throat infection should avoid any close contact with other uninfected individuals for at least three days from the start of their antibiotic therapy. In some cases, recurrent throat infections need to be treated with a tonsillectomy (removal of the tonsils). The ENT specialist can evaluate you for recurrent bacterial throat infections.
REMEMBER PATIENTS WITH A HISTORY FOR RHEUMATIC HEART DISEASE OR MITRAL VALVE PROLAPSE MUST BE WARY OF THROAT INFECTIONS, SEE THE DOCTOR PROMPTLY.
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