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Full text of "Diseases Of The Nose Throat And Ear"

CHAPTER 26
AFFECTIONS OF THE TONSILS

ACUTE TONSILLITIS

Acute tonsillitis may affect any age group but it is most frequently found in
children. Streptococci, staphylococci and H. influenzae are the most common
organisms, either in pure growth or in combination, but pneumococci may
also be cultured.

SYMPTOMS. The symptoms are those of acute pharyngitis but there is usually
more constitutional disturbance, especially in the case of children. The onset
is often sudden with the temperature rising to 40 C. The tongue is furred and
the breath is offensive. There is some trismus and a constant yet dreaded
desire to swallow; dysphagia is considerable and pain radiates up to the ears.
Constipation is common, and the urine is scanty and highly coloured. There
are often abdominal pains due to a mesenteric adenitis.

CLINICAL FEATURES. In the early stages the tonsil is enlarged, red and
swollen, while later the infection involves the crypts which fill with fibrin.
This turns purulent within the follicles and necrotic areas appear. In this
stage the tonsils are congested, swollen and studded with yellow beads of pus
which at first appear in the mouths of the crypts (Plate VI, 4) but later coalesce.
The cervical glands are enlarged and tender.

DIAGNOSIS. This is usually easy. A throat swab may be taken to isolate the
organisms. If there is confluence of the infected material the condition may be
mistaken for glandular fever, and a blood film and serological tests may be
necessary. Scarlet fever presents with a similar throat appearance but there is a
strawberry tongue in most cases. At times scarlet fever may not be diagnosed
Sntfl the typical rash appears, but even then the rash may be a streptococcal
one which does not desquamate. Skin eruptions due to sensitivity to anti-
biotics may confuse the picture.

TREATMENT. The patient should be sent to bed, and aspirin, in a dose
appropriate to the age of the patient may be given every 4 hours until the
temperature falls. Antibiotics are usually prescribed, and they must be given
in full doses because if they are discontinued too early a relapse may occur.
The disadvantage of giving ampicillin in glandular fever has been mentioned,
but it is most useful in a tonsillitis due to H. influenzae. Penicillin, tetracycline
or erythromycin may be used. In mild attacks one may be justified in with-
holding antibiotics to allow the patient to develop his own resistance to
the infecting organisms. The administration of fluids is important to
prevent dehydration, and they are more acceptable than solid or semisolid
food.

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