Definition

It is defined as chronic inflammation of the palatine tonsil which occurs as a result of repeated attacks of acute tonsillitis or due to inadequately resolved acute tonsillitis.

Etiology/ risk factors

•           Alpha- and beta-hemolytic streptococcal species

•           S.aureus

•           H.influenzae

•           Local immunologic mechanisms are equally responsible in causing chronic tonsillitis.

Clinical Features

•           Sore throat

•           Cough

•           Halitosis

•           Bad taste in mouth due to pus in crypts

•           Thick speech

•           Difficulty in swallowing

•           Sleep apneic episodes

•           Persistent congestion of the anterior pillars

•           Positive tonsillar squeeze

•           Jugulo-digastric lymoh node enlargement

Lab Diagnosis

•           CBC

•           Throat swab for culture and sensitivity

•           X Ray lateral view neck

•           DNE to rule out co-existent adenoid hypertrophy.

Management

A.     Non-Pharmacological

Maintaining adequate hydration and caloric intake.

B.  Pharmacological

1.   Antibiotics:

•           Amoxicillin with clavulanic acid

Adults                  625mg P0 BD in adults

Children              375mg P0 BD

•           Amoxicillin

Adults                  500- 875 mg P0 TDS

Children              30-40 mg/kg/day in 3 divided doses

•           Erythromycin: given to those who are sensitive to penicillin

Adults                  250-500 mg P0 q 6 hrs

Children              30-50 mg/kg/day P0 divided q 6 hrs

2.   Analgesics

•           Paracetamol (Oral,IM)

Adults                  0.5-1 gm every 4-6 hours upto maximum of 4 gms

Children     10mg/kg every 4-6 hours

•           lbuprofen

Adult                  400mg4-6hrs

Children(6-l2yrs)     1Omg/kg8hourly

C.    Surgical

Tonsillectomy