Overview of Diagnostic and Treatment-4523 PDF

International Journal of Healthcare Sciences ISSN 2348-5728 (Online)
Vol. 5, Issue 1, pp: (66-73), Month: April - September 2017, Available at: www.researchpublish.com
OVERVIEW OF DIAGNOSTIC AND

TREATMENT APPROACHES OF ACUTE
TONSILLITIS AND ITS COMPLICATIONS
1
Abdulmohsen Abdullah AlHumayn, 2Awath Fahim Alsulami, 3Naif Ayidh Almalki,
4
Abdulelah Ali Ahmed Asiri, 5Ahmed Abdulaziz Alabdulkarim,
6
Ahmad Nueva AlMutairy, 7Ahmed Ali Mohajer, 8Abdulrhman Awaji Al-na'ami,
9
Shaykhah Ali Almalki, 10Tamadhor Ahmed Alghamdi
Abstract: Acute tonsillitis is the commonest reason for emergency circumstance admissions to ENT solutions
worldwide. The aim of this review was to discuss the complications follow acute tonsillitis, and before that we
intended to overview the diagnostic methods as well as the treatment options for acute tonsillitis. A computerized
review was conducted using; (PubMed, Embase, and direct science Databases) Mesh terms were used in search
through PubMed; „tonsillitis‟, „Acute tonsillitis‟ “treatment”, “complication” and „diagnosis‟. Search was involving
studies published up to February, 2017 with language restrictions to English language. A proof based evaluations
of ideal practice has actually existed right here, however additional evidence will be needed in the future, especially
analyzing making use of corticosteroids and oral versus intravenous prescription antibiotics, ensuring method is
proof based as well as scientifically pertinent. Tonsillectomy works in reducing the variety of episodes of sore
throat as well as the variety of days with sore throats in children. The gain is more marked in those most severely
impacted. However, the result is small. Removing the tonsils will protect against tonsillitis, the effect on aching
throats due to pharyngitis is a lot less predictable.
Keywords: Acute Tonsillitis, diagnostic methods, treatment options for acute tonsillitis.
1. INTRODUCTION
Acute tonsillitis is the commonest reason for emergency circumstance admissions to ENT solutions worldwide.
Undoubtedly, from 2010 to 2011, there mored than 61,000 patients admitted to university hospital with this medical
diagnosis alone in UK (1). The public health of tonsillitis has been well explained (1,2). Between 50% and also 80% of
infective aching throat, symptomatology is of viral beginning, mostly including coronavirus, rhinovirus and parainfluenza
infections, and seldom much more uncommon organisms such as primary herpes simplex. Additionally, about 1-- 10% of
situations are set off by the Epstein - Barr infection (EBV; setting off transmittable mononucleosis or glandular high
temperature) (1). A lot more extreme scientific situations tend to be microbial and also regularly develop complying with
a preliminary viral infection (1,2). One of the most normal microbial microorganism is team A beta-haemolytic
streptococcus (GABHS), believed to be gotten in touch with 5 - 36% of tonsillar infections (3).
Patients confessed with acute tonsillitis generate a significant work for the National Health Service (NHS), putting big
financial pressures on a presently overstretched budget plan. To this particular day, requirements published concerning the
administration of aching throat mostly target those working within a health care environment (3).
A patient with acute tonsillitis is normally treated with penicillin because of thought infection with 8-haemolytic
streptococci group A. Repeated occasions of acute tonsillitis treated with countless training courses of penicillin may
cause an adjustment in the regular oral microflora with an option of various cardio and also anaerobic P-lactamase-
producing bacteria such as Huemophilus injuenzae, Staphylococcus aureus and a variety of Bacteroides (fragilis,
melaminogenicus and oralis). Surgical elimination of the tonsils (tonsillectomy) is amongst the commonest significant
Page | 66
Research Publish Journals
procedures carried out on children (4,5). Progressively, it is performed on adults that in the past would probably have had
their tonsils gotten rid of in young people as an issue of routine. However, the treatment is a suspicious one, and also
viewpoints vary substantially as to the family member dangers and also advantages (5).
The aim of this review was to discuss the complications follow acute tonsillitis, and before that we intended to overview
the diagnostic methods as well as the treatment options for acute tonsillitis.
2. METHODOLOGY
A computerized review was conducted using; (PubMed, Embase, and direct science Databases) Mesh terms were used in
search through PubMed; „tonsillitis‟, „Acute tonsillitis‟ “treatment”, “complication” and „diagnosis‟. Search was involving
studies published up to February, 2017 with language restrictions to English language, and studies with human subjects
only. Titles and abstracts were initially screened, Furthermore the bibliographies of included articles were searched for
relevant references.
3. RESULTS
Overview about tonsils:
The tonsils serve immune purchase as well as immune defence by antigen discussion, which is why they consist of T-
lymphocytes, macrophages as well as germinal centres of B-lymphocytes (6). They are the very first and also easiest-to-
reach station of the mucosa associated lymphoid cells system (MALT) in people (7,8). Considering that the main phase of
the immune acquisition proceeds till the age of 6, the palatine tonsils are physiologically hyperplastic currently (9). After
that there is an involution, which is mirrored mostly in a regression until the age of 12 (10). The lymphatic tissue is
separated by an essentially harsh capsule from the surrounding muscle (premium pharyngeal constrictor) (11). The
palatine tonsils have a strong blood flow from four various vessels, the lingual artery, the rising pharyngeal artery and the
rising and coming down palatine arteries. These vessels radiate mostly to the upper as well as lower tonsil pole, as well as
the precise centre of the tonsils side to side (6). The tonsils have deep crypts to maintain the organ surface area as large as
possible and to develop a docking surface for potential antigens (10,11). The crypts and their nearby germinal centres are
separated from each various other by fragile connective tissue (Figure 1) (12).
Figure 1: Specimen of a tonsil in keratine colouring after extracapsular tonsillectomy & HE-Colouring of the same
tonsil with many lymph follicules
4. DIAGNOSIS
The diagnosis of “acute tonsillitis” in children and also grownups can be made on purely professional indications by a
specialist (13). Whereby it concerns primarily blended infections (viral and bacterial) (14). In viral tonsillitis, in addition
to pain and also fever, mainly cough, hoarseness, and rhinorrhoea happen, while in microbial tonsillitis, in addition to pain
with lymph node swelling, there are primarily tonsillar deposits/exudate and fever > 38.3 ° C (15). A streptococcal
antigen examination can validate the medical diagnosis as well as specifies to 98% for streptococci, although not
especially delicate. For that reason, the manufacturers recommend that in case of an unfavorable test result, a number of
tests need to be performed straight. The tests are straightforward, fast (10 minutes) and cheap. Since the tests are easily
Page | 67
available, concerned parents likewise feature favorable or negative test results and need (antibiotic) therapy from the ENT
doctor. One trouble with these tests is the high number of asymptomatic chronic providers (10% of healthy children) of
streptococci as well as staphylococci, that are certainly not in need of therapy (16,17). Smears or bacterial and viral RNA
quick tests need to for that reason have actually carried out just on symptomatic children that are not yet identified (18). In
the early stage, the distinction in between microbial and also viral tonsillitis is usually tough to earn. Particularly when
one thinks about that in 97.5% of situations, at the very least one infection, even in the bacterial tonsillitis, is discovered
(adenovirus and also parainfluenza infection specifically in 47.5% of the situations (19,20,21). These viruses show up,
nonetheless, as does the Epstein Barr infection in the pharyngeal tonsil (22), often be scientifically occult. Therefore,
testing by utilizing quick tests (such as required by some kindergartens or schools) does not make sense due to the fact
that a lot of false-positive results are found (18,23). The same might put on the antistreptolysin titre, which rises
completely non-specifically in streptococcal infections that have actually taken place and then increases over years (18).
The searching‟s for on the responsible bacteria, specifically in the chronic persistent tonsillitis, have altered in recent
years due to increasingly better discovery methods (24,25,26). While with the exploration of rheumatic high temperature,
primarily the group A streptococci (GAS) were criticized for all the sickness in the upper breathing system in the
seventies (27,28,29), lately there are anaerobes, such as Fusobacterium necrophorum, Streptococcus intermedius and
Prevotella melaninogenica and also histicola (30,31).
Few modern-day jobs illuminate the virus range in the tonsils precisely. Swidsinski and also Lochs from the Charité in
2007 analyzed the virus of the tonsil in different phases of tonsillar life sometimes a lot more specifically (32). They
located that children as much as 8 years of age tend to a diffuse, intracellular pathogen enrichment with interstitial
abscesses, while they can verify in grownups or teenagers an extra superficial bacterial buildup at the edge of the crypts.
Particularly when it comes to reoccurring tonsillitis, numerous pathogens and bacteria play a role together. These are
jointly able to form microorganisms and biofilms collections as well as hence avert antibiotic therapy (33). The mouth and
specifically the furrowed tonsil is a tank for numerous virus (infections and also microorganisms), bloodsuckers and also
fungi (34). Nevertheless, all these microbes come from the transient plants and we live in symbiosis with them for aeones
(35). Jensen A. et al. had the ability to discover greater than 100 microorganisms in the tonsils of children and also adults
with as well as without frequent tonsillitis. 52 different bacterial pressures form the basis were observable in each patient,
whether child or adult, whether healthy and balanced or sick. These represent 90% of the complete microorganism tons
(35).
It nearly appears that nearly all pathogens are obvious in the sick, yet also healthy tonsils with the proper discovery
approach. In acute tonsillitis, tonsil hyperplasia or chronic recurrent tonsillitis clearly there is a modification just in the
ratio in favour of some pathogenic bacteria (35). In the medically acute tonsillitis in childhood the streptococci still play
the largest duty with 30% (36), followed by Haemophilus influenzae as well as Neisseria (35). Mainly, however,
combined infections (viral and microbial at first) are responsible for the clinical image (21) (Figure 2).
Figure 2: Open crypt after tonsillotomy with radiofrequency dissection

Page | 68
5. COMPLICATIONS ASSOCIATED WITH ACUTE TONSILLITIS

As a whole, acute tonsillitis runs its course without problems and heals within 3 to 4 days. Rare however severe
difficulties after strep tonsillitis are the glomerulonephritis and rheumatic high temperature, which triggers
cardiomyopathies and also rheumatic-like joint pain (28). Early and lasting (10 days) antibiotic therapy with penicilline or
cephalosporins could reduce the frequency of both these complications by 70% (37). In locations of the third world where
rheumatic fever is more common, the avoidance of this difficulty is the main debate in favour of penicilline treatment
(37). In Europe, the probability of rheumatic fever is so low that of twelve general practitioners just one will certainly
ever before experience a brand-new beginning instance (38).
A 2nd, a lot more regular difficulty is peritonsillar abscess. This usually takes place on one side. But acute tonsillitis
blazes a trail just in one third of situations (39). Also the properly performed antibiotic therapy of acute tonsillitis could
not actually stop peritonsillar abscess (in comparison to rheumatic high temperature) (40). Considering that peritonsillar
abscess is a possibly lethal situation as well as could swiftly spread to the neck soft cells, the primary treatment in
grownups as well as children is surgical and immediate (39,40). Whether the abscess is needle aspirated, incised or treated
by tonsillectomy does not issue (41). Prior to the procedure, a high-dose steroid treatment, in addition to penicillin as well
as metronidazole ought to be provided, as is frequently done for mixed infections (41). In just concerning 30% of
instances after a peritonsillar abscess in children is there a loved one indicator for tonsillectomy in the interval (42) either
due to the fact that a restored abscess takes place or due to the fact that tonsillitis persists. The postoperative blood loss
risk is reduced with the abscess tonsillectomy on the abscess side compared to on the other side, so with peritonsillar
abscess in children a reciprocal tonsillectomy must be dissuaded (43).
6. ANTIBIOTIC THERAPY FOR ACUTE TONSILLITIS

Cochrane Institute benefited years on the exact analysis of the efficiency of antibiotic therapy for throat pain (sore throat)
and also acute tonsillitis (44,45,46). Throughout the alteration of its most recent meta-analysis of 2010, the authors
described a total of seven useful research studies with children under 18 years old (46). In medically precise or proven
microbial tonsillitis related to distress, antibiotic treatment using a beta-lactam antibiotic is justified. It shortens the course
of the disease by an average of someday. Prescription antibiotics lower the high temperature as well as lower pain
compared with placebo, most plainly on the 3rd day after administration. In addition, a beta-lactam antibiotic treatment
gives relatively reputable defense against the dreadful rheumatic high temperature and also glomerulonephritis, which
typically leads particularly in developing nation to joint inflammation, myocarditis and also death. Some researchers have
shown that antibiotic therapy can stop sequelae such as peritonsillar abscesses, acute otitis and also sinusitis (444,6).
A current Cochrane evaluation from 2013 revealed the performance of different anti-biotics in acute (streptococcal)
tonsillitis (47). The penicilline, particularly in adolescents as well as children, reveal the best benefit at the most
affordable expense. There were no differences to cephalosporines. Cephalosporines are, however, a lot more effective in
children under 12 years old and also for chronic persistent tonsillitis, as they can eliminate a lot more stress of
streptococci (48). Macrolides and also clindamycin in children stimulate more negative effects with the exact same
efficacy and for that reason must be booked only for tested penicilline allergy victims (49,50).
One advantage of modern-day macrolide anti-biotics is a substantially shorter duration of therapy, which must increase
conformity. As previously, the period of the suggested criterion therapy with penicillines for acute streptococcal infection
is 10 days (28,50). With regard to the reduction of the course of the disease and also the decrease of the signs and
symptoms, the short-term treatment with azithromycin (20 mg/kg) (51) for 3 days or clarithromycin as well as
cephalosporin for five days amounts to the lasting penicillin treatment with much better conformity (52,53). The very
early discontinuation of penicilline after 5 days revealed no disadvantages in the disease procedure, the price of
recurrence or the development of resistance (54). Only the low-dose azithromycin (10 mg/kg) management is not advised
since a substantially greater relapse price could be demonstrated (53). However, not considered in the temporary
antibiotic therapies are the late difficulties of rheumatic fever and also glomerulonephritis, which nonetheless are among
the major disagreements for a long-lasting beta-lactam antibiotic treatment for acute streptococcal tonsillitis, although the
incidence of rheumatic fever in Europe is reported at only 0.5 instances per 100,000 children of school age (53).
7. TONSILLECTOMY AS ALTERNATIVE TREATMENT OF ACUTE TONSILLITIS

A leading healing approach for such a problem has been tonsillectomy (TE). Generally, referral for TE has depended
mostly on the regularity of tonsillitis episodes. Patients with at least 3 episodes per year, regardless of appropriate medical
Page | 69
treatment, may be taken into consideration as candidates for TE, and surgical treatment is absolutely advised for patients
with greater than four or five episodes per year (55,56). Adult patients commonly have fewer or much less serious
tonsillitis episodes, yet the prominence of various other indices of chronic disease, such as poor basic health and wellness,
time loss from college or work, decreased life quality because of comorbid diseases or systemic results, group A β-
hemolytic streptococcus carriage state, as well as raised serum focus of antibodies, which have actually also been taken
into consideration as ideal indicators for TE (57).
Tonsillectomy is among one of the most common surgeries in Germany, carried out around 115 000 times annually (58).
The medical diagnoses most regularly leading to tonsillectomy are chronic tonsillitis as well as frequent tonsillitis (59).
Tonsillectomy for these indications guarantees an ascertainable change in quality of life, yet data on this subject are
sporadic; as a result, we chose to carry out this research study (60).
Compared to various other research studies, the 85% feedback rate among our patients is high. Prices between 26% and
also 56% have been reported in the literature (61,62). The greatest rate was achieved in one of the most recent research
(62), where the investigators, like us, not only wrote to the participants yet attempted, in some cases repetitively, to reach
them by telephone. These authors consequently estimated the choice impact that can be expected for call-back methods
(job-related flexibility, migration, fatality, and so on) as slight in their instance. Tonsillectomy significantly reduced the
number of attacks of tonsillitis or aching throat (p = 0.0001). Wolfensberger and Mund (59) likewise observed a
significant reduction from approximately 6 to 2 episodes of aching throat annually.
8. CONCLUSION
A proof based evaluations of ideal practice has actually existed right here, however additional evidence will be needed in
the future, especially analyzing making use of corticosteroids and oral versus intravenous prescription antibiotics,
ensuring method is proof based as well as scientifically pertinent. Tonsillectomy works in reducing the variety of episodes
of sore throat as well as the variety of days with sore throats in children. The gain is more marked in those most severely
impacted. However, the result is small. Removing the tonsils will protect against tonsillitis, the effect on aching throats
due to pharyngitis is a lot less predictable.
REFERENCES
[1] Gleeson M.J., Browning G., Burton M.J. et al. (2008) Scott-Brown‟s Otorhinolaryngology: Head and Neck Surgery,
7th edn. Hodder Arnold, London
[2] Ebell M.H., Smith M.A., Barry H.C. et al. (2000) The rational clinical examination. Does this patient have strep
throat?JAMA 284, 2912–2918
[3] Little P., Williamson I., Warner G. et al. (1997) Open randomised trial of prescribing strategies in managing sore
throat. BMJ 314, 722–727
[4] Paradise JL, Bluestone CD, Colborn DK, Bernard BS, Rockette HE, Kurs-Lasky M. Tonsillectomy and
Adenotonsillectomy for Recurrent Throat Infection in Moderately Affected Children. Pediatrics 2002;110(1 (Pt
1)):7–15.
[5] Paradise JL, Bluestone CD, Colborn DK, Bernard BS, Rockette HE, Kurs-Lasky M. Tonsillectomy and
adenotonsillectomy for recurrent throat infection in moderately affected children. Pediatrics 2002;110(1 (Pt 1)): 7–
15.
[6] Westermann J. Organe des Abwehrsystems. Berlin, Heidelberg: Springer; 2010. pp. 361–362.
[7] Brandtzaeg P. Immune functions of nasopharyngeal lymphoid tissue. Adv Otorhinolaryngol. 2011;72:20–24. doi:
10.1159/000324588.
[8] Brandtzaeg P. The B-cell development in tonsillar lymphoid follicles. Acta Otolaryngol Suppl. 1996;523:55–59.
[9] Kaygusuz I, Gödekmerdan A, Karlidag T, Keleş E, Yalçin S, Aral I, Yildiz M. Early stage impacts of tonsillectomy
on immune functions of children. Int J Pediatr Otorhinolaryngol. 2003 Dec;67(12):1311–1315.
[10] Kaygusuz I, Alpay HC, Gödekmerdan A, Karlidag T, Keles E, Yalcin S, Demir N. Evaluation of long-term impacts
of tonsillectomy on immune functions of children: a follow-up study. Int J Pediatr Otorhinolaryngol. 2009
Mar;73(3):445–449. doi: 10.1016/j.ijporl.2008.11.014.
Page | 70
[11] Perry ME, Slípka J. Formation of the tonsillar corpuscle. Funct Dev Morphol. 1993;3(3):165–168. doi:
10.3109/00016488809125005.
[12] Perry ME, Jones MM, Mustafa Y. Structure of the crypt epithelium in human palatine tonsils. Acta Otolaryngol
Suppl. 1988;454:53–59. doi: 10.3109/00016488809125005.
[13] Stuck BA, Götte K, Windfuhr JP, Genzwürker H, Schroten H, Tenenbaum T. Tonsillectomy in children. Dtsch
Arztebl Int. 2008 Dec;105(49):852–860.
[14] Proenca-Modena JL, Pereira Valera FC, Jacob MG, Buzatto GP, Saturno TH, Lopes L, Souza JM, Escremim Paula
F, Silva ML, Carenzi LR, Tamashiro E, Arruda E, Anselmo-Lima WT. High rates of detection of respiratory viruses
in tonsillar tissues from children with chronic adenotonsillar disease. PLoS ONE. 2012;7(8):e42136. doi:
10.1371/journal.pone.0042136.
[15] Österreichische Gesellschaften für Hals-Nasen-Ohren-Heilkunde KuH, Kinder- und Jugendheilkunde. Gemeinsame
Empfehlung zur Entfernung der Gaumenmandeln (Tonsillektomie) Monatsschr Kinderheilkd. 2008 Mar
7;3(156):268–271.
[16] Kaplan EL. The group A streptococcal upper respiratory tract carrier state: an enigma. J Pediatr. 1980
Sep;97(3):337–345. doi: 10.1016/S0022-3476(80)80178-8.
[17] Kaplan EL, Top FH, Jr, Dudding BA, Wannamaker LW. Diagnosis of streptococcal pharyngitis: differentiation of
active infection from the carrier state in the symptomatic child. J Infect Dis. 1971 May;123(5):490–501. doi:
10.1093/infdis/123.5.490.
[18] Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G, Martin JM, Van Beneden C. Infectious
Diseases Society of America. Clinical practice guideline for the diagnosis and management of group A streptococcal
pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis. 2012 Nov;55(10):e86–102.
doi: 10.1093/cid/cis629.
[19] Drago L, Esposito S, De Vecchi E, Marchisio P, Blasi F, Baggi E, Capaccio P, Pignataro L. Detection of respiratory
viruses and atypical bacteria in children's tonsils and adenoids. J Clin Microbiol. 2008 Jan;46(1):369–370.
[20] Piacentini GL, Peroni DG, Blasi F, Pescollderungg L, Goller P, Gallmetzer L, Drago L, Bodini A, Boner AL.
Atypical bacteria in adenoids and tonsils of children requiring adenotonsillectomy. Acta Otolaryngol. 2010
May;130(5):620–625.
[21] Proenca-Modena JL, Pereira Valera FC, Jacob MG, Buzatto GP, Saturno TH, Lopes L, Souza JM, Escremim Paula
F, Silva ML, Carenzi LR, Tamashiro E, Arruda E, Anselmo-Lima WT. High rates of detection of respiratory viruses
in tonsillar tissues from children with chronic adenotonsillar disease. PLoS ONE. 2012;7(8):e42136.
[22] Karlıdağ T, Bulut Y, Keleş E, Alpay HC, Seyrek A, Orhan İ, Karlıdağ GE, Kaygusuz İ. Presence of herpesviruses in
adenoid tissues of children with adenoid hypertrophy and chronic adenoiditis. Kulak Burun Bogaz Ihtis Derg. 2012
Jan-Feb;22(1):32–37.
[23] Shulman ST, Tanz RR, Dale JB, Beall B, Kabat W, Kabat K, Cederlund E, Patel D, Rippe J, Li Z, Sakota V. North
American Streptococcal Pharyngitis Surveillance Group. Seven-year surveillance of north american pediatric group
a streptococcal pharyngitis isolates. Clin Infect Dis. 2009 Jul;49(1):78–84. doi: 10.1086/599344.
[24] Al-Mazrou KA, Al-Khattaf AS. Adherent biofilms in adenotonsillar diseases in children. Arch Otolaryngol Head
Neck Surg. 2008 Jan;134(1):20–23.
[25] Chole RA, Faddis BT. Anatomical evidence of microbial biofilms in tonsillar tissues: a possible mechanism to
explain chronicity. Arch Otolaryngol Head Neck Surg. 2003 Jun;129(6):634–636. doi: 10.1001/archotol.129.6.634.
[26] Drago L, De Vecchi E, Torretta S, Mattina R, Marchisio P, Pignataro L. Biofilm formation by bacteria isolated from
upper respiratory tract before and after adenotonsillectomy. APMIS. 2012 May;120(5):410–416. doi:
10.1111/j.1600-0463.2011.
[27] Alpert JJ, Peterson OL, Colton T. Tonsillectomy and adenoidectomy. Lancet. 1968 Jun;1(7555):1319. doi:
10.1016/S0140-6736(68)92344-1.
[28] Feinstein AR, Levitt M. The role of tonsils in predisposing to streptococcal infections and recurrences of rheumatic
fever. N Engl J Med. 1970 Feb;282(6):285–291. doi: 10.1056/NEJM197002052820601.
Page | 71
[29] Feinstein AR, Levitt M. Tonsils and rheumatic fever. N Engl J Med. 1970 Apr;282(14):814. doi:
10.1056/NEJM197004022821423.
[30] Klug TE, Henriksen JJ, Fuursted K, Ovesen T. Significant pathogens in peritonsillar abscesses. Eur J Clin Microbiol
Infect Dis. 2011 May;30(5):619–627. doi: 10.1007/s10096-010-1130-9.
[31] Klug TE, Henriksen JJ, Fuursted K, Ovesen T. Similar recovery rates of Fusobacterium necrophorum from
recurrently infected and non-infected tonsils. Dan Med Bull. 2011 Jul;58(7):A4295.
[32] Swidsinski A, Göktas O, Bessler C, Loening-Baucke V, Hale LP, Andree H, Weizenegger M, Hölzl M, Scherer H,
Lochs H. Spatial organisation of microbiota in quiescent adenoiditis and tonsillitis. J Clin Pathol. 2007
Mar;60(3):253–260.
[33] Ramírez-Camacho R, González-Tallón AI, Gómez D, Trinidad A, Ibáñez A, García-Berrocal JR, Verdaguer JM,
González-García JA, San Román J. Microscopia electrónica de barrido ambiental para la detección de biopelículas
en las amígdalas. [Environmental scanning electron microscopy for biofilm detection in tonsils]. Acta
Otorrinolaringol Esp. 2008 Jan;59(1):16–20.
[34] Mücke W, Huber HC, Ritter U. Mitteilung über die Keimbesiedelung der Gaumenmandeln bei gesunden Kindern im
Einschulalter. [The microbe colonization of the palatine tonsils of healthy school age children]. Zentralbl Hyg
Umweltmed. 1994 Aug;196(1):70–74. (Ger).
[35] Jensen A, Fagö-Olsen H, Sørensen CH, Kilian M. Molecular mapping to species level of the tonsillar crypt
microbiota associated with health and recurrent tonsillitis. PLoS ONE. 2013;8(2):e56418.
[36] Brook I, Foote PA., Jr Comparison of the microbiology of recurrent tonsillitis between children and adults.
Laryngoscope. 1986 Dec;96(12):1385–1388.
[37] Del Mar CB, Glasziou PP, Spinks AB. Antibiotics for sore throat. Cochrane Database Syst Rev.
2006;(4):CD000023.
[38] Howie JG, Foggo BA. Antibiotics, sore throats and rheumatic fever. J R Coll Gen Pract. 1985 May;35(274):223–
224.
[39] Segal N, El-Saied S, Puterman M. Peritonsillar abscess in children in the southern district of Israel. Int J Pediatr
Otorhinolaryngol. 2009 Aug;73(8):1148–1150.
[40] Powell EL, Powell J, Samuel JR, Wilson JA. A review of the pathogenesis of adult peritonsillar abscess: time for a
re-evaluation. J Antimicrob Chemother. 2013 Sep;68(9):1941–1950. doi: 10.1093/jac/dkt128.
[41] Powell J, Wilson JA. An evidence-based review of peritonsillar abscess. Clin Otolaryngol. 2012 Apr;37(2):136–145.
doi: 10.1111/j.1749-4486.2012.02452.x.
[42] Herzon FS. Harris P. Mosher Award thesis. Peritonsillar abscess: incidence, current management practices, and a
proposal for treatment guidelines. Laryngoscope. 1995 Aug;105(8 Pt 3 Suppl 74):1–17.
[43] Windfuhr JP, Remmert S. Peritonsillarabszess Trends und Komplikationen bei der Behandlung, insbesondere bei
Kindern. [Trends and complications in the management of peritonsillar abscess with emphasis on children]. HNO.
2005 Jan;53(1):46–57.
2000;(2):CD000023.
2004;(2):CD000023.
2006;(4):CD000023.
[47] van Driel ML, De Sutter AI, Keber N, Habraken H, Christiaens T. Different antibiotic treatments for group A
streptococcal pharyngitis. Cochrane Database Syst Rev. 2013;4:CD004406.
[48] Casey JR, Pichichero ME. Meta-analysis of cephalosporin versus penicillin treatment of group A streptococcal
tonsillopharyngitis in children. Pediatrics. 2004 Apr;113(4):866–882. doi: 10.1542/peds.113.4.866.
[49] Chiappini E, Principi N, Mansi N, Serra A, De Masi S, Camaioni A, Esposito S, Felisati G, Galli L, Landi M,
Speciale AM, Bonsignori F, Marchisio P, de Martino M. Italian Panel on the Management of Pharyngitis in
Page | 72
Children. Management of acute pharyngitis in children: summary of the Italian National Institute of Health
guidelines. Clin Ther. 2012 Jun;34(6):1442–1458.
[50] Chiappini E, Regoli M, Bonsignori F, Sollai S, Parretti A, Galli L, de Martino M. Analysis of different
recommendations from international guidelines for the management of acute pharyngitis in adults and children. Clin
Ther. 2011 Jan;33(1):48–58.
[51] Cohen R, Reinert P, De La Rocque F, Levy C, Boucherat M, Robert M, Navel M, Brahimi N, Deforche D, Palestro
B, Bingen E. Comparison of two dosages of azithromycin for three days versus penicillin V for ten days in acute
group A streptococcal tonsillopharyngitis. Pediatr Infect Dis J. 2002 Apr;21(4):297–303.
[52] Altamimi S, Khalil A, Khalaiwi KA, Milner R, Pusic MV, Al Othman MA. Short versus standard duration antibiotic
therapy for acute streptococcal pharyngitis in children. Cochrane Database Syst Rev. 2009;(1):CD004872. doi:
10.1002/14651858.CD004872.pub2.
[53] Altamimi S, Khalil A, Khalaiwi KA, Milner RA, Pusic MV, Al Othman MA. Short-term late-generation antibiotics
versus longer term penicillin for acute streptococcal pharyngitis in children. Cochrane Database Syst Rev.
2012;8:CD004872. doi: 10.1002/14651858.CD004872.pub3.
[54] Gerber MA, Randolph MF, Chanatry J, Wright LL, De Meo K, Kaplan EL. Five vs ten days of penicillin V therapy
for streptococcal pharyngitis. Am J Dis Child. 1987 Feb;141(2):224–227.
[55] American Academy of Otolaryngology-Head and Neck Surgery.
[56] Scottish Intercollegiate Guidelines Network: Management of sore throat and indications for tonsillectomy. A
national clinical guideline. Edinburgh. 1999
[57] Mui S, Rasgon BM, Hilsinger RL: Efficiacy of tonsillectomy for recurrent throat infection in adults. Laryngoscope.
1998, 108: 1325-1328. 10.1097/00005537-199809000-00012.
[58] Statistisches Bundesamt Deutschland. Fallpauschalenbezogene Krankenhausstatistik (DRG-Statistik), Diagnosen
und Prozeduren der vollstationären Patienten und Patientinnen in Krankenhäusern. 2006. Fachserie 12, Reihe 6.4.
[59] Wolfensberger M, Mund MT. Evidenzbasierte Indikation zur Tonsillektomie. Ther Umsch. 2004;61:325–328.
[60] Leplège A, Hunt S. The problem of quality of life in medicine. JAMA. 1997;278:47–50.
[61] Schwentner I, Höfer S, Schmutzhard J, Deibl M, Sprinzl GM. Impact of tonsillectomy on quality of life in adults
with chronic tonsillitis. Swiss Med Wkly. 2007;137:454–461.
[62] Bhattacharyya N, Kepnes LJ, Shapiro J. Efficacy and quality-of-life impact of adult tonsillectomy. Arch Otolaryngol
Head Neck Surg. 2001;127:1347–1350.
Page | 73

Overview of Diagnostic and Treatment-4523 PDF

Hochgeladen von

Dokumentinformationen

Originaltitel

Copyright

Verfügbare Formate

Dieses Dokument teilen

Dokument teilen oder einbetten

Freigabeoptionen

Stufen Sie dieses Dokument als nützlich ein?

Sind diese Inhalte unangemessen?

Copyright:

Verfügbare Formate

Overview of Diagnostic and Treatment-4523 PDF

Hochgeladen von

Copyright:

Verfügbare Formate

International Journal of Healthcare Sciences ISSN 2348-5728 (Online)

OVERVIEW OF DIAGNOSTIC AND

Figure 2: Open crypt after tonsillotomy with radiofrequency dissection

5. COMPLICATIONS ASSOCIATED WITH ACUTE TONSILLITIS

6. ANTIBIOTIC THERAPY FOR ACUTE TONSILLITIS

7. TONSILLECTOMY AS ALTERNATIVE TREATMENT OF ACUTE TONSILLITIS

Das könnte Ihnen auch gefallen