Though
ENT specialists will be happy to diagnose acute tonsillitis
more often, I would like to remind the family physicians
that this is a rare clinical entity. After seeing nearly
100 patients of pharyngitis (which could be viral, allergic
or bacterial), I see one occasional case of acute tonsillitis.
Remember and try to make the diagnosis by the same method, which you
use to diagnose acute appendicitis (often over diagnosed by the clinicians).
A patient having acute tonsillitis always presents with fever (which
could be high) and pain at the angles of the mandible. On examination,
the tonsils must show white exudate and the glands in the anterior part
of the neck are often enlarged and tender.
However, the negative findings are more important. There should be no
history of:
| i. |
coryza; |
| ii. |
cough; |
| iii.. |
generalised sore throat |
| iv. |
Hoarseness of voice. |
Finally, like acute appendicitis, raised white cell count helps make the
final diagnosis. ESR or CRP are also raised. Of course, once diagnosed,
these patients must receive full ten days or 2 weeks' course of penicillin
or other macrolide antibiotics. |
