ENT and Head & Neck Surgery
Tonsillitis and Tonsillectomy
Recurrent tonsillitis in adults and children, peritonsillar abscess, and modern tonsillectomy techniques.
When is tonsillectomy indicated?
Tonsillectomy indications follow Paradise criteria: 7+ episodes in 1 year, 5+/year for 2 consecutive years, or 3+/year for 3 consecutive years. Other indications: obstructive sleep apnea (large tonsils), recurrent peritonsillar abscess, chronic tonsillitis, and suspected malignancy. Modern tonsillectomy uses coblation (controlled ablation) or coagulation (electrocautery); classic dissection is still used. Adult tonsillectomy is more painful than paediatric and recovery takes 14 days.
Clinical picture and diagnosis
Acute tonsillitis: high fever, sore throat, dysphagia, cervical lymphadenopathy, and enlarged erythematous tonsils. Mostly viral; bacterial cases are largely Group A Beta-haemolytic streptococcus (GAS). Centor / McIsaac score guides clinical decision-making; >2 points warrants rapid GAS test or throat culture.
Bacterial tonsillitis is treated with penicillin/amoxicillin for 10 days. Cephalosporin or macrolide alternatives apply for penicillin allergy.
Frequently Asked Questions
- Yes, particularly in adults. First 7 days feature significant throat pain, referred ear pain, and dysphagia. Regular analgesia + soft-cold diet manages pain.
- 10–14 days of cold, soft diet (ice cream, purée, yogurt, soft pasta). Avoid acidic, spicy, and hard foods — they raise bleeding risk.
- Yes — recovery is faster (7–10 days), pain milder. Paediatric tonsillectomy is the most common children's surgery.
- Yes. Severe unilateral throat pain, trismus (jaw-opening restriction), uvular deviation, and "hot-potato" voice are classic. Drainage + IV antibiotics treat it.
- Primary bleeding (within 24 hours) 0.5–1%, secondary bleeding (days 5–10, eschar fall) 2–3%. Active bleeding is an emergency — go to the clinic.
References
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