Tonsillitis classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:  Luke Rusowicz-Orazem, B.S., Usama Talib, BSc, MD [2]

## Overview

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Tonsillitis can be classified into acute, and recurrent forms. Acute tonsillitis is primarily caused by viral or bacterial infection; the former of which is usually self-limited. Bacterial acute tonsillitis will usually resolve with antimicrobial therapy. Recurrent tonsillitis is primarily caused by bacterial infection - usually group A streptococcus. Systemic symptoms, including fever, are usually absent due to their association with viral acute manifestations of tonsillitis. Tonsillectomy may be indicated for patients with recurrent tonsillitis if antimicrobial therapy is ineffective.

## Classification

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Tonsillitis can be classified into[1][2]

* Acute tonsillitis, either bacterial or viral
* Subacute tonsillitis, mostly caused by a bacteria actinomyces
* Chronic tonsillitis, mostly bacterial
* Recurrent tonsillitis

### Acute Tonsillitis

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* Primarily caused by bacterial or viral infection.[1]
* Presents with tonsillar erythema, edema, odynophagia, dysphonia, fever, rhinorrea, cough and headache.[3][4]
* Tonsillectomy is not usually indicated to treat acute tonsillitis; viral tonsillitis is self-limited and bacterial tonsillitis will resolve with antimicrobial therapy.[4]

### Recurrent Tonsillitis

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* Tonsillitis that is recurrent is primarily caused by bacterial infection - usually group A streptococcus.[4]
* Presents primarily with tonsillar erythema and edema, along with odynophagia, dysphonia, dyspnea, and dysphagia.
* Systemic symptoms, including fever, are usually absent due to their association with viral acute manifestations of tonsillitis.
* Tonsillectomy is indicated for patients with recurrent tonsillitis if the following criteria are met:[5]
* 7 episodes of tonsillitis in a single year OR
* 5 episodes in each of 2 consecutive years OR
* 3 episodes in each of 3 consecutive years

### Chronic Tonsillitis

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Persistence of the infection for a duration over 3 months is known as chronic tonsillitis. The viruses usually stay and lead to chronic inflammation or it results from repeated allergies or GERD.[6][7][8]

## References

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1. ↑ 1.0 1.1 Stelter K (2014). "Tonsillitis and sore throat in children". GMS Curr Top Otorhinolaryngol Head Neck Surg. 13: Doc07. doi:10.3205/cto000110. PMC 4273168. PMID 25587367.
2. ↑ Darrow DH, Siemens C (2002). "Indications for tonsillectomy and adenoidectomy". Laryngoscope. 112 (8 Pt 2 Suppl 100): 6–10. doi:10.1002/lary.5541121404. PMID 12172229.
3. ↑ "Tonsillitis - NHS Choices".
4. ↑ 4.0 4.1 4.2 Stuck BA, Götte K, Windfuhr JP, Genzwürker H, Schroten H, Tenenbaum T (2008). "Tonsillectomy in children". Dtsch Arztebl Int. 105 (49): 852–60, quiz 860–1. doi:10.3238/arztebl.2008.0852. PMC 2689639. PMID 19561812.
5. ↑ Paradise JL, Bluestone CD, Bachman RZ, Colborn DK, Bernard BS, Taylor FH, Rogers KD, Schwarzbach RH, Stool SE, Friday GA (1984). "Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and nonrandomized clinical trials". N. Engl. J. Med. 310 (11): 674–83. doi:10.1056/NEJM198403153101102. PMID 6700642.
6. ↑ Sadeghi-Shabestari M, Jabbari Moghaddam Y, Ghaharri H (2011). "Is there any correlation between allergy and adenotonsillar tissue hypertrophy?". Int J Pediatr Otorhinolaryngol. 75 (4): 589–91. doi:10.1016/j.ijporl.2011.01.026. PMID 21377220.CS1 maint: Multiple names: authors list (link)
7. ↑ Akcay A, Tamay Z, Dağdeviren E, Guler N, Ones U, Kara CO; et al. (2006). "Childhood asthma and its relationship with tonsillar tissue". Asian Pac J Allergy Immunol. 24 (2–3): 129–34. PMID 17136878.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
8. ↑ Proenca-Modena JL, Pereira Valera FC, Jacob MG, Buzatto GP, Saturno TH, Lopes L; et al. (2012). "High rates of detection of respiratory viruses in tonsillar tissues from children with chronic adenotonsillar disease". PLoS One. 7 (8): e42136. doi:10.1371/journal.pone.0042136. PMC 3411673. PMID 22870291.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)

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